As we collectively work to recover and rebuild from the COVID-19 pandemic, much attention has been paid to the tsunami of mental and behavioral health needs. From physical, emotional, and financial upheaval and the unaddressed depths of loss and grief, rates of anxiety, depression and more have skyrocketed. But long before the pandemic, Black, Indigenous, communities of color faced structural barriers to accessing mental health services, especially services that are culturally and linguistically competent and trauma informed.

There has been extensive research on behavioral health disparities in Black, Indigenous, and People of Color (BIPOC). At theCalifornia Pan-Ethnic Health Network, we believe that structural racism – not deficits of the individual looking for mental health services-– is what drives these mental health disparities. We believe that meeting the mental health and wellness needs of BIPOC communities means eliminating practices that systemically exclude BIPOC people from mental health care while also uplifting and celebrating their strengths, cultures, and diversity.

Today, structural racism has resulted in the exclusion of behavioral health interventions developed and tested by and for BIPOC and LGBTQ+ communities’ health and wellbeing. This BIPOC mental health month, we want to elevate solutions that work and that recognize the strength and resilience of our communities. What do solutions that address racial and ethnic mental health disparities look like?

Building solidarity between BIPOC communities and recognizing that our struggles for mental health, racial justice, health, and equity are intertwined is essential to reducing mental health disparities. As a multi-ethnic network representing organizations serving millions ofCalifornians, we bring together and build power in our diverse communities of color- including multicultural, Black, Native American, Asian and Pacific Islander, and Latinx. Today, CPEHN is one of five statewide advocacy organizations working to deliver on some of the equity promises of the Mental Health Services Act. Over the last year, we worked with a network of state-wide advocacy organizations representing diverse racial and ethnic communities to conduct listening sessions across California to better understand access issues related to the implementation of the Mental Health Services Act. On September 22nd, we will host a “Right To Heal” event, unveiling our mixed methods analysis of the collective needs of communities of color across California while also elevating the voices of community members.  

To adequately address racial and ethnic mental health disparities, we must also advocate for federal, state and local policies that advance racial equity in behavioral health.The state of California is responsible for including evidence-based practices into their plans, but these policies have not sufficiently taken into account structural racism. For example, practitioners are still more likely to misdiagnose Black people such as through the over-diagnosis of schizophrenia and the under-diagnosis of depression. Health care continues to exclude many undocumented people, primarily Latinx and Asian and Pacific Islanders, from behavioral health benefits because of racialized ideas of citizenship. Many behavioral health providers also do not collect—or are inadequately collecting—information on sexual orientation and gender identity (SOGI), rendering LGBTQ+ populations invisible to policymakers and others who continue to make decisions that affect their health. Behavioral health leaders around the country have spoken out on the connection between racism, marginalization, and behavioral health.

In the face of structural racism and oppression, BIPOC communities shave formed community-defined evidence practices (CDEPs), a set of cultural practices that communities use to improve their mental health and wellbeing. To increase the value and acceptance of community-defined evidence practices, we released a concept paper: policy options for community-defined evidence practices detailing the successes of the California Reducing Disparities Project. This concept paper demonstrates different approaches to addressing the behavioral health needs and wellbeing of communities of color and LGBTQ+ communities outside of the mainstream medical model. Community defined practices is giving the community credit for what they already do, and must be taken into consideration, funded, and resourced to address inequity. 

Policy research that can educate, persuade, and pressure decision makers on behalf of our communities is another vital component of addressing disparities . Despite individual actions and intentions,California’s health care system, as designed, often makes mental health outcomes worse for BIPOC and LGBTQ+ communities by perpetuating the very inequities it seeks to address. In 2017, CPEHN supported bill AB 470, authored by Assembly member Arambula, was signed into law. It requires robust tracking and evaluation measures for mental health services in Medi-Cal. Newly available Medi-Cal data, released as required by AB 470, details stark racial and ethnic mental health access disparities for adults in Medi-Cal. To better understand what factors influence these disparities in access, we interviewed primary care physicians and community partners for our report focused on mild to moderate mental health services. We found that many Medi-Cal providers are not aware of a plan’s behavioral health care benefit, provider networks, or how to make referrals. Although California was an early leader in enforcement of federal mental health parity law, both the utilization data and our focus group findings demonstrate that the majority of Medi-Cal members remain unaware of the availability of mild to moderate services or their rights to access them. Prior to the release of the report, you can join us on July 27th for a preview of the findings at our webinar on Medi-Cal Mental Health Services: An Unfulfilled Promise for Mild to Moderate Consumers.

At CPEHN we believe that a key component of change is shifting power to the hands of our communities. Communities have long had practices and interventions by the community, for the community that have been excluded or stigmatized by traditional health delivery systems. From local, state, and federal advocacy to coalition building and championing people power to rigorous data and research, change must happen on every level to create more equitable and just health outcomes.

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