Kimberlydawn Wisdom, M.D., M.S.
IFDHE Board Chairperson
Senior Vice President, Community Health & Equity and Chief Wellness & Diversity Officer,
Henry Ford Health System, Detroit
What are the specific challenges that minorities and diverse communities encounter in trying to access mental health services?
There are multiple challenges for people living in minority and diverse communities when it comes to taking the first step toward accessing mental health services.
First of all, behavioral health or mental health issues need to be taken just as seriously as physical conditions, such as diabetes or heart disease. However, many people don’t understand the importance of mental health and well-being and how inextricably linked it is to physical health. They need to know it’s a condition that is often treatable, that needs to be taken very seriously and that it’s not a minor condition that a person can easily “get over” or just push through a “rough patch” without proper counseling and in some cases treatment with medication.
The other aspect is that particularly in diverse communities or communities of color, there is often a fairly significant stigma associated with seeking mental health services. It’s seen as a sign of weakness, deficiency or even vulnerability when a person admits to being concerned about having a mental health condition. In fact, the stigma actually exacerbates the condition because then people are less-inclined to want to seek health care services.
Furthermore, there can often be challenges related to communication with a provider. It’s not uncommon for someone to sense there’s a lack of understanding when speaking with a health care professional who can’t relate well or understand the lived experience of the patient. So, that too can create specific challenges for minorities and diverse populations when seeking mental health services. The provider needs to be culturally appropriate, culturally competent and understand the key aspects of culture, communication style and choice of words.
What’s also important is the role that implicit bias (or unconscious bias) related to race/ethnicity/culture plays in the interaction between clinician and patient. The implicit biases or ‘blind spots’ are those behaviors, language or recommendations that are not recognized by the provider that may come into play during an encounter.
Those facing mental health challenges may not take good care of themselves and may even harm themselves. Mental health and physical health go hand-in-hand and they both need to receive the appropriate attention to achieve overall health and well-being.
How are you ensuring new mothers are aware of potential complications that may develop into issues affecting their mental health?
It’s important that we screen women for potential mental health issues before, and after delivering a baby, because we know postpartum depression is a significant problem and needs to be recognized and addressed early.
“…behavioral health or mental health issues need to be taken just as seriously as physical conditions, such as diabetes or heart disease.”
We have community health workers (CHWs), who work closely with the certified nurse midwives, working closely with moms all throughout their pregnancy, after delivery and until their infant reaches one year of age. What has been particularly beneficial in that setting is that these CHWs develop a great trusting relationship with the moms, and so the CHWs can notice more readily if the expecting and new mothers they are working with are having problems adjusting, exhibiting depression signs/symptoms or if there are changes in behavior. And because these CHWs have become trusted sources of information, they can help new and soon-to-be moms seek services that they may otherwise be reluctant to seek.
One effort that I’m particularly excited about is our perinatal behavioral health integration program, where there’s the integration of mental health services in the women’s health department. So for instance, if our patients are showing signs or symptoms of changes in their mental health or behavioral health, they don’t have to wait for an appointment to go see a psychologist or psychiatrist on another day; there’s actually the ability for them to connect with a behavioral health specialist during that same visit. The true benefit is not only the expedited nature of an immediate appointment, but it also removes some of the stigma of having to go see a psychiatrist or a psychologist in a behavioral health clinic.
Can you elaborate on programs your team has initiated to address minority mental health outreach, care or treatment?
For some of our prenatal programs, we bring pregnant women together as a group. So, there might be 10 or 12 women that present for their appointment and spend two hours together utilizing the group visit model. Similarly, the DBT or dialectical behavioral therapy, is also provided in a group session, which provides a tremendous amount of support and safety, for these women.
That’s key, due to the fact that some of these people may feel very isolated and think they are the only ones that are feeling the way they do. When they participate in this group setting, they have the opportunity to feel supported by others in a safe environment. They can clearly see they are not alone in their mental health struggles, which can have a therapeutic impact, and in addition, perhaps provide support or encouragement to other women in the group.
Separately, we partnered with a local organization that provides housing, clinical services and mental health support to members of the LGBTQ community – particularly teens and younger individuals. To proactively provide mental health services for a particularly vulnerable population, such as LGBTQ teens and children, is another effort to address minority mental health concerns.
“…ensure that you have diverse providers, particularly focused on providers that represent the demographic of the community served.”
We’ve also developed partnerships here at Henry Ford Health System with the transgender community. We help guide them to receiving mental and behavioral health services within our system. We also, when necessary, direct members of the transgender community to additional supportive entities that may not be provided traditionally by health systems (i.e., housing, etc.). So, one way or another, we can definitely help address the mental and behavioral health needs of the transgender population and support other basic needs as well.
We consistently try to deliver a care model that extends beyond the traditional models and find innovative ways to reach particularly vulnerable communities related to behavioral and mental health.
What are some immediate steps that hospitals and health systems can initiate right away to address minority mental health and help people from diverse communities and backgrounds?
There are several immediate steps that hospitals, health systems and plans can initiate right away to address minority mental health needs. One is to ensure that you have diverse providers, particularly focused on providers that represent the demographic of the community served. The recruitment is insufficient without the development of retention efforts, also.
It is important to have partnerships with other organizations outside of health care, such as schools or businesses or faith-based organizations that can actually help to raise awareness. Whether it’s providing education to those so they can recognize mental health concerns or address challenges in diverse populations, community partnerships are very important.
Another immediate step to consider is for hospitals and health systems to focus on the culture competency of their providers. Whether it’s training on unconscious bias mitigation and skills building or just addressing general culture competency – clinicians should be trained to learn how to recognize, how to best treat and how to best engage minorities who may be affected by mental health conditions. Exercising cultural humility is essential in the work as well.
Part of that is educating providers to recognize symptoms of mental health because they may not manifest themselves the same way in different populations. Sometimes, a person will demonstrate a mental health condition by harming themselves. In other cases, mental health conditions may be presented by people who neglect themselves. So, certain behaviors may vary by the population depending on the demographic – vary according to race or ethnicity or age. In addition, knowing up front about how to recognize the various types of presentations that a practitioner may be confronted with is critical for detecting an underlying mental health condition.
"We consistently try to deliver a care model that extends beyond the traditional models and find innovative ways to reach particularly vulnerable communities related to behavioral and mental health."
Community outreach and educational services about preventive care is also another immediate step that can be taken. Engaging partners such as neighborhood organizations or faith-based organizations and partnering with them in creative ways can be an effective method to reach the target populations that traditionally do not seek services.
Furthermore, having programming and outreach targeted to specifically meet the needs of certain populations is also something that can be addressed expeditiously, including providing mental health services where the patient is located. To reiterate, our behavioral health integration program also provides virtual care on site. If a concern is recognized during an on-site visit, that patient can immediately have a virtual, secure online session with a behavioral health professional during that same visit.
Finally, I can’t underscore enough the importance of advocacy for mental health coverage for all populations. Recognizing that mental health is just as important as physical health, and not providing health coverage for all populations when they have mental health conditions is problematic.
We are focused on launching some of these innovative approaches of reaching populations that we have not done before and having an even greater impact.