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Addressing Behavioral Health Equity for Systemic Change

Dr. Creshelle Nash, MD, MPH, CHIE
Medical Director for Health Equity and Public Programs
Arkansas Blue Cross and Blue Shield

A healthy, balanced life requires stable mental health. Our psychological, emotional, and social well-being factor into our overall health; however, individuals’ experiences with mental health and the treatment of it can vary based on the context of our lives or what is often referred to as social determinants of health.

While we continue to work toward building healthier communities, we recognize that until we establish ways to work together to address injustice in all areas, including healthcare, we cannot truly be healthy. For this reason, we’re dedicated to promoting health equity within our communities. Drawing awareness to the issues all Arkansans encounter daily is the first step to significant systemic change. As a company and a member of this community, we are dedicated to ensuring a more equitable future.

Behavioral Health Issues on the Rise

Communities of color endure a wide range of ongoing oppression, racism, and unfairness that contribute to both collective and individual trauma. These traumas often go untreated due to lack of resources, lack of access, and poor-quality treatment in the healthcare system due to implicit bias. In fact, people with mental illness are overrepresented in prisons. About 2 million times each year, people with serious mental illness are booked into jails. Nearly 2 in 5 people who are incarcerated have a history of mental illness (37% in state and federal prisons and 44% held in local jails). The criminal justice system and incarceration not only exacerbate preexisting mental illness but can also cause lasting damage to mental health through solitary confinement and other conditions. In order to live a healthy, balanced life, people must receive care to prioritize stable mental health.

While, in many ways, the past two years have seen a lot of change and growth, the COVID-19 pandemic aided in the rise of behavioral health issues that will be felt for years to come. In fact, anxiety and depression have increased by 25%, according to the World Health Organization (WHO), since the start of the global pandemic. Black, Indigenous, and People of Color (BIPOC) make up a significant component of those who have been impacted. They frequently experience social injustices in greater numbers and are consequently more impacted by the pandemic’s by-products – such as job losses and access to care in addition to the traumatic loss of family members and friends due to COVID-19.

WHO has also compiled data on how the pandemic has impacted young people’s mental health, including an increase in suicidal and self-harming behaviors. Here, once again, suicide rates increased at a faster pace for American Indians and Alaska Natives, Black Americans and Hispanic Americans, according to CDC data. By understanding the impacts that social determinants of health are having on different population segments, we can begin to identify areas where we can effect change and eliminate barriers to care.

Mental Health Stigma & Barriers to Receiving Treatment 

The stigma surrounding mental illness can keep people from getting the mental healthcare they need, especially if they have already experienced discrimination. Many individuals in minority communities must overcome the shame and fear frequently associated with mental healthcare if they want to pursue treatment. For example, if a person of color had a previous negative interaction with their healthcare provider, they may opt not to seek out a mental health provider. Those who have sought care may have been faced with a provider who does not understand racism, current and historical trauma, and its impact. They may lack cultural humility and understanding to provide the best care, which is a barrier for patients seeking care.

As a primary care physician, having witnessed numerous instances of patients being unable to access care quickly, I became convinced that there must be a more equitable way for everyone to receive high-quality healthcare, particularly for the people of Arkansas, the place where I grew up and call home. Health disparities are highly pronounced here, especially in the Delta region of Arkansas, and often among communities of color. For example, the uninsured rates among racial/ethnic groups in Arkansas range from 9% to 25%. These structural gaps hinder access to potentially life-saving care and increase distrust of health initiatives, resulting in poorer quality of care and negative patient experiences.

Another obstacle to people of color seeking mental health therapy is the lack of diversity among behavioral health professionals. Patients from racial and ethnic minorities are more likely to choose doctors and have better outcomes when their doctors look like them or have similar life experiences. To make their patients as comfortable as possible and instill trust, all mental health professionals in communities of color must be culturally sensitive and knowledgeable. This cannot be achieved if there is a lack of representation among our healthcare professionals.

How Arkansas Blue Cross is Helping Make Lives Healthier

As difficult as it may be to acknowledge, there are several barriers to care and structural and systemic prejudices that can impact receiving behavioral health support. There is no single or simple solution to this issue, but if we work together and break down silos, we can all contribute to a stigma-free healthcare environment. Change has to come from all levels. We can develop policies that increase the accessibility of low-cost wellness care. Healthcare organizations can enhance the diversity of their personnel and extend their services to neglected areas. And as medical professionals, we can listen to our patients and advocate for every facet of their care.

Below are some ways Arkansas Blue Cross is actively helping individuals across Arkansas:

  • Whole Person Approach to Health: Arkansas Blue Cross is committed to addressing how lifestyle, behavior, environment and medical history can affect the physical and mental health of those we serve. We call this a “Whole Person Approach to Health.” Supporting whole person health allows us to view health and medical care from a wider perspective. Instead of concentrating on a single aspect of our healthcare, we assist in addressing the numerous, interrelated aspects of our lives. We prioritize providing our members with mental healthcare support as part of our whole person health approach, given the additional stressors brought on by the pandemic and the fact that behavioral health disorders are on the rise. We feel that factors like financial stability, access to nutritious food, a person’s race and gender, and the environments where we live, work, and socialize all impact a person’s overall health.
  • Normalize the Conversation around Mental Health: The first step in eliminating the stigmas associated with behavioral health is to start the conversation, but it’s not always simple to locate a physician when you need one. That’s why we support UAMS Health AR ConnectNow, which makes care more accessible by providing mental health support 24/7 with no insurance or appointment needed.
  • Traditional and Non-Traditional Partnerships: Collaboration is key to improving the health of Arkansas. That includes everything from improved resources for addiction and suicide prevention to expanding access for healthcare specialists in rural and minority populations. Together with the Blue & You Foundation for a Healthier Arkansas, we believe that by working together and getting involved, we can all have healthier futures.

Mental health equity is a complex undertaking but badly needed in our state. By increasing awareness of the challenges BIPOC groups have in accessing high-quality mental healthcare and establishing programs that move the needle, we can move toward more transparent and inclusive mental healthcare for all Arkansans.

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