Hurdle aims to expand mental health for patients of color

The digital health company offers culturally intentional care. Kevin Dedner, founder and CEO, says it’s needed because the mental healthcare system wasn’t designed for everyone.

Kevin Dedner wants to eliminate the barriers that patients of color face in accessing mental health services.

Dedner is the founder and CEO of Hurdle, a digital mental health startup. Dedner created the company in 2018 with a goal of providing culturally intentional care.

Many patients from minority groups, particularly Black patients, stop therapy because their clinicians don’t acknowledge the impact of race in their life experiences. Dedner said the inspiration for creating the company stemmed from his own battle with depression and his difficulty in finding the right therapist.

“The mental healthcare system as we know it was not designed for everyone,” Dedner told Chief Healthcare Executive.

Hurdle connects patients to therapists using techniques developed by Norma L. Day-Vines, Hurdle’s clinical research lead and associate dean for diversity and faculty development at Johns Hopkins University’s school of education.

Patients with Hurdle are staying with therapists more often than the national average, Dedner said.

“We think this is quite significant … because 50% of ethnic minorities terminate therapy prematurely because of that lack of provider fit,” Dedner said.

Dedner and Day-Vines talked with Chief Healthcare Executive about mental health, the challenges for Black Americans, and what healthcare leaders should be doing to help employees from minority groups. (The story continues after the video.)

‘It can be equally draining’

Hurdle just issued a recent report on vicarious racism and its impact on Black mental health.

Many Black Americans experience a profound health impact from racial acts of violence aimed at others, such as the killing of 10 Black people in a supermarket in Buffalo, New York, earlier this month.

“One of the things we are finding is that impact with direct racism and vicarious racism can be equally problematic,” Day-Vines said. “‘It can be equally draining. It can be equally sort of stressful, creating a psychological distress that contributes to a lot of other problematic kinds of concerns for people.”

Some participants in Hurdle’s report described vicarious racism as having a toll on mental health and even suffering physical discomfort. “In many ways it was like people were reliving some of those experiences,” Day-Vines said. “There’s a physiological reaction often to what people encounter as they engage with vicarious racism.”

The massacre in a predominantly Black neighborhood in Buffalo elicits many of the same fears and anxieties as the killing of George Floyd did among Black Americans. Floyd was killed by a Minneapolis police officer almost exactly two years ago, on May 25, 2020.

“There is something that has been happening in the daily life and daily experience of what it means to Black in America that takes a toll on you,” Dedner said.

The day after the Buffalo shooting, Dedner recalled following his normal routine of going to the grocery store in northwest Washington, D.C., a predominantly Black neighborhood. “I wondered about the other folks who were in the grocery store with me,” Dedner said. “Like, who else was there?”

Therapists need to acknowledge these fears among Black patients. Too often, clinicians aren’t comfortable talking about those experiences.

“People don’t come to counseling because they’re Black,” Day-Vines said. “They don't come to counseling because they’re gay. They don’t come to counseling because they’re poor. All of those dimensions may shape how they experience life.”

If a client talks about their experiences and the clinician pivots away, she said, “People do not feel heard or understood. They feel like their concerns are invalidated.”

There are health consequences for not talking about issues of race, ethnicity and culture, Day-Vines said.

“The opportunity for clients to come in and have space within which to talk about these issues is really important,” she said. “Once you begin to talk about what is going on, you have a cathartic moment. Following the cathartic moment, you can begin to think, ‘How am I going to manage this?’”

‘Serious workforce issues’

The lack of diversity in mental health contributes to the barriers for Black patients and other patients of color.

Nationwide, only 2% of psychiatrists are Black, according to data from the American Psychiatrist Association.

“We have really, in the country, failed at creating a diverse mental healthcare system,” Dedner said.

“We have really, really serious workforce issues that it will, candidly, take generations for us to fix.”

Health advocates have urged Congress and President Biden’s administration to invest more in expanding and diversifying the nation’s mental health workforce. Many don’t pursue mental health careers because of the heavy student loan debt.

Dedner called on the National Institutes of Health and the U.S. Centers for Disease Control to place a greater focus on the mental health needs of Black Americans.

“We need the NIH and CDC to take a broader understanding about black folks' mental health and how these issues are impacting people,” Dedner said.

Events such as the mass shooting in Buffalo “really do impact people’s mental health,” Dedner said.

“It shows up in ways that we’re just now beginning to articulate our understanding of it,” he said. “And we don’t know enough. So our government really needs to double down and try to understand more so we can support people through these challenges that they experience in their daily lives.”

Dedner said the discussion about race in mental health is an essential conversation that needs to happen more broadly. “I’m exhausted having this conversation,” he said. “I’m exhausted trying to bring attention to this issue.”

Lessons for leaders

Healthcare leaders must be mindful of the issues weighing on their Black patients, and their Black employees, Dedner said.

For hospital and healthcare leaders who want to help their Black employees, Dedner outlined three steps to consider.

First, health leaders must create space for conversation about race and stress. After the Buffalo shooting, Dedner asked members of Hurdle how they were coping. “The pain and fear and anxiety among the black mothers literally brought me to tears, and I needed to go off camera,” he said. “We have to create space for people to acknowledge how they feel.”

Secondly, health leaders have to make sure employees know they have access to services and assess how often workers are taking advantage of employee assistance programs. “It’s not enough to say, ‘We have an EAP,’” Dedner said. “We should be thinking about utilization rates.”

Finally, Dedner said leaders should examine the internal look of their organization. “Do a gut check around your culture,” he said.

“Are there systems and processes that you have put in place that sort of reinforce these biases and stigmas or even perpetuate stigmas associated with people of color in your company? We can all do that,” he said.

Dedner views Hurdle’s model of cultural humility and cultural responsiveness as filling a critical need at such a crucial time. Since the killing of George Floyd, more honest conversations about race are happening, Dedner said.

“I’m glad that we’re having the conversation,” he said. “But it also points to the need to make sure that our mental healthcare system is prepared to support people of color.”