Overview
People with mental health conditions often struggle to find and/or afford care in their area, with certain historically marginalized populations shouldering the heaviest burden. Access to health care services, including behavioral health services, varies greatly across populations in the United States and continues to be one source of the health system’s greatest disparities.
About SEED
The State Exchange on Employment and Disability is a unique state-federal collaboration that supports state and local governments in adopting inclusive policies and practices that lead to increased employment opportunities for disabled people, and a stronger, more inclusive American workforce and economy. SEED is funded by the U.S. Department of Labor’s Office of Disability Employment Policy.
This policy report explores mental health-related disparities across rural, racial and ethnic communities. It reflects intensive deliberation and research conducted by the Mental Health Matters National Task Force, a bipartisan group of policymakers and experts convened by the State Exchange on Employment and Disability (SEED) in collaboration with the National Conference of State Legislatures and The Council of State Governments. The task force explored policy options to address major workforce challenges and barriers to employment for people with mental health conditions. Its preliminary findings outlined principles and factors policymakers may want to consider when drafting and evaluating related policies.
The policy options presented here were informed by the findings of the task force’s Underserved, Rural, Racial and Ethnic Communities Subcommittee; they fall into four broad categories:
Understanding the Challenge
According to Harvard University, social and emotional factors can contribute to mental health status, and these social determinants of health can lead to mental and physical health disparities. As such, someone’s chronic and acute stressors in everyday life can play a role in increasing the risk of developing a mental health condition. Unequal access to mental health care may also exacerbate negative outcomes.
Social Determinants of Health
Economic stability: The connection between financial factors—income, cost of living, socioeconomic status, etc.—and health. This includes poverty, employment, food security and housing stability.
Educational access and quality: The connections between and the factors that influence education, health and well-being. This includes early childhood education, educational attainment, language, literacy and quality of education.
Health care access and quality: The connections between and the factors that influence people’s access to and understanding of health services as well as their own health. This includes access to health care, health insurance coverage status and health literacy.
Neighborhood and built environment: The connections between and the factors that influence where a person lives—such as housing, neighborhood and environment—and their health and well-being. This includes quality of housing, access to transportation, availability of healthy foods, air and water quality, and neighborhood crime and violence.
Social and community context: The connections between and the factors that influence relationships and interactions with family, friends, co-workers and community members. Both positive (cohesion within a community, civic participation, etc.) and negative (discrimination, incarceration, etc.) factors can impact connections for a person.
Harvard research shows people of color and other minority groups not only lack access to mental health services but also are less likely to receive high-quality services when accessing care. A number of factors may contribute to such disparities, including provider discrimination, differences in insurance coverage and/or a lack of culturally competent care. Disparities also exist between individuals living in rural communities versus urban areas, as behavioral health workforce shortages, transportation barriers and social stigma often create greater challenges for rural residents.COVID-19 highlighted differences in health care and health care access for rural and underserved communities. Addressing these disparities continues to be a priority area for policymakers.