Finding Equitable Behavioral Health

Mental and behavioral health is health. When someone’s experiencing depression, anxiety, a substance use disorder, or other problems of this kind, it not only affects their quality of life but also impacts their overall health. Therefore, it’s vital for them to get help as quickly as possible.

Depression alone affects almost 30 percent of adults in the United States at some point in their lives. In 2022, the Blue Cross and Blue Shield Association (BCBSA), an association of independent Blue Cross and Blue Shield Plans, conducted an analysis of member data and found major differences in rates of depression diagnoses based on the ZIP codes where members lived.

Depression was identified in:

• 9 percent of people living in majority-white communities
• 1 percent of people living in majority-Black communities
• 4 percent of people living in majority-Hispanic communities

And that isn’t because fewer Black and Brown people experience depression. Quite the opposite, in fact. Rates of depression tend to be higher among Hispanic people and non-Hispanic Black people over the age of 20 than among their non-Hispanic white and Asian peers.

And that’s not surprising. There’s plenty of evidence that racism is harmful to the mental health of communities of color. So, why is depression being under-diagnosed in these populations?

Attitudes Toward Mental Health and the Health System

In our culture, mental illness is often dismissed as weakness or self-indulgence. While that’s hopefully starting to change, stereotypes and prejudices are still very widespread. This can make it difficult for people to admit — to themselves or to others — that they’re having mental health challenges, or to seek help.

In addition to those stereotypes and prejudices, Black and Hispanic people are much more likely to distrust the health system than their white counterparts. This is often because of personal experiences of race-based discrimination. And this mistrust has increased over time.

People in marginalized communities often have legitimate concerns that reporting their behavioral health issues will have negative repercussions — such as over-escalation, involvement of the authorities, invasion of privacy, and loss of rights or opportunities.

Given all these concerns, it’s not surprising that Black and Hispanic people are more likely to seek information about mental health from other sources instead of talking to their health care providers. However, when these populations have access to health care providers with similar lived experiences, they’re more likely to trust them and seek their help.

Racial and Ethnic Inequities in Depression Screening

The United States Preventive Services Task Force recommends that all adults be screened for depression. However, the results of the BCBSA study suggest that Black and Hispanic people may be less likely to receive this screening from their health care providers than white or Asian people.

This is what we’re seeing in other research findings as well. For example, an analysis of adult patients in a California health system between 2017 and 2019 revealed that:

• Initially, when depression screenings were being conducted at the discretion of health care providers, white patients were much more likely to get screened than their Black and Hispanic counterparts.
• Then, the health system began requiring depression screenings for all patients; and by 2019, the racial and ethnic differences in screening rates had basically vanished.

Diagnosis Isn’t Enough

Being told you have depression or other mental and behavioral health issues doesn’t do you any good if you don’t have access to treatment. That’s a problem many Black and Brown people face. They have trouble accessing behavioral health services, for reasons that include shortages of:

• Behavioral health providers in general. This results in long wait times for an appointment — or makes it difficult to even find a provider who is accepting new patients
• Providers who accept health insurance, if you even have health insurance
• Providers who look like them (only two percent of psychiatrists and four percent of psychologists are Black)

What We’re Doing to Improve Health Equity

Independence Blue Cross (Independence) is committed to making health care more equitable for all of the communities we serve. Access to behavioral health care is a key part of that. Therefore, we are taking the following steps:

• Rewarding primary care doctors for performing depression screenings for all their patients. This keeps it top of mind to check for symptoms of depression, which is the first step towards getting someone help.
• Making it easier for our members to access behavioral health providers, with options and resources such as telebehavioral health and Quartet.

We also have a new program that gets people to mental health care even faster. Here’s how it works: When a member calls our new Behavioral Health Advocate Unit, they will be evaluated for behavioral health issues immediately, and can have appointments set up with a provider right away based on their needs.

What You Can Do to Support Your Own Health

First and foremost, if you’re struggling with feelings such as constant hopelessness, worry, shame, irritability, fatigue, or loneliness, please prioritize your well-being. You don’t need to “power through it” or expect yourself to “snap out of it.” A variety of very effective treatment options are available to help support you in feeling better. You owe it to yourself and your loved ones to be your best self, and that means not ignoring potentially devastating health problems.

Get help. Whatever negative experiences you may have had with health care professionals in the past, please don’t let it stop you from trying again. Behavioral health treatment works.

And yes, you can get an appointment with a behavioral health practitioner. Especially if you’re an Independence plan member. We have more in-network therapists than ever before.

Be honest with your primary care provider. If they ask you questions about your mental health, that means that they’re doing their job. Tell them how you’re doing, and not just physically. If you’re struggling emotionally…that’s something your doctor needs to know.

If your primary care provider doesn’t ask you questions about your emotional and behavioral health, tell them how you’re doing anyway! Let them know what you’re experiencing, and ask them to help guide you to appropriate resources.

If you don’t have a primary care provider, get one! And see them at least once a year, even if you’re feeling healthy. They’ll check for health issues that you might not know you have. Including depression.

You’re worth it. You matter. You deserve to get help when you need it.

Quartet is an independent company.

Original post by Dr. Seun Ross, DNP, CRNP-F, NP-C from Independence Blue Cross.