7 Access to Mental Health
Chyna Thompson
Overview
People perceive and define health in many ways. One of the most common ways to define health is the absence of disease. However, to encompass what health means overall, we must expand this definition to include physical, social, and mental dimensions of health. Mental health is an essential part of health, that has the ability to mold our decisions, and the types of relationships we build. Mental health can be defined as, the ability to build and maintain healthy relationships, manage emotions such as sadness and stress, and make positive contributions to the community (Bhugra et al., 2013). However, many people lack the knowledge or the means to access mental health care, which can lead to negative effects both internally and externally.
Internal factors that can contribute to subpar mental health include, poor self- esteem and social status, isolation, feelings of hopelessness, and low emotional resilience (Bhugra et al., 2013). There are also external factors such as low autonomy, perceived stigma or discrimination, and poor social conditions such as unemployment or unfavorable housing (Bhugra et al., 2013). Along with personal factors, there are other outside sources that can contribute to low mental health, as well as insufficient treatment. Common examples are unintentional neglect of men’s mental health by categorizing common disorders such as depression and anxiety as feminine, as well as poor understanding of stereotypically masculine symptoms such as substance abuse (Smith et al., 2018). Such interactions within the healthcare system can often present as barriers to men’s desire to access mental health care.
Mental health care can include a wide array of sources, as they can all combat mental struggles differently. Examples of mental health care can include counseling, as well as visits with medical professionals such as a psychologist. Within the category of mental health, there are nuances that can present differently between men and women. Ways to help combat low mental health care usage, is proper identification of symptoms. Along with this, men have emphasized the importance of care being visible, while also providing services that expand beyond a generalized program but is actually specialized to men’s different needs.
Access By Race and SocioEconomic Status
A large portion of the existing research on gender and mental health focuses on between gender comparisons rather than within-gender comparisons in mental health outcomes. Neglecting research within the separate genders can lead to incomplete and incorrect conclusions about how individuals cope with mental health issues. It has been found that men and women experience almost equal rates of disorders overall, according to the majority of research on gender and mental health, but men and women typically encounter different psychiatric conditions (Smith et al., 2018). The current findings are influenced by prejudice found in clinical research which could result in incorrect presumptions about gendered symptoms (Smith et al., 2018). Men, especially young men, are less likely than women to seek help for mental health problems, have symptoms that fit standard measurement tools, and have their mental health problems identified by primary care physicians(Smith et al., 2018). Thus, mental illness in men is likely underestimated. In the end, factors other than gender predominately contribute to gender inequalities. Important factors to be considered are race and socioeconomic status.
Race
While men tend to have the greatest need for psychological intervention, they are also seen to be most reluctant to access these services. Some studies have noted that young men may be reluctant to access these studies due to experiences of stigma in the forms of discomfort, fear, embarrassment, and shame around asking for help (Lynch et al., 2016). Race and ethnicity are often associated with reduced access to mental health services. Studies show that Hispanic and Black men have the highest reported prevalence of serious psychological distress. Despite these findings, both Black and Hispanic men utilize mental health services at much lower rates than their white counterparts, and Asian men access these services the least out of everyone (Manuel, 2018). Comparatively to White Americans, Black and Mexican Americans have less access to professionals that are culturally appropriate and competent (Parent et al., 2016). Among young men ages 18-25, white men were about two times more likely than their Black, Asian, and Hispanic counterparts to use any mental health services (SAMHSA, 2015). In studies where health utilization was attempted to be increased through insurance improvements, Hispanic and Black men showed the least improvement in accessing mental health services. (Manuel, 2018). Research on young men showed that races outside of Non-Hispanic Whites were more likely to have negative attitudes or beliefs towards mental health services (Lynch et al., 2016). Taken together, other factors such as cultural beliefs, culturally competent care, and insurance play a large role in how men of minoritized races/ethnicities utilize health care services. For example, 81% of all mental health providers are White, and only 26% of these providers are men (Zippia, 2022). This could amplify the disconnect felt between many men of color and their providers.
The main drivers of race/ethnic differences in the utilization of mental health services can be attributed to both attitudinal and structural barriers. Attitudinal barriers can be best linked to those who experience stigma and discrimination due to race and are often more reported than structural barriers (Harris et al., 2016). Those experiencing barriers due to race are often also affected by structural barriers such as lack of help from others. Income is another structural barrier, as Black and Hispanic individuals are usually more impoverished and uninsured, further impeding on their ability to access health services (Manuel, 2018).
Socioeconomic Status
Socioeconomic barriers have also been highly endorsed as barriers to mental health access. Socioeconomic status can be defined in terms of income, education and employment. Large populations of men experience low income or unemployment. In these cases these men generally lack the means to afford insurance that covers mental health services or can’t pay out of pocket. When deciding which areas to allocate funds, healthcare, especially mental health care, is generally a much lower priority in comparison to basic needs (Scholz et al., 2022). Acknowledgment of the inability to afford these services can lead to decreased efforts in seeking help. Data trends support this by displaying that men with higher incomes tend to seek help more frequently (Parent et al., 2016). At the same time, almost three quarters of men have cited not using mental health services because they cannot afford it (Seidler et al., 2019). Another barrier that is associated with income is lack of transportation to appointments (Seidler et al., 2019). Some men who are employed and insured may also encounter the issue having insurance with minimal coverage. Often times their insure may exclude coverage for mental health services, putting those with low incomes back in the position of not being able to afford care (Seidler et al., 2019).
