The Morehouse School of Medicine examined the toll of inequities. Daniel Dawes of the Satcher Health Leadership Institute spoke with Chief Healthcare Executive about the need for equity in behavioral health.
While many health organizations are focusing more on health equity, disparities in mental health are leading to deaths that could have been avoided.
The Satcher Health Leadership Institute, part of the Morehouse School of Medicine, examined the toll of disparities in mental health in a report released earlier this month.
In an analysis of data between 2016 and 2020, the institute estimates there were 116,722 preventable deaths among members of minority groups. The institute also estimated the total cost of those disparities reached $278 billion over that four-year span.
Daniel Dawes, executive director of the Satcher Health Leadership Institute, said the report is the culmination of “a 15-year dream of studying the economic burden of mental health inequities in the United States.”
“I think we expected that the numbers were going to be quite frightening, and that’s probably an understatement,” Dawes told Chief Healthcare Executive.
Even though Dawes described those figures as “astronomical,” he also said it was certainly a low estimate. Nearly 6 million Americans were excluded from the data sets, including those in the military, residents of nursing homes, and those who are incarcerated. Many are the most marginalized and medically underserved, he said.
“Lives are being lost, yes, but also decisions are being made based on inaccurate data, which quite frankly, is perpetuating that ongoing cycle of inaction,” Dawes said. “So that’s why this is huge.”
In an interview with Chief Healthcare Executive, Dawes discussed the factors contributing to inequities in mental health and what healthcare leaders and policy makers can do to close those disparities. (See excerpts of our interview with Dennis Dawes in this video. The story continues below the video.)
‘It is not an organic outcome’
David Satcher, the former U.S. surgeon general and founder of the Satcher Health Leadership Institute, has said, “There is no health without mental health.”
Plenty of factors are preventing members of racial and ethnic minority groups from their optimal mental health, Dawes said.
“What we found in our study is, there really is a link between race, economics and mental illness,” he said.
“We know that they’re exacerbated by, when we talk about the social determinants of health, those are the structural conditions that all of us are born into, that we live in, that we die in,” Dawes continued. “Are we able to access transportation? How about getting quality education? Can we access employment, true employment opportunities? Housing is a major one as well.”
Collectively, when members of underserved communities have trouble accessing those basic needs make it extraordinarily difficult to be healthy.
These barriers to mental health, and all health, didn’t just happen to members of racial and ethnic minority groups, Dawes stressed.
“This society has intentionally erected barrier after barrier to weaken their bodies and hasten their deaths,” Dawes said.
“We know it is not an accident,” he said. “It is not an organic outcome when we see these health disparities, these health inequities, among racial and ethnic minority groups.”
Political determinants of health, which determine how resources are allocated and how policies shape communities, play a major role in shaping those social drivers, Dawes said. “Those factors have led to the higher rates of health inequities,” he said.
The stigma surrounding mental health is also a barrier that must be addressed, Dawes said. Many members of minority communities also have a distrust of the medical establishment. Such distrust stems from decades past, including the infamous Tuskegee syphilis study of Black men, who weren’t given penicillin or even informed consent about the nature of the study.
“Stigma has played a long role,” he said. “You go into the 1800s when blacks were excluded from mental health services, because they weren’t deemed as having the capacity to have a mental illness.
“We know there is still a huge stigma … There is significant mistrust because these population groups were experimented on, either systemically or mentally,” Dawes said. “For us, it is really important that we address the issue in a very wholesome manner. If we don’t, it’s going to get worse before it gets better.”
Closing the gaps
It’s critical to educate the public on the nature of mental illness, Dawes said.
“Mental illness is a chronic disease. It is not an acute or temporary condition,” he said.
“I think for too long in our country, mental health, behavioral health has been relegated to an inferior position. On this hierarchy of chronic diseases, it falls really low.”
Hospitals and healthcare systems can play a significant role in addressing the disparities in mental health.
“Healthcare administrators, healthcare executives, really could help us bolster greater attention that is paid to this critically important issue, if they were to prioritize it, if they were to ensure that there is parity between mental health and physical health, and actually dedicate the investments, the time and attention to it, so that we could elevate whole health,” Dawes said.
Members of minority communities often don’t come in contact with any health services, and Dawes said it’s even worse when talking about behavioral health services.
Because of that, Dawes said, “It’s absolutely critical that we integrate primary care and behavioral healthcare.”
Only 13.5% of children in minority groups have access to behavioral health services, Dawes said. Many Black, Hispanic, Asian and Native American communities rely on emergency departments or federally qualified health centers for their health needs.
“If they are able to touch our primary care system, if they’re able to go to the community health center, for instance, imagine how much healthier we could help them become, if we were able to offer those services within those settings,” Dawes said.
Telehealth has been showing more potential to expand access to behavioral health services. Mayo Clinic researchers have found a high degree of accuracy in psychiatry diagnoses through telehealth, according to a study published Sept. 2 in Jama Network Open. A separate study found telehealth reduced the risk of overdoses among those struggling with substance use.
Telemedicine can potentially help those in underserved communities, Dawes said, but there are still some barriers to improve access.
“I think we also need to address the digital divide in communities of color,” Dawes said. “There are so many folks that don’t even have broadband access, who would need that in order to access telepsychiatry or telehealth services. I think if we can get over that gap, that chasm, then I think we would see greater results.”
Outside the health industry, the federal government needs to invest more in mental health and substance use, he said.
“We often see the federal budget giving basically cents to the dollars that physical health conditions like diabetes and cancer and heart disease have,” Dawes said.
Dawes said he hopes the study drives greater attention to the glaring gaps in mental health and the economic burdens from those disparities.
“It was sobering, but it was also vindication of what we had anticipated was the result,” Dawes said. “I think it provided the tangible evidence that we needed in order to demonstrate this is a real problem and is worthy of our attention.”