Mental health inequality refers to the unequal distribution of mental health care quality, accessibility, and outcomes among social, economic, and demographic groups. Globally, the World Health Organization estimates that 350 million people are affected with depressive disorders. Mental health can be defined as an individual's well-being and/or the absence of clinically defined mental illness. Inequalities that can occur in mental healthcare may include mental health status, access to and quality of care, and mental health outcomes, which may differ across populations of different race, ethnicity, sexual orientation, sex, gender, socioeconomic statuses, education level, and geographic location. Social determinants of health, more specifically the social determinants of mental health, that can influence an individual's susceptibility to developing mental disorders and illnesses include, but are not limited to, economic status, education level, demographics, geographic location and genetics. Mental health inequalities can be addressed through changes in healthcare policies, culturally responsive mental health interventions, adjunctive therapeutic interventions, and telemedicine.
Disparities in accessing and quality of mental health care African Americans are less likely to have access to mental health care and are more likely to have lesser quality care when they do find it. African Americans and other members of racial minorities are more likely to be uninsured or have Medicaid, limiting the amount and type of access that they have mental health outpatient sources. In one study, of all those who received mental health care, minority populations reported a higher degree of unmet needs and dissatisfaction with the services they were given (12.5% of whites, 25.4% of African Americans, and 22.6% of Hispanics reported poor care). Therefore, due to differing insurance discrepancies and costs, there is an increased likelihood of minority groups utilizing different sources of care. More specifically, African Americans are more likely to use emergency services or alternative treatments instead of going to a specialized physician for mental health issues.
In addition, mental illnesses are often under- and over-diagnosed among different minority groups for various reasons. In fact, in the 12 months leading up to 2010, the prevalence of psychiatric disorders were 15% in African Americans and 16% for Hispanics, but 21% of non-Hispanic whites . Despite this, African Americans and Hispanics are more likely to be diagnosed with an affective disorder than white individuals. For example, schizophrenia is often over-diagnosed in African Americans, whereas mood disorders, depression, and anxiety are under-diagnosed.
The LGBTQ+ population, while still open to the same disparities as racial minority groups, is often confronted with the problem of being denied mental health treatment because of the gender they identify as or their sexual orientation. In a study conducted by The National Center for Transgender Equality and the National Gay and Lesbian Task Force, 19% of the LGBTQ+ sample reported being denied the healthcare they needed. In addition, 28% of the sample reported being harassed or even physically assaulted during the health visit. While denial of treatment and harassment during treatment are large causes of the disparities among mental health care quality, the lack of knowledge is also of concern among the LGBTQ+ population. As it is such a newly developing field of study, there is very little knowledge or research conducted that relate specifically to LGBTQ+ health and healthcare. In 2012, about 50% of transgender people surveyed reported having to teach aspects of their health and treatment to the health care providers.
Socioeconomic status disparities
Lack of socioeconomic resources can lead to development of traumatic experiences that precipitate into mental health disorders. For example, not having employment or having limited access to resources can influence the course of developing some of the most common mental health disorders, such as depression, anxiety, bipolar disorder, and psychological stress. Living with a mental health disorder can also contribute to disparities in receiving mental health care. Living with a mental health disorder could affect an individual's economic status, which can additionally lead into their mental health quality as well as life expectancy.
When looking at socioeconomic statuses, it is important to look into the discrepancies that homeless individuals face pertaining to mental health. Most, if not all, homeless individuals live in poverty, which as stated before, causes them to have less access to proper mental healthcare or health insurance. At least one-third of homeless individuals report one or more psychiatric illness, which is mostly due to the abuse of drugs or alcohol. Furthermore, the stress from previous mental health problems and economic instability, tend to become worse once an individual becomes homeless. This results in other mental health problems arising such as schizophrenia, suicidal ideation, paranoia, and psychosis. Due to homeless individuals not having any economic independence, they tend to lack adequate care from mental health specialists and this causes them to be put in unsafe conditions or situations.
Another socioeconomic factor that can lead to barriers and inequalities in accessing mental health care services include financial restraints. There has been a rise in cost for uninsured individuals in accessing mental health care services compared to individuals who have private or public insurance.
