By Dr. Beall-Wilkins and Dr. Jamie Hanna

Magellan Health hosted a free webinar for September Suicide Prevention Awareness Month. If your question wasn’t answered during the webinar, or if you would just like to learn more about suicide prevention, read on for information shared by our webinar presenters, Dr. Rakel Beall-Wilkins, MD, MPH, and Dr. Jamie Hanna, MD. For more information and resources addressing suicide prevention, and to watch the recording of this webinar, visit MagellanHealthcare.com/Suicide-Prevention.

Question: Please say more about the interplay between chronic pain and suicide risk.

Dr. Beall-Wilkins: It is estimated that the prevalence of suicidal ideation is roughly three times greater in people living with chronic pain compared to those who do not have chronic pain, and chronic pain is linked to higher rates of not only suicidal ideation but also suicide attempts and completed suicides.[1] When coupled with impaired functionality and disability, chronic pain can result in socioeconomic hardships and limitations in access to care that further exacerbate both physical and mental health symptoms. Chronic pain and depression often go hand-in-hand, and clinical studies have shown that upwards of 85% of people with chronic pain have experienced severe depression.[2] It is essential that patients with chronic pain be routinely screened for psychiatric symptoms and acute safety concerns, and that they be referred to treatment if issues arise.

Question: Is a person really considered suicidal if they have considered it a lot but have never acted on their thoughts? What measures can we put in place for individuals with a baseline of passive suicidal ideation who are in outpatient therapy?

Dr. Hanna: Understanding the risk factors that can lead to suicidal behavior provides an opportunity to identify and support people at risk for suicide. Risk factors include a previous suicide attempt, diagnosis of mental illness/substance use, isolation, social/legal problems, trauma in childhood, a family history of suicide, recent stressors and access to lethal means. Learn more about suicide risk and protective factors from the American Foundation for Suicide Prevention and the Centers for Disease Control and Prevention. Suicidal ideation – or thoughts about suicide – is also an important risk factor and can be a warning sign of imminent suicidal behavior. There is greater risk when suicidal thoughts occur more often, over greater time periods or are more challenging to control; there are fewer barriers to acting on the thoughts; and the reason for the suicidal thoughts is to stop the pain. Identifying suicidal ideation and implementing treatment strategies are critical in preventing suicide.

It is always the goal to treat suicidality in the least restrictive setting and subsequently, treatment of suicidal ideation often occurs in the outpatient setting. There are a variety of measures that can be put in place to assess and treat suicidal thoughts in the outpatient setting. Some of these include screening, crisis intervention, and evidence-based and research-informed interventions.

One example of a screening tool is the Columbia-Suicide Severity Rating Scale (C-SSRS). This scale focuses on evidence-based metrics to assess the severity of suicidal ideation and behavior. Items on the scale also serve to differentiate between suicidal and non-suicidal self-injurious behavior.

Crisis intervention assistance is typically provided by connecting a person in crisis to trained staff for support and referral to additional services. The goal is to impact key risk factors for suicide, including depression and hopelessness, increase future mental healthcare access, and put space and time in between suicidal thoughts and action. Examples of crisis intervention services include the National Suicide Prevention Lifeline (1-800-273-8255) and Crisis Text Line (text HOME to 741741).

There are only a small number of evidence-based treatment interventions directly targeting suicide risk. These include cognitive behavioral therapy for suicide prevention (CBT-SP), dialectical behavior therapy (DBT) and Collaborative Assessment and Management of Suicidality (CAMS). Additional research-informed interventions include collaborative safety planning and reducing access to lethal means. These interventions are emphasized in both the CDC suicide prevention strategy and the Zero Suicide approach to suicide prevention.

Question: What do you say to someone who says they want to die and that life is torture, and asks why they were born? What types of things can you tell the person going through this, and how do you do it without sounding judgmental?

Dr. Beall-Wilkins: Feelings of despair, hopelessness, worthlessness and helplessness are commonly experienced by people who are in the midst of a mental health crisis. During episodes of emotional distress, it can be very difficult for some people to think positively or constructively, and this can manifest itself in the form of self-deprecating statements and thoughts of self-harm. When someone is feeling this way, it can be helpful to reassure them that things can get better, and that comprehensive treatment can improve how they feel. It’s also very important to assess their safety, inquire about any thoughts they may be having of hurting themselves or someone else, and encourage them to seek immediate professional help if they’re feeling unsafe.

Question: I had a family member take her life on 9/7. She went about her day as normal, and then chose to take her life that evening after placing her kids down for the night. As a family member, we are still trying to figure out why. Is this a normal feeling? Similarly, for people attempting to support those with suicidal thoughts, or who have tried to support someone who died by suicide, what suggestions do you have to help them find the balance between supporting the suicidal individual and feeling overly responsible for the suicidal individual’s choices, behaviors, etc.?

Dr. Hanna: When a loved one dies by suicide, intense emotions – such as disbelief, anger, guilt, isolation and despair – can become overwhelming, and there is no right or wrong way to feel. Many people will feel confused as they try to understand why their loved one chose suicide. And it is likely there will always be unanswered questions. The events which lead to suicide are often complex and most commonly there are many factors that contribute to a person ending their life.

