Youth mental health needs are rising at unprecedented rates. An estimated one in five children and adolescents will face at least one mental health problem during their K-12 years (1). And school districts are taking on an ever-increasing role in supporting student mental health needs while facing various barriers, including counselor shortages, staff burnout, and limited available mental health resources to meet the demand.
An additional barrier to students getting treatment is the varying degrees of stigma and cultural gaps that commonly exist within families and communities. Our work is to better understand these barriers and help bridge the gaps while keeping a student’s best interests and families at the center.
What are the cultural barriers to mental health?
People of various cultural groups have differing relationships to mental health and medical institutions in general. And there are many reasons why parents and caregivers–particularly those who identify with groups who have been historically oppressed–may be skeptical about connecting children with mental health treatment and/or connecting with support for themselves, even when the need is there.
Mental health stigma
Family origin, culture, and cultural values can impact a person's understanding of mental health. In some communities, mental health is rarely discussed, so mental health issues, symptoms, and impacts are not well understood. Mental health diagnoses and the idea of seeking treatment may also be seen as weaknesses or something that brings shame, and could impact a family’s social standing within a community or group.
Different cultural groups may also have an alternative understanding of mental health issues due to culturally-driven conceptualizations of mental health and/or religious or spiritual beliefs. Some groups may be less likely to utilize Western medicine for mental health concerns, and families may prefer to seek out spiritual leaders or use natural medicine options.
Lack of diverse providers
Despite the growing diversity within the U.S., there is still a noted lack of diversity in the mental health workforce. Reports show that BIPOC therapists are significantly underrepresented in the mental health field, with over 80% of therapists identifying as White (2). However, research indicates that working with a provider with a shared racial or ethnic background may lead to greater satisfaction, higher engagement, and better clinical outcomes (3).
Language and other systemic barriers
Language gaps and other systemic barriers (long waitlists, financial/insurance barriers) are also important concerns. Studies show that language-based discrimination presents a significant barrier to mental health access. In one study, one in five Spanish-speaking treatment seekers in California were hung up on or not assisted despite nearly 30% of California residents speaking Spanish at home (4). Data from the Centers for Disease Control and Prevention (CDC) also show that White adults (24.4%) were significantly more likely to have received mental health counseling in the past 12 months compared to Black or African American (15.3%), Hispanic (12.6%), or Asian or Native Hawaiian/Pacific Islander (7.7%) adults (5).
Racism and historical trauma
Many cultural groups also have a valid mistrust of the medical system due to institutional racism and historical trauma (6). Unspeakable offenses have been committed against Black, native, and other POC groups in America, from “medical” experiments like the infamous Tuskegee syphilis study and experimentation on Indigenous children, to the forced sterilization of Black women.
Unfortunately, this trauma is not only historic but ongoing. Pregnancy-related deaths are 3.2 times higher for Black women than White women and 2.3 times higher for Native women. BIPOC patients are more likely to be labeled as “drug-seeking” and refused necessary medication, but less likely to receive life-saving treatments like dialysis and kidney transplants.
For school districts, this may translate to a general mistrust of any health service, including school-based mental health services.
How districts can address barriers and get families on board
So what can school districts and staff do to address cultural barriers and support students and families connecting with mental health resources when needed?
Remember families are the experts
First and foremost, remember to practice cultural humility. We can never be “experts” in a culture that is not our own, and a key component is understanding that each person is the expert on their cultural values.
Be careful about making assumptions or generalizations about a cultural group. Culture is intersectional, meaning that each of us is made up of a variety of different identities and cultural impacts, and the way culture affects one person may not affect another in the same way. So allow each student and family to teach us about their values, beliefs, and experiences.
Prioritize empathy and understanding
Always come from a place of empathy and understanding. Learn about the ways in which the medical system has failed people of color and other marginalized groups throughout history and presently. Understand that the mistrust that many groups feel is valid, and it’s our job (as institutions and professionals in education and/or health care) to break down systemic barriers in order to provide equitable care to all students and families.
Practice community outreach
Assign school ambassadors and create community partnerships to support outreach to the broader school community. Create opportunities for open dialogue about mental health with families to support psychoeducation and address stigma and misinformation. Consider the specific language and cultural needs within your district when planning outreach and events. Invite students, parents, and community leaders from historically underserved and marginalized groups to participate in decision-making and make sure they have a voice at the table. Ensure that communication comes from a place of humility, empathy, and understanding.
Ensure availability of diverse clinicians and staff
Build a diverse school staff and counseling team. Again, take into consideration your district’s language and cultural needs. Recognizing significant shortages across the U.S., look to community and telehealth service providers to help close workforce gaps. Virtual care in particular provides opportunities for more rapid access to diverse staff who are able to address racial, ethnic, and/or language needs that may not be available within your community.
Key takeaways
- There are various barriers to students connecting with mental health treatment, including mental health stigma, cultural barriers, and systemic barriers.
- School districts and staff need to be aware of the above in order to best meet the needs of their students and to connect students in need with care.
- Families are the experts of their own culture and beliefs, and approaching students and families with empathy and understanding is critical.
- Practicing cultural humility, engaging in community outreach, and welcoming students, parents, and community leaders from historically underserved and marginalized groups are important ways to learn about and break down barriers.
- Building a diverse staff and partnering with community and/or telehealth providers are additional ways that schools can overcome barriers and ensure every child gets the mental health treatment they need.
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1. 2022 National Healthcare Quality and Disparities Report
2. Census.gov
3. Cabral, R. R., & Smith, T. B. (2011)
4. Usher-Pines, L. et. al (2023)
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