Mental Health and Diverse Populations

Mental health disorders affect people from all walks of life, regardless of age, gender, ethnicity, or background. However, certain groups face unique challenges when it comes to mental health.¹

These challenges are often rooted in societal, cultural, and historical factors. These factors can combine and lead to differences (disparities) in access to care and outcomes. Some of these special populations include:¹

• BIPOC (Black, indigenous, and people of color) community
• Lesbian, gay, bisexual, transgender, queer (LGBTQ+) community
• Children
• Older adults
• Veterans
• People with disabilities

Black, indigenous, and people of color (BIPOC)

Everyone’s mental health experience is unique and influenced by many factors. In the United States, reports show that the rate of mental illness among Black and white Americans is about the same. However, for some communities like the BIPOC community, there are shared experiences that must be acknowledged.^2,3

For the BIPOC community, mental health challenges are complicated by:^2,3

• Historical trauma
• Discrimination
• Racism
• Cultural stigma
• Violence
• Economic disparities

In addition, systemic racism and microaggressions can lead to chronic stress, anxiety, and depression. Systemic racism is built into a society’s institutions and legal system. Microaggressions are subtle, discriminatory remarks, actions, or behaviors. They are often unintentional. But they make people feel belittled based on their race, ethnicity, gender, or other aspect of their identity.^2,3

Mental health treatment in the Black community

Only 1 in 3 Black adults with mental illness receive treatment. And, according to several studies, Black adults are:^2-4

• Less likely to receive consistent care
• More likely to use emergency rooms or primary care instead of mental health experts
• Less frequently included in research and standards are based on research that didn’t consider their experiences
• More likely to be involved in the criminal justice system but less likely to be identified as having a mental health issue
• Overdiagnosed with psychotic disorders

These trends in how Black people access mental health care often are caused by barriers to care. These barriers include:²

• Lack of access to treatment or health insurance
• Past negative experiences with medical treatment
• Stigma around mental health – viewing mental health challenges as “weak” or shameful
• Inequality of care or provider bias

Healthcare providers may have bias against certain groups and not even know it. This is called implicit bias. But whether or not it is intentional, bias can lead to misdiagnosis and inadequate treatment. For example, Black adults are more likely to receive a misdiagnosis of schizophrenia when they report mood disorder symptoms.²

Lesbian, gay, bisexual, transgender, queer (LGBTQ+) community

In recent decades, the LGBTQ+ community has had to overcome major adversity due to societal prejudice, acts of violence, and the struggle for equal rights. These things can have an effect on a person’s mental health.⁶

The stress of facing discrimination can lead to higher rates of depression, anxiety, and suicide among LGBTQ+ folks. The National Alliance on Mental Illness (NAMI) reports that:⁶

• Lesbian, gay, and bisexual adults are more than twice as likely to develop a mental health disorder than straight adults.
• Transgender people are nearly 4 times more likely to develop a mental health condition than people who are not trans (cisgender people).
• Youth who identify as LGBTQ+ have feelings of sadness, hopelessness, and depression more often than those who identify as straight.
• Rates of having suicidal thoughts (suicidal ideation) and trying to die by suicide are higher among transgender youth.

People who identify as LGBTQ+ may also grapple with mental health disparities due to:⁶

• Prejudice and discrimination in the form of homophobia, biphobia, or transphobia
• Family rejection
• The process of coming out
• Increased risk of experiencing trauma

Homophobia, biphobia, and transphobia also can lead to physical harm and violence. The LGBTQ+ community is at an increased risk of hate crimes, harassment, and assault due to these prejudices.⁶

These forms of discrimination also contribute to systemic inequities. This means that LGBTQ+ folks might face challenges in securing employment, housing, and healthcare due to their sexual orientation or gender identity.⁶

Children

Childhood mental health sets the foundation for lifelong well-being. But some children face challenges that can damage their mental health. These could include academic pressures, bullying, or family violence.⁷

About half of mental health disorders start before the age of 14. And about three-fourths begin before age 24.⁷

It is important to know the signs of a mental health disorder in a child. Kids go through many developmental phases, so these signs might be easy to miss. You might need to seek help if your child:^7,8

• Starts having a hard time at school
• Withdraws from social situations or friends
• No longer finds interest in activities or hobbies they used to enjoy
• Has a sudden change in behavior that is concerning

The earlier a child with a mental health disorder is diagnosed, the better. Early diagnosis also reduces the risk of more severe disorders later in life. Talk with your child’s doctor if you have any concerns about their mental well-being.⁷

Older adults

The mental health of older adults is often overlooked, despite the fact that aging comes with unique challenges. The following factors and more can contribute to mental health challenges like depression and anxiety:⁹

• Coping with a serious illness
• The loss of loved ones
• Social isolation
• Changes in life such as retirement
• Fixed income or low income
• Limited access to mental health care

Symptoms of mental health disorders in older adults can include:⁹

• Changes in mood, appetite, or energy level
• Aggressive behavior, anger, or irritability
• Obsessive thinking or compulsive behaviors
• Misuse of alcohol or drugs
• Trouble sleeping or sleeping too much
• Issues with memory or confusion

Veterans

Military service can have profound impacts on veterans and active duty service members. One report found that 1 in 4 active duty members experience symptoms of a mental illness. Some common conditions that may arise in veterans and active duty service members are:¹⁰

• Post-traumatic stress disorder (PTSD)
• Depression
• Traumatic brain injury (TBI)

Unfortunately, the stigma surrounding mental health in the military can prevent veterans from seeking help. This may lead to long-term suffering. Some active duty service members might think that speaking up about mental health issues will hurt or destroy their military career. But this is not the case. Current rules state that speaking with a doctor about mental health symptoms cannot affect a person’s military career.¹⁰

Transitioning from military service to civilian life also presents challenges. But you are not alone. If you are struggling, the Veterans Crisis Line is available 24/7. Call 1-800-273-8255, then press 1.¹⁰

People with disabilities

The intersection of disability and mental health is also complex. Some may live with a physical limitation that takes an emotional toll as well. For instance, navigating the world in a wheelchair can lead to feelings of frustration, isolation, and low self-esteem. And those with an invisible disability – like learning disability or developmental disability – may face similar challenges.¹¹

Sadly, a stigma that people with disabilities are somehow “less than” runs through our society. This can be very harmful to someone’s self-esteem and overall mental well-being.¹¹

People with disabilities also may experience barriers to accessing mental health services, including:¹¹

• Lack of physical accessibility
• Limited provider training in disability-specific concerns
• Financial constraints

These challenges can make it harder to get necessary therapy and treatment. A good place to start if you are in need of mental health services is speaking with your primary care doctor. They can help connect you with resources that can help.¹¹

Addressing mental health disparities

Efforts to address mental health disparities in these special populations can promote individual well-being. But they also contribute to a healthier and more resilient society as a whole. Acknowledging and understanding the unique challenges each group faces can help foster empathy, reduce stigma, and support a future where mental health care is accessible to everyone.

Remember that when seeking mental health care services, it is important to trust your provider. You should be able to speak openly with them about your concerns. The following questions can help you gauge whether a mental health provider is the right fit for you:²

• Did my provider communicate openly and honestly with me?
• Did my provider acknowledge and hear my concerns, symptoms, etc.?
• Was I treated with dignity and respect?