Socioeconomic status disparities were especially prevalent worldwide during the 2020 COVID-19 pandemic. A study conducted over the first two years of the pandemic in Japan found that lower-income individuals were more heavily impacted by the shifts in the socioeconomic conditions and social capital resources during the pandemic, leading to higher levels of mental distress among the population. For example, a reduction in in-person communication was associated with a decline in mental health only among lower-income groups. During the second year of the pandemic, economic instability had a stronger correlation with declining mental health with lower-income cohorts.
Food insecurity associated with lower socioeconomic statuses is also correlated with more severe levels of mental illness. A study conducted in Guatemala found that populations who are moderately food insecure were 7.4 times more likely to experience signs of depression than individuals who were food secure, and people who were extremely food insecure were 11.9 times more likely to show the same symptoms. While food insecurity was linked to many physical health conditions that contributed to mental health outcomes, it was also linked to psychosocial stressors due to the uncertainty and pressure of acquiring adequate food quantity and quality. This stress unequally impacted women due to public stigma stemming from not being able to provide sufficient food for their families.
Stigma of mental health and care in rural communities
Mental health care tends to be more stigmatized in rural communities because many residents do not recognize mental illness nor accept a diagnosis of mental illness. In rural American communities, the issue of mental health is not seen to be as prevalent or at all existing as it is in more urban areas with many brushing off mental health symptoms and having difficulty in recognizing when one needs to seek help. Specific characteristics of rural communities can make it more difficult to understand mental health or seek out care. Many living in rural areas do not have the same education on mental illness as others in urban areas do, especially in schools. This lack of understanding leads to judgment and disbelief, which in turn leads individuals to not seek care for any emotional issues they may be experiencing. Most rural areas are characterized by being tight-knit and self-reliant, which leads many to distrust care providers and their diagnosis. Residing in a tight-knit community comes with disadvantages such as a lack of privacy. Rural parents are hesitant to get their child mental health care for fear of stigma by association. What stops many parents from seeking help for their child is the fear of isolation from friends and community members if their child were to be diagnosed. The adults of these communities can and do also experience fear of stigma for their own possible mental health diagnosis. Both men and women can experience mental illness in rural communities. Men tend to brush off mental health with the concern that they will appear less of a man if they seek out help. Females experience higher rates of depression and public and self-stigma leading them to avoid seeking care just as much as men. Many parents reported fear of judgment from community members. It was also reported from surveys that many feel mental health can start to lose its stigma in rural areas if more effort and time are put into creating mental health programs in schools and the fostering of a more positive and educated community.
Education disparities Educational disparities can be defined as unjust or unfair differences in educational outcomes that can be a result of difference in treatment of certain minority groups in schools, varying socioeconomic statuses, and varying educational needs. These disparities in education can ultimately lead to issues of mental health. When this happens, individuals from disadvantaged socioeconomic backgrounds get looped into the cascading effects of inequality.
Disparities in education, contributory to socioeconomic status, immigrant status, and ethnic/racial status can be another contributing factor to mental health inequality. Socioeconomic status plays a large role in the difference in access to educational resources. School districts are split geographically. Because the current funding for public schools comes from local property taxes, there is more incentive for high-status individuals to narrow the boundaries to not include lower income families from their school districts. Because each school district is then only encompassing one socioeconomic group, the programs and quality are affected. This is where we begin to see the dramatic differences between school districts. While some schools offer amazing guidance departments, advanced classes, and phenomenal facilities, other areas struggle to find qualified and motivated teachers to teach basic classes. Although public education is something that is supposed to be a right for all, an individual's socioeconomic status can greatly affect the quality of that education.
An individual's immigration status also affects the quality of education received. While there are some immigrant groups which do well after immigrating to the United States, many do not have the same level of success. There are many barriers that prevent the academic success of immigrant children. These barriers include but are not limited to the fact that most parents of immigrant children do not understand the United States educational system, inadequate English as a Second Language programs, and segregation. There are also differences in outcomes across immigrant generation, with first-generation immigrants performing better than subsequent generations. This is termed the immigrant paradox. These issues along with the psychological effects of acculturation (e.g., adapting to a whole new country, language, and culture) amplify educational inequality.