A Call for Diversity in the Mental Health Field

Danish/AdobeStock

COMMENTARY

Across the board, we as mental health professionals have been struggling with a persistent issue that we can no longer ignore: the glaring lack of diversity in our industry. Despite the continued increase in diversity across the United States, the mental health workforce remains predominantly White. As of 2021, the American Psychological Association (APA) reported that approximately 80.85% of the psychology workforce in the United States was made up of White professionals.¹ This number proves even more disheartening when we consider that 10 years prior, this figure stood at 85.75%, indicating that we have made only slight progress towards our goal of having an industry that is reflective of the individuals we serve. More troubling still is that Black and African American professionals accounted for a meager 5.08% of the psychology workforce in 2021.

As a result, for countless individuals of color, trying to find a psychiatrist, therapist, or other mental health provider who shares their unique cultural experiences is a difficult journey. It is a pursuit driven not just by a desire for professional guidance but also by a yearning for a therapeutic partnership rooted in community. But the reality is that mental health care providers who can truly understand their lived experiences are few and far between. This scarcity forces them to settle for care from professionals who may not fully grasp the nuances of their cultural context. But it does not have to be like this—much like our commitment to promote mental healing, we must extend the same dedication to addressing the inequalities that have long impacted our field.

Today, the numbers show that individuals from underrepresented backgrounds are hesitant to seek help when experiencing mental health challenges. Compared to the 40% of White Americans who seek mental health treatment, only 25% of African Americans reportedly seek care.² When Black individuals do seek care, they often find themselves doing so in nontraditional environments. The numbers show that Black adults are almost twice as likely to seek treatment for a mental health disorder in an emergency department than White adults.³ Consequently, despite experiencing mental health challenges at similar rates to other racial groups, Black individuals are more likely to struggle with chronic and persistent, rather than episodic, mental health conditions.⁴ While these numbers cannot be solely attributed to the lack of representation in our field, it is a contributing factor, together with other barriers such as limited access to insurance⁵ and a lack of financial resources, with those from minority communities more likely to straddle the poverty line.⁶

Addressing these issues requires more than just recognizing their existence. It calls for culturally competent mental health professionals who can provide diverse patients with adequate support. Broadly defined, cultural competence refers to our ability to use our knowledge to effectively address the needs of clients with different backgrounds, from race and ethnicity to religion and sexual orientation. Specifically, when it comes to racial diversity, cultural competence means not only understanding but also actively addressing the significant hurdles that individuals of color face daily. Research has shown that cultural competence training can improve the abilities of providers when treating patients from diverse communities.⁷ But it is not merely an added benefit; it is an absolute necessity. Mental health symptoms can manifest differently across cultures, making it essential for practitioners to understand these differences and respond accordingly.

However, to truly understand the depth of this issue, we must recognize that the lack of diversity in the mental health profession is not solely due to a lack of interest or desire among individuals from diverse backgrounds. Rather, it is rooted in the barriers they encounter when attempting to enter the field that create a cycle that disproportionately affects aspiring mental health professionals of color.

One of the most formidable challenges is the financial burden associated with pursuing an education in mental health. Consider the financial realities: the average cost of a Doctorate from a public university is $93,670, while at a private university, this figure soars to $129,395.⁸ For those aiming for a Master’s degree, the costs are, on average, $59,060 at public universities and $87,950 at private institutions.⁹ The financial commitment becomes even more significant for aspiring psychiatrists who attend medical school, with the average cost reaching an astonishing $218,792.¹⁰ This financial strain is particularly challenging for Black students, who not only take out student loans at higher rates than their White counterparts but also end up owing more on average.¹¹

So, how can we address the glaring underrepresentation of individuals of color within our profession? The answer lies in proactively engaging with diverse communities and taking concrete steps to remove the barriers they face when entering the field.

1. Provide Opportunities for Education

We must take a multifaceted approach that starts with providing meaningful exposure to the inner workings of the field. This exposure is essential for helping the next generation of students, particularly those from underrepresented backgrounds, understand the purpose and possibilities that a career in mental health can offer. Career education programs can serve as invaluable platforms for educating diverse youth about the pivotal role mental health professionals play not only in promoting individual well-being but also in community-building. Moreover, paid internship opportunities can provide students of color with firsthand experience in professional settings, helping to bridge the gap between theory and practice. University job fairs are another meaningful way for students to interact with mental health professionals and learn about career opportunities, especially for institutions with diverse student populations, such as Historically Black Colleges and Universities (HBCUs).

