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Considerations for Providing Mental Health Care to Racial and Ethnic Minority Communities

According to data from the American Psychiatric Association, people from racial/ethnic minority groups are 50% less likely to receive mental health care. There are many barriers to care at play including access to care such as lack of insurance or underinsurance, mental illness stigma, language barriers, etc. Inger Burnett-Zeigler, PhD, is interested in understanding the factors associated with mental health service utilization. Her research focuses on examining attitudes and beliefs about mental health, access to mental health treatment, engagement in mental health treatment, and barriers to mental health treatment among under resourced populations including racial/ethnic minorities and those with low income, limited education, and limited access to resources.
Considerations for Providing Mental Health Care to Racial and Ethnic Minority Communities
Inger Burnett-Zeigler, PhD
Inger Burnett-Zeigler is an assistant professor of Psychiatry and Behavioral Sciences at Northwestern Medicine. Her clinical interests are in mood and anxiety disorders, comorbid substance use disorders, stress management, wellness and interpersonal relationships. She is has training and experience in several psychotherapy interventions including psychodynamic psychotherapy, cognitive behavioral therapy, motivational interviewing, behavioral activation, and mindfulness meditation. Her research focuses on examining the factors associated with mental health service utilization. She is specifically interested in attitudes and beliefs about mental health, access to mental health treatment, engagement in mental health treatment, and barriers to mental health treatment among disadvantaged populations including racial/ethnic minorities and those with low income, limited education, and limited access to resources. 

Learn more about Inger Burnett-Zeigler, PhD

Melanie Cole, MS (Host): Racial, ethnic, gender, and sexual minorities often suffer from poor mental health outcomes due to multiple factors. Here to tell us about some of those today is Dr. Inger Burnett-Zeigler. She’s an associate professor of psychiatry and behavioral sciences at Northwestern Medicine. Dr. Burnett-Zeigler, I'm so glad to have you joining us today. This is such an important topic. It’s a great topic really. Data shows that people from racial or ethnic minority groups are less likely to receive mental healthcare. Can you share some of your recent findings and help us understand more about why this is the case?

Inger Burnett-Zeigler, PhD (Guest): Sure. Just to frame this a little bit, we do know national studies have shown us that about 50% of people in general regardless of racial ethnic minority status receive the mental healthcare that they need. Within that, racial ethnic minorities are even 50% less likely to access mental healthcare. Some of the things that are associated with barriers to care are what I like to think about as both psychological and concrete factors. So the concrete factors are things that many of us are already aware of. Insurance coverage, transportation, childcare, just the financial component of being able to access care. Also important to consider are the psychological factors, which are things like even recognizing that you have a need for treatment. Believing that treatment will be helpful to you. Stigma associate with you accessing treatment, embarrassment, shame. Those types of things. So when I think of barriers to care, I think of both those psychological and those concrete factors.

Host: Well I'm glad you brought up stigma because that, no matter who you are, seems to be a barrier to access to mental healthcare. People are still concerned of what others will think and others in their community. Then there's also language barriers when you're talking about minority groups. You recently published a study that examined the mindfulness based interventions in low income African American women with depressive symptoms. Share some of these findings for us, doctor, and tell us what mindfulness based interventions really means.

Dr. Burnett-Zeigler:   Sure. So this study came about with the knowledge that racial and ethnic minority groups, particularly in the African American community, are less likely to engage in traditional mental healthcare. By that I mean cognitive behavioral therapy, other types of psychotherapy, and receive antidepressant treatments. So I was really interested in understanding well if we know that folks are not going to come to these standardized methods of mental healthcare, what other things might be useful? There's hefty literature at this point indicating that mindfulness based interventions do help with symptoms of stress, depression, and anxiety. Mindfulness based interventions are anything from increased awareness about stressors, breathing exercises, yoga, mindful walks. There's kind of a whole host. When we generally talk about mindfulness based interventions, they're based in breathing, awareness of the psychical responses to stress, and yoga.

So I conducted a study that taught folks on the south side, primarily African American women how to use these mindfulness based practices in a group based intervention that ran over eight weeks. In that study we found that people did report less stress, increased mindfulness, less depression, and fewer symptoms related to trauma. We were really excited to see that something like mindfulness could be particularly useful in a community that has limited access to traditional mental healthcare.