Intervention
As research continues, steps can be taken to help increase men’s access to mental health services. Different methods of health care reform are the most current forms of intervention. However, given how strongly respondents endorsed structural and attitudinal barriers, it is clear that service delivery must change in order to better address dominant masculine norms while also enhancing men’s ease of access to an open and honest treatment process (Seidler et al., 2019). Many participants noted that the word “mental health” carried too many stigmatizing associations and that new terms like “mental fitness” may reframe such language (Parent et al., 2016). Outside of the Affordable Care Act (ACA) in 2012, there have not been any other notable efforts to increase access. While the ACA worked to increase insurance coverage, and overall improve access to health services, it was not targeted to mental health care specifically. Furthermore, they aren’t any current efforts that specifically target men and their access to mental health care. Based on patient responses, efforts for intervention should include, increasing education on the subject, improved patient-doctor interactions, and enhancement of current efforts such as the ACA. This is especially important for men to enhance their feelings of support, and normalize help-seeking behaviors. Many participants from current research believed that the normalcy of getting professional help might be achieved by implementing a consistent, unbiased mental health education program in schools starting in early childhood (Seidler et al., 2019). In addition, participants agreed that to encourage help-seeking behavior, mental health services must reach out to families and young men and provide them with information: “Provide the right conditions and then provide all the right key information… I think eventually they’ll reach for the help and the support.” Noting the significance of education, it is also important to account for differences in access to quality education especially among marginalized groups such as those with lower income.
This image shows the various way health care coverage affects mens access to health services including mental health care.
“Health Care Coverage and Access for Men, 2013-2015” by Kaiser Family Foundation is licensed under CC BY-NC-ND 4.0
Key Takeaways
- While men tend to have the greatest need for psychological intervention, they are noted as most reluctant to access these services.
- Marginalized groups outside of Non-Hispanic Whites, more often have negative attitudes or beliefs towards mental health services, causing young men among these races to be less likely to seek help.
- Among all races, almost three quarters of men are not utilizing mental health services because they cannot afford it.
Chapter Review Questions
- Men and women experience almost equal rates of disorders overall. True or False
- A. True
- B. False
- Which groups of men have been reported as having the highest prevalence of serious psychological distress?
- A. Black men
- B. Hispanic men
- C. Non-Hispanic White men
- D. Asian men
- E. Black and Hispanic men
- Who utilizes mental health services the least?
- A. Black men
- B. Non-Hispanic White men
- C. Asian men
- D. Native American men
- Men with higher incomes tend to seek help more frequently. True or False
- A. True
- B. False
References
Bhugra D, Till A, Sartorius N. (2013).What is mental health? International Journal of Social Psychiatry. 59(1):3-4. doi:10.1177/0020764012463315
Harris, M., Baxter, A., Reavley, N., Diminic, S., Pirkis, J., & Whiteford, H. (2016). Gender-related patterns and determinants of recent help-seeking for past-year affective, anxiety and substance use disorders: Findings from a national epidemiological survey. Epidemiology and Psychiatric Sciences, 25(6), 548-561. doi:10.1017/S2045796015000876
Lynch, L., Long, M., & Moorhead, A. (2018). Young Men, Help-Seeking, and Mental Health Services: Exploring Barriers and Solutions. American journal of men’s health, 12(1), 138–149. https://doi.org/10.1177/1557988315619469
Manuel J. I. (2018). Racial/Ethnic and Gender Disparities in Health Care Use and Access. Health services research, 53(3), 1407–1429. https://doi.org/10.1111/1475-6773.12705
Parent, M. C., Hammer, J. H., Bradstreet, T. C., Schwartz, E. N., & Jobe, T. (2016). Men’s Mental Health Help-Seeking Behaviors: An Intersectional Analysis. American journal of men’s health, 12(1), 64–73. https://doi.org/10.1177/1557988315625776
Scholz, B., Lu, V. N, Conduit, J., Szantyr, D., Crabb, S., & Happell, B. (2022, June 23). An Exploratory Study of Men’s Access to Mental Health Services. Psychology of Men & Masculinities. Advance online publication. http://dx.doi.org/10.1037/men0000404
Seidler, Z. E., Rice, S. M., Kealy, D., Oliffe, J. L., & Ogrodniczuk, J. S. (2019). What gets in the way? Men’s perspectives of barriers to mental health services. The International journal of social psychiatry, 66(2), 105–110. https://doi.org/10.1177/0020764019886336
Smith DT, Mouzon DM, Elliott M.(2018). Reviewing the Assumptions About Men’s Mental Health: An Exploration of the Gender Binary. American Journal of Men’s Health;12(1):78-89. doi:10.1177/1557988316630953
Substance Abuse and Mental Health Services Administration. (2015). Racial/ Ethnic Differences in Mental Health Service Use among Adults. HHS Publication No. SMA-15-4906.Rockville, MD.
Zippia, Inc. (2022, September 9). Mental Health Professional Demographics and Statistics in the US. Zippia: The Career Expert. Retrieved November 1, 2022, from https://www.zippia.com/mental-health-professional-jobs/demographics/