The feeling of guilt can lead suicide survivors to blame themselves for the death of their loved one. It is critical that survivors do not blame themselves, and that they seek support and engage in self-care. Support and self-care can include reaching out to community members, such as friends, family, co-workers and mental health providers. Both in-person and online support groups are available specifically for suicide survivors. The American Foundation for Suicide Prevention provides resources to find a support group. It can also be beneficial to seek professional help with a licensed therapist or psychiatrist, especially for symptoms of depression and thoughts of suicide.

Question: The hardest part about helping someone who is suicidal is the concern that the police will be called, and the person will end up in handcuffs. How can we change this?

Dr. Beall-Wilkins: It is often the case that family and friends of those who are experiencing acute mental health crises face the prospect of summoning law enforcement to assist in maintaining safety and facilitating transportation to care. This can be a very daunting prospect and a growing movement of advocates, policymakers and mental health providers are now pushing for reforms that would reduce the likelihood of adverse outcomes in these circumstances.[3] One such reform involves greater collaboration between police departments and mental health clinicians, including training, education and joint response to crisis calls. Preliminary data indicate this approach can be a very effective means of reducing adverse outcomes, increasing public safety and strengthening trust within communities.[4]

Question: Is being suicidal hereditary? Are the mental/emotional issues that caused a previous suicide in a family hereditary?

Dr. Hanna: There is clear evidence that suicide can run in families, and family history of suicide has been identified as a significant risk factor for suicide. Studies show that individuals who have a parent or sibling die by suicide are two and a half times more likely to die by suicide than those without a family history of suicide. Research has identified a number of genes that appear to be associated with suicide risk. Psychiatric illness has also been shown to run in families and is a risk factor for suicide. Depression plays a role in over half of all suicide attempts. Children of parents with depression are three times as likely to develop major depression, anxiety disorders and substance use – all of which increase the risk of suicide.

While family history of suicide and psychiatric illness are important risk factors of suicide, other risk factors include previous suicide attempts, depression, substance use, stressful life events, physical illness and access to lethal means, among others. Suicide occurs as a result of many interacting genetic and environmental factors. Family members share genes, and they often share experiences – they eat together, live together and face economic stressors and loss together. These shared experiences may combine with genetics to increase an individual’s vulnerability to suicide. This does not mean that everyone with a family history and increased risk of suicide will have suicidal behavior, but that they could be more vulnerable and should take steps to reduce their risk. These may include early evaluation and treatment of mental illness and building protective factors to buffer against suicidal behavior.

Question: Could you speak to the legalities of those who need help but are past the age of responsibility, and family members and friends are told there is nothing they can do if the person refuses the help or that we can’t keep them somewhere against their will?

Dr. Beall-Wilkins: In most jurisdictions, the ability to commit an individual to treatment against their will is typically conferred by the courts based upon three guiding principles: harm to self, harm to others and evidence of significant mental deterioration that renders an individual unable to practice self-care in their own best interest. If an adult person is explicitly stating an intention to hurt themselves or others, or exhibiting grave mental disability, they can be involuntarily committed for observation, evaluation and acute stabilization.

Rakel Beall-Wilkins, MD, MPH, serves as a medical director for Magellan Healthcare. Prior to joining Magellan in 2018, Dr. Beall-Wilkins assisted in the launch of an addiction psychiatry clinic embedded within Harris Health System’s Healthcare for the Homeless Program, to combat local impacts of the nationwide opioid and synthetic cannabinoid (“K2”) epidemics. Dr. Beall-Wilkins also served as a member of the Baylor College of Medicine faculty with clinical duties at both the Ben Taub General Hospital Psychiatric Emergency Center and the Thomas Street Health Center. There she helped to expand behavioral health services by launching a neurocognitive clinic collaborative to better screen, diagnose and treat individuals with HIV/AIDS-associated neurocognitive disorder and psychiatric comorbidities. She is a graduate of the University of Texas at Austin and the Johns Hopkins School of Public Health, where she obtained a Master of Public Health degree. She obtained her medical degree from Baylor College of Medicine. 

Jamie Hanna, MD, serves as the medical director for the Magellan of Louisiana Coordinated System of Care (CSoC) program. She is board certified in Psychiatry and Child and Adolescent Psychiatry. Prior to joining Magellan in 2020, Dr. Hanna served as an assistant professor and assistant training director with Louisiana State University School of Medicine, working with the acute behavioral health unit, and leading the psychiatric consultation liaison service and emergency psychiatric services at Children’s Hospital of New Orleans. Dr. Hanna completed medical school at the University of Alabama School of Medicine and a subsequent internship in Pediatrics, residency in General Psychiatry, fellowship in Child and Adolescent psychiatry, and fellowship in Infant Mental Health with Louisiana State University in New Orleans.

For more information and resources addressing suicide prevention, and to watch the recording of this webinar, visit MagellanHealthcare.com/Suicide-Prevention.

[1] Pergolizzi JV (2018) The risk of suicide in chronic pain patients. Nurs Palliat Care 3: doi: 10.15761/NPC.1000189.

[2] Sheng, J., Liu, S., Wang, Y., Cui, R