Host: How did you get people to participate in the study doctor?

Dr. Burnett-Zeigler:   Well, one thing that we were especially mindful of is we did not use words like depression in our flyers. So we talked about stress, we talked about wellness. We talked about things like irritability, feeling overwhelmed, feeling fatigued. We flyered. We asked physicians to refer participants. So be honest, contrary to what a lot of studies experienced, folks were interested. I think right now that conversations are increasing around mental health. There's more of a recognition that people are stressed. People are overwhelmed, people are frustrated. We found that folks were really taking that important first step to do something to promote their own mental health and wellness.

Host: As I said at the beginning, this is a really great topic. I think we are all feeling these types of stress today. If providers tuning in are interested in incorporating mindfulness based interventions into their practice no matter who their practice is aimed at, where’s a good place for them to start?

Dr. Burnett-Zeigler:   I think the best place for a provider to start that’s interested in mindfulness based interventions is to start their own mindfulness practice. One could go about doing that by looking up mindfulness based stress reduction, which is one of the most commonly known mindfulness based interventions. There’re MBSR, which it’s known for for short, offered across the city. The do come at a fee. They're typically around $300 to $400. I think the one that’s through Northwestern is a little bit less expensive. Just understanding what it is for yourself developing a personal mindfulness practice, learning to recognize our own stressors as providers is a really important step. Then there are lots of ways to continue that education after that point, but that’s where I would recommend starting.

Host: That’s great advice, doctor. So as we’re talking about mental health and disparities and barriers to access, what would you like other providers to know about providing better treatment for diverse populations across the spectrum? Whether it is mental health related or women’s health, gynecological care, any of these things. How can they address the diversity and help with some of those barriers because it’s a real problem. I think that more providers can get involved, but they need to know what to do and how to do it.

Dr. Burnett-Zeigler: I think a great place to start is just with an awareness. Just being aware of some of the unique factors that patients that you're working with might be experiencing and bringing that into a clinical setting. We do know from a psychology/psychiatry perspective that many of the evidence based interventions like mindfulness based interventions like cognitive behavioral therapy are evidence based, but they're not necessarily tested on diverse populations. What that means is that although these are tools at our disposal, we also have to adopt a flexible perspective when we’re using these types of approaches with diverse groups knowing that everything may not fit everyone.

Another thing I think is really important is really adopting a strength based approach. So we know that folks particularly in the African American community may have greater rates of stress, more experiences with trauma, but also have a lot of tools and strategy and resilience that can be worked with not only to improve mental health, but also used to engage people in their physical health as well. So it’s definitely important that we don’t lose sight of the strength that our patients are coming to us with.   

Host: What a great point. As we wrap up, give us some of your top recommendations that you would like physicians or healthcare providers to consider when they're treating patients from any racial or ethnic minority group. Maybe something special that you have realized or teaching mindfulness, empathy, understanding. I think that that’s a big problem and a big issue for providers is trying to understand what these ethnic minority groups are going through and what their special needs for healthcare might be. Wrap it up with your best advice, what you would like them to know about this.

Dr. Burnett-Zeigler:   I love that you said empathy. I think that that’s something that’s really important to underscore. It’s also important to underscore where we as providers have blind spots and how we have to be aware of our blind spots and use that awareness to educate and inform ourselves about people who are not like us. I think that that holds true no matter who you are as a provider or who you may be working with, and to adopt an empathetic approach when working with people. We have to stay on top of our game. We have to be educated and informed about what's happening in diverse communities so that we can bring that knowledge to our clinical practice as well.

Host: Well said. Absolutely true. Thank you so much for the studies that you're doing and for coming on, joining us, and letting other providers know really what's important when they're dealing with ethnic minorities and how to make their practice more mindful based. Thank you again and that wraps up this episode of Better Edge, a Northwestern Medicine podcast for physicians. For more information on the latest advances in medicine, check our to get connected with one of our providers. If you found this podcast as informative as I did, please share with other providers that you know because that way we can all learn together and use that empathy in healthcare practices all over the country. Don’t miss all the other interesting podcasts in the Northwestern Medicine library. Until next time, I'm Melanie Cole.