Promoting Mental Health Equity in Your Practice

What is Health Equity?

In the public health arena, “health equity” refers to an environment where all types of patients have equal access to appropriate and quality healthcare services, regardless of their economic background or social identity. Creating a space where health equity can be achieved requires a concentrated effort from community members on a social, political, and economic level. In addition, the process involves confronting historical and modern-day inequalities that have limited people’s access to healthcare. The ultimate goal of health equity is to make healthcare more accessible and remove health disparities for underprivileged groups.

Why is Health Equity Necessary?

The need for health equity stems from a history of discrimination against certain groups of people, as well as current inequalities that exist today. Many people with limited access to healthcare in the US come from marginalized groups that have undergone various forms of discrimination. Recent studies conducted by NAMDI demonstrate the current inequalities within mental healthcare; a few of their findings include:

• Black and Hispanic children are about 14% less likely than White youth to receive treatment for their depression. 
• Between 1991-2019 self-reported suicide attempts rose nearly 80% among Black teens, while the rate among other races and ethnicities did not change significantly. Adolescents of color who identify as LGBTQ may be especially at risk of a suicide attempt. 
• Individuals identifying as two or more races (24.9%) are more likely to report having a mental health disorder within the past year than any other race or ethnic group.
• Asian Americans were 60% less likely, and Hispanic Americans 50% less likely, to have received mental health treatment than non-Hispanic Whites.

Additional factors may contribute to marginalized groups not receiving equal treatment in healthcare, which include language barriers between patients and providers and cases where a person’s cultural presentation of symptoms leads to a misdiagnosis by an unfamiliar practitioner.

Health Equity in Mental Healthcare

Health equity means all individuals should have access to necessary services regardless of socioeconomic status, race, ethnicity, sexual orientation, gender identity, or religion. Mental health equity may be one of the most pressing contemporary issues, as studies indicate that racial, sexual, and gender minorities experience higher levels of negative emotion due to their experiences with discrimination and marginalization. They may also have limited access to mental health education or deal with cultural stigmas around seeking the care they need. For example, more than 80% of Black Americans are very concerned about the stigma associated with having a mental illness (NAMI, 2018). 

Another reason mental healthcare is less accessible to marginalized groups is the expensive nature of therapy. Minorities are 2.5 times more likely to live in poverty than non-minorities, and according to UCLA’s Williams Institute, 22% of all LGBT people in the U.S. live in poverty. In addition, groups who tend to experience discrimination are also more likely to live in poverty, which means that members of society who may need mental healthcare the most are the least likely to afford the financial burden of seeking help. Unfortunately, many psychiatric and behavioral problems among Black or Indigenous People Of Color (BIPOC) youth often result in school punishment or incarceration instead of mental health care. 

Minority groups often have less access to mental health services and face more significant barriers to accessing care. Professionals in the mental health field should be aware of these unfair conditions and find ways to make therapy more accessible and affordable. By actively promoting mental health equity in their practices, therapists can help ensure that all individuals have the opportunity to receive the care they need.

Ways to Achieve Health Equity Within a Practice

Re-education around DEI:

To effectively promote mental health equity, therapists need to provide culturally responsive care. They should seek education to help them understand and respect their clients' cultural and individual differences, so they can provide treatment that meets their needs; this includes actively learning about the nuances of different cultures, ethnicities, and communities. When therapists try to learn about different types of people, it builds trust and rapport among clients from marginalized groups. In addition, a mental healthcare provider’s lack of cultural understanding can lead to under diagnosis and misdiagnosis of mental illness in their clients, so mental health workers need to educate themselves beyond their own culture. 

Diversity and representation in your practice:

Another way to promote mental health equity is by embracing diversity and workforce representation. Bringing professionals from various backgrounds to practice can attract new clientele because many clients feel more comfortable discussing their issues with someone who shares their same culture and beliefs. Adding a therapist from a unique background may also introduce the practice to new approaches to therapy that could benefit its operation as a whole. When a team is representative of the diverse communities they serve, it promotes a culture of understanding and respect. In addition, it increases the likelihood of clients finding a clinician who truly understands their needs.

It is also essential to address any biases or discrimination present in the workplace, which may include challenging stereotypes or judgments about certain groups of people or being mindful of one’s privilege and how it can impact their interactions with clients. During this process, it is important to self-reflect and be open-minded to new ideas, significantly when finding areas to improve.

Making therapy more affordable

In addition to education, therapists can contribute toward health equity by developing plans that make their services more affordable. A few ways to lower the costs of mental healthcare include:

• Single Case Agreements (SCA): A Single Case Agreement functions as a temporary contract between a clinician and insurance company to pay for a certain amount of services at a negotiated rate, so the client will not have to pay for therapy entirely out of pocket. If therapists have an area of expertise that an insurance provider does not cover in their plans, they may be able to obtain a Single Case Agreement for nearly the total cost of their out-of-network care
• Accepting Assignment of Benefits: This is when therapists accept insurance payments on the client’s behalf. It can be helpful for clients who can't afford to wait for the potentially lengthy and grueling process of getting reimbursed by their insurance provider. Therapists can also charge their clients a “copay” up front and receive the rest of the insurance payment, reducing the client’s out-of-pocket expenses.
• Grants and charity programs: Practices can find out if they, or their clients, qualify for any assistance or charitable programs that would decrease the cost of therapy. There is an extensive list of government programs and non-profits looking to help therapists make mental healthcare more accessible globally.
• Sliding scale rates: Some therapists may offer their services to a few clients pro bono. Those who cannot afford such an undertaking can offer their services at a sliding scale rate or a general price range that therapists are willing to accept from clients. For example, suppose a therapist typically provides their service for $75 an hour. They may want to consider a sliding scale rate of $55-$75 an hour to make their services more accessible to lower-income clients while maintaining the ability to charge their total rate to those who can afford it. Establishing a suitable range for a sliding scale rate can be difficult, so Nirvana developed a reimbursement calculator that allows therapists and clients to find insurance benefits to help cover their sessions. This tool estimates how much a therapy session will cost, with reimbursement already factored in, so therapists and clients can find a price that works for them both. 

How Nirvana helps therapists implement Health Equity in practice

Promoting mental health equity in therapy is essential to ensuring all individuals have access to the care they need, regardless of their background. In addition, when healthcare providers establish an environment of health equity, society is one step closer to being just and fair to its people. 

Nirvana assists therapists striving towards health equity by helping their clients understand and access their insurance benefits. Due to the confusing nature of insurance, many clients need to be aware of their benefits, especially when receiving therapy that is out-of-network from their provider. Tools such as Nirvana’s reimbursement calculator can help therapists and clients see if their out-of-network session can receive any type of coverage from their provider, even if it is partial. Nirvana also offers tools to therapists that automatically submit these out-of-network claims to the provider, allowing them to focus on giving their clients the support they need. In addition, making therapy affordable and accessible allows more people to receive much-needed help, raising patient satisfaction.