People are in pain. We are experiencing an onslaught of public health crises that is affecting our overall functioning. The fierce urgency of now to collectively move us to a space of wellness is imperative to our quality of life. The current crisis care continuum is not designed to meet the needs of those in behavioral health crisis. First responders are not sufficiently trained to intervene. This lack of training leads to negative outcomes particularly for those communities who experience the most inequities and trauma: people who identify as Black, Indigenous, people of color, LGBTQIA+, people with disabilities, non-English speaking people, rural communities, older adults, houseless people, returning citizens from a carceral state, immigrants and youth. This is further compounded by the health crisis of mental health stigma in historically harmed communities. Evidence shows that mental illness stigma is higher among ethnic minorities than majorities. An important clinical implication of these findings would be to tailor anti-stigma strategies related with mental illnesses according to specific racial and/or ethnic backgrounds with the intention to improve mental health outreach (Eylem, et.al 2020).
Barriers in Mental Health Care for Harmed Communities
Racism is a public health crisis (APHA, 2021). Racism is a system—consisting of structures, policies, practices, and norms—that assigns value and determines opportunity based on the way people look or the color of their skin. This results in conditions that unfairly advantage some and disadvantage others throughout society.
According the Center for Disease Control, a growing body of research shows that centuries of racism in this country has had a profound and negative impact on communities of color. The impact is pervasive and deeply embedded in our society—affecting where one lives, learns, works, worships and plays and creating inequities in access to a range of social and economic benefits—such as housing, education, wealth, and employment. These conditions—often referred to as social determinants of health—are key drivers of health inequities within communities of color, placing those within these populations at greater risk for poor health outcomes.
As a result of inequitable social determinants of health, communities of color are caught in a perpetual state of mitigating layers of compounded trauma which includes the ongoing impact of COVID 19, the pillaging of histories via book bans, harmful policies, state sanctioned brutality and financial losses. Most racial/ethnic minority groups overall have similar—or in some cases, fewer—mental disorders than whites. However, the consequences of mental illness in historically harmed groups may be long lasting (American Psychiatric Association, 2017).
Historically harmed communities have a healthy paranoia with the mental health systems. They have been either under and over-diagnosed, complaints ignored or dismissed. Or they have not been properly assessed but prescribed medications that may not address their underlying causes of presenting problems. To add, lack of insurance, underinsurance, mental illness stigma, lack of diversity among mental health care providers, lack of providers who practice cultural humility and language barriers contribute to underutilization of mental health services.
The 988 Suicide & Crisis Lifeline
On July 16, 2022, the National Suicide Prevention Lifeline transitioned to the three-digit access code 988 and a new name – the 988 Suicide & Crisis Lifeline (988 Lifeline). Funded by the U.S. Department of Health and Human Services (HHS) through Substance Abuse and Mental Health Services Administration (SAMHSA) and with Vibrant Emotional Health (Vibrant) as the nonprofit administrator, the 988 Lifeline network includes over 200 locally-operated centers offering free and confidential emotional support to people in suicidal crisis or emotional distress, available 24 hours a day, seven days a week.
With this transition, everyone in the United States and territories can call, text 988 or visit 988lifeline.org to chat, and reach a trained crisis counselor. This move to 988 Lifeline can shift how we care for people who are in need of behavioral health supports. In order for the service to be truly impactful, it requires a collective approach that is inclusive of all experiences across of the lifespan.
Vibrant recognizes that embracing diversity, equity, inclusion and belonging is a form of suicide prevention, and that by addressing systems of oppression that create disadvantages, centering this will only expand perspectives, frameworks and approaches to survivorship and well-being for all.
Vibrant has operationalized this commitment by hiring a dedicated Equity and Belonging Department to ensure that the values of equity and belonging are embedded throughout all areas and services within 988. This will be accomplished through collaboration, training, relationship building, advocacy and capacity building. This happens by bringing barriers and experiences of persistently harmed populations to the center while utilizing their feedback as a guiding force in all our work. Equity and Belonging seeks to imagine 988 as a system of action, accessibility and accountability. The goal is to continue to task ourselves with upholding our own values by striving towards the reality that each caller experiences a sense of support, affirmation and belonging, no matter their race, gender, culture, language, location, or ability.
Why Commit to the Approach of Co-Creating the Crisis Care Continuum?
The last three years have taught us that when one person or community is in crisis, it collectively impacts us all. We have the opportunity to create a system of care that can address the needs of all people. The idea of the most harmed communities co-creating a system of care is powerful and can shift the power dynamics of systems of care. Engaging with impacted communities is a critical component of suicide prevention, as it allows for the development of community-led solutions and increases participation in prevention programs and initiatives; which ultimately mitigates harm, enhances trust and reduces mental health stigma.
Equity and Belonging will engage in a robust community listening sessions and surveys. The audiences will include those with lived experience, rural populations, LGBTQIA+ communities, older adults, unhoused, AAPI, Black communities and other persistently excluded populations. This will make sure that efforts to prevent suicide and provide care are centered in the most culturally appropriate and affirming ways. Once suicide data and community feedback have been analyzed, the results will be utilized to inform resource allocation, training needs, and accessibility gaps to ensure the most impactful suicide prevention efforts.
Normalizing Conversations about Mental Health
The ongoing pandemic has increased conversations about mental health and is playing a role in reducing stigma. We are moving towards prioritizing mental health as part and parcel to our physical health. It is creating the space for us to better advocate for better policies and resources to ensure a positive environment. Targeted mental health messaging can also be effective in reducing stigma. When people see themselves represented, it disrupts the narrative that mental health support is limited to the majority population and not those who have the most need.
The National Alliance on Mental Illness offers 9 ways to Fight Mental Health Stigma, they include:
- Talk Openly About Mental Health
- Educate Yourself and Others
- Be Conscious of Language
- Encourage Equality Between Physical and Mental Illness
- Show Compassion for Those with Mental Illness
- Choose Empowerment Over Shame
- Be Honest About Treatment
- Let the Media Know When They’re Being Stigmatizing
- Don’t Harbor Self-Stigma
Dr. Vivek Murthy, US Surgeon General, says the mental health crisis is the biggest concern facing the country because it impacts so many people and different facets of life. Co-creating an equitable crisis care continuum that provides culturally responsive and affirming care is vital to our quality of life. We are all interconnected by the social contract of humanity that relies on us all to care for one another. Everyone deserves to have access to the resources they need to thrive. If we center the most harmed, all will get what they need.
Sa’uda K. Dunlap, LCSW is the Assistant Vice President of Equity and Belonging and Johnell Lawrence is the Director of Equity and Belonging at Vibrant Emotional Health.
References
Eylem, O., de Wit, L., van Straten, A. et al. Stigma for common mental disorders in racial minorities and majorities a systematic review and meta-analysis. BMC Public Health 20, 879 (2020).
Racism is a public health crisis. Available at: https://www.apha.org/topics-and-issues/health-equity/racism-and-health/racism-declarations (Accessed: March 9, 2023).
Racism and health (2021) Centers for Disease Control and Prevention. Centers for Disease Control and Prevention. Available at: https://www.cdc.gov/minorityhealth/racism-disparities/index.html (Accessed: March 9, 2023).
Mental health disparities: Diverse populations (2017) Psychiatry.org – Mental Health Disparities: Diverse Populations. Available at: https://www.psychiatry.org/psychiatrists/diversity/education/mental-health-facts (Accessed: March 9, 2023).
9 ways to Fight Mental Health Stigma (2017) NAMI. Available at: https://www.nami.org/blogs/nami-blog/october-2017/9-ways-to-fight-mental-health-stigma (Accessed: March 9, 2023).
Mental health is biggest health concern in US says surgeon general (2022) Bloomberg.com. Bloomberg. Available at: https://www.bloomberg.com/news/videos/2022-11-02/mental-health-is-biggest-health-concern-in-us-says-surgeon-general (Accessed: March 9, 2023).
