Research on “health care disparities,” the euphemism for unnecessary deaths and adverse outcomes among people from low socioeconomic groups and from communities of color, often attribute them to individual characteristics and structural barriers within mental health systems. Most often an individual’s use of services as well as the way services are arranged and delivered are cited as causes.
I want to begin by commenting on what is going wrong and then discuss what is hopeful in the provider-client relationship. Although research is taking place, there is little agreement about best practices and ethical standards in minority mental health care. The issues of staff bias, racism, institutional racism, prevailing practices, and methods of prioritizing who gets time and attention are omitted from the discussion. Also, questions of discrimination that stem from preconceived notions and racial profiling of African American people and/or questions of how stigma influences medical decisions are absent, if not actively avoided, in discussions of healthcare disparities.
I have experienced how the focus on the business of medicine impacts my medical care. I met with a provider for a couple of years. He would enter the room and go over to the computer. He was preoccupied with documentation. This took up most of our visit. Then, he would place the stethoscope on my chest and tell me to continue my medication.
I stayed with this doctor for two years even though my respiratory and cardiac problems escalated. I felt hopeless—and that starting with a new provider would lead to more of the same. I focused on trying to make the relationship work. I believed if I could get the doctor to see me as an individual, he would provide better health care. This did not work. I realized waiting for this provider to invest in my treatment was futile.
The overbearing pressures in medicine can make even a good provider or staff member succumb to prioritizing the business aspects of medicine. There is little or no time left for building relationships and trying to understand the perspective and stated needs of the patient. This is a systemic problem. The demands of seeing at least four patients an hour within a high stress environment leaves little time to understand patient needs and wishes, plan treatment, and focus on preventive care. When this is compounded by stigma and racism, the situation seems almost unsolvable. Read more of Gloria's thoughts on the effect of health disparities.
When racism, bias, and provider attitudes automatically lead to negative judgments about people seeking help, there is little recourse for patients who have been victimized. African American men and women with mental health histories run a risk when they voice “No” in medical settings. Their no is often met with aggressive responses.
On many levels, the outlook for African American access to quality care appears to be hopeless. However, I think there are rays of hope emerging on the horizon. The U.S. Department of Health and Human Services Office of Minority Health is beginning to implement steps to eliminate healthcare disparities. Research is being translated into action and implementation. The concerns of African Americans who have lost loved ones needlessly are being addressed.
In my case, nothing can bring back my brother. However, if the health care system is truly transformed to a place where everyone gets equal access and medical decisions do not spring from considerations of who deserves care, the pain I feel will be somewhat eased. To date, when I am needlessly ignored or bullied in medical settings, I resonate with the injustice of being met with disdain instead of with care. It is a hard pill to swallow. It is stressful knowing any attempts to address incidents of victimization will be met with disbelief and demands that I must prove it happened. If your daughter, mother, or sister had a mental illness, and they were victimized, you might get a glimpse of what I am describing. This is a scenario I wish none of you have experienced.
There are good doctors and staff in medical systems. I urge them to stand up and say no when they see a colleague who is abusing his or her power. I hope there are good people who will stand up to those who bully patients either because of racism or stigma. I hope they will use their voice to actively support vulnerable people who are seeking medical care. Care should be actively visible and transparent in all medical settings. Let's revive trauma-informed, person-centered care and provide care to all who seek medical help!
Hear more from Gloria about her and her brother's experiences in this t3 Podcast "Minority Mental Health Month."