2. Increase Scholarship Programs

Scholarships serve as powerful tools for breaking down financial barriers and fostering inclusivity in higher education. By specifically targeting individuals who have historically been underrepresented in mental health professions, these scholarships send a clear message: the mental health field values diversity and is committed to ensuring equitable access to education. Whether they help cover tuition costs, provide financial support for living expenses, or even extend support with professional development, these scholarships will not just serve as financial aid; they are investments in the future of mental health care, enriching the profession with a broader range of perspectives and experiences, ultimately leading to more inclusive and effective mental health services for all.

3. Offer Higher Paid Licensure Programs

One of the most significant barriers to diversifying the mental health workforce is the financial burden associated with pursuing an education in this field. Depending on the specific profession, licensure upon graduation is a lengthy process that often pays low wages. This means that after spending time and money to earn their education, aspiring mental health professionals must grapple with any student loan debt they may have accumulated while balancing prolonged periods of limited income. As an alternative, licensure programs that offer competitive pay will help ensure that a student’s financial investment in their education aligns with their earning potential upon graduation.

Diversifying our mental health workforce is not just a matter of inclusivity; it is a response to an impending national shortage of mental health professionals. At present, a startling 160 million Americans reside in areas with mental health professional shortages.¹² In the years ahead, the nation is projected to face a deficit ranging from 14,280 to 31,109 psychiatrists,¹³ while psychologists, social workers, therapists, and counselors will undoubtedly be stretched to their limits as well. It is only through our concerted efforts that we can hope to provide equitable mental health care to all, ensuring that no one is left without the support they need in times of crisis. We must recognize that fostering diversity is not merely a moral imperative; it is essential for the overall well-being of society as a whole.

Mrs Cohen is the founder and CEO of CWC Coaching & Therapy.

References

1. Data tool: demographics of the U.S. psychology workforce. American Psychological Association. 2022. Accessed October 26, 2023. https://www.apa.org/workforce/data-tools/demographics

2. Black mental health: what you need to know. Mass General Brigham McLean. January 30, 2023. Accessed October 26, 2023. https://www.mcleanhospital.org/essential/black-mental-health

3. Peters Z, Santo L, Davis D, Defrances C. Emergency department visits related to mental health disorders among adults, by race and hispanic ethnicity: United States, 2018–2020. Natl Health Stat Report. 2023;(181):1-9.

4. Black and African American communities and mental health. Mental Health America. 2020. Accessed October 26, 2023. https://www.mhanational.org/issues/black-and-african-american-communities-and-mental-health

5. Tolbert J, Drake P, Damico A. Key facts about the uninsured population. Kaiser Family Foundation. December 19, 2022. Accessed October 26, 2023. https://www.kff.org/uninsured/issue-brief/key-facts-about-the-uninsured-population/

6. Ethnic and racial minorities & socioeconomic status. American Psychological Association. 2017. Accessed October 26, 2023. https://www.apa.org/pi/ses/resources/publications/minorities#

7. McGregor B, Belton A, Henry TL, et al. Improving behavioral health equity through cultural competence training of health care providers. Ethn Dis. 2019;29(Supp2):359-364.

8. Hanson M. Average cost of a doctorate degree. Education Data Initiative. October 11, 2021. Accessed October 26, 2023. https://educationdata.org/average-cost-of-a-doctorate-degree

9. Hanson M. Average cost of a master’s degree. Education Data Initiative. October 11, 2021. Accessed October 26, 2023. https://educationdata.org/average-cost-of-a-masters-degree

10. Hanson M. Average cost of medical school. Education Data Initiative. October 11, 2021. Accessed October 26, 2023. https://educationdata.org/average-cost-of-medical-school

11. Nerkar S. Canceling student debt could help close the wealth gap between White and Black Americans. FiveThirtyEight. May 31, 2022. Accessed October 26, 2023. https://fivethirtyeight.com/features/canceling-student-debt-could-help-close-the-wealth-gap-between-white-and-black-americans/

12. Shortage areas. Health Resources & Services Administration. Updated October 25, 2023. Accessed October 26, 2023. https://data.hrsa.gov/topics/health-workforce/shortage-areas

13. Satiani A, Niedermier J, Satiani B, Svendsen DP. Projected workforce of psychiatrists in the united states: a population analysis. Psychiatr Serv. 2018;69(6):710-713.