By Atyya Chaudhry
Senior Program Manager, Women's and Infant Health
Despite recent efforts to improve access to mental health and substance use services, the United States still lags in providing access to adequate care for marginalized populations. Provider shortages, lack of inpatient treatment beds, and limited culturally competent services all contribute to persistent disparities in mental health and substance use (MH/SU) treatment. Fifty-six percent of American adults with a mental illness do not receive treatment, according to Mental Health America, and one in five adults report an unmet need. Specifically, within the maternal and child health (MCH) population, youth mental health is continuing to worsen. Mental Health America reports that rates of severe youth depression increased from 5.9 percent to 8.2 percent from 2012 to 2015.
Disparities in mental health and substance use treatment persist in diverse segments of the population including racial and ethnic groups; lesbian, gay, bisexual, transgender, and questioning populations; people with disabilities; transition-age youth; and young adults. In addition, certain segments of the population – such as individuals facing poverty, childhood trauma, domestic violence, and foster care – have historically had less access to services, low utilization of services, and even poorer behavioral health outcomes.
Understanding the persistent challenges and barriers in MH/SU care, several initiatives and policies have taken effect at the federal and state levels. At the national policy level, this includes the Mental Health Parity and Addiction Equity Act of 2008, which requires group health insurance plans to offer coverage for mental health or substance use disorders that is comparable to medical coverage. In addition, in the fiscal year 2018 omnibus budget, funding was created to address mental health, including $5 million for screening and treatment of maternal depression and $10 million for pediatric mental health care access. States that receive funding through national legislation create programs to address the mental health care challenges faced by the populations they serve.
To promote health equity in mental health and substance use, the American Psychological Association provides the following recommendations for designing programs and interventions:
- Increase the availability of culturally and linguistically competent mental and behavioral health services accessible to racial and ethnic minorities.
- Foster positive relationships and programs within racial and ethnic minority communities to increase awareness of mental health issues and prevent environmental factors that may place individuals at risk.
- Increase funding for training mental and behavioral health professionals and to train these professionals to become culturally and linguistically competent.
- Develop and implement policy and programs based on psychological and behavioral research ensuring that racial and ethnic minorities are empowered through culturally and linguistically informed and evidence-based strategies.
- Advocate for local, state, and national funding agencies to incorporate culturally and linguistically competent guidelines into proposals for programs for racial and ethnic minority children, youth, and families.
Federal agencies also address mental health and substance use disorder through the creation of grant opportunities for national organizations as well as states and jurisdictions. AMCHP is pleased to announce receipt of one such opportunity through the U.S. Health Resources and Services Administration. The five-year grant, Promoting Innovation in State MCH Policy, will focus on building state Title V policy capacity to address SU/MH in MCH populations, in collaboration with the Association of State and Territorial Health Officials. This opportunity will allow AMCHP and partners to work on designing programs to advance health equity in mental health and substance use and to support state efforts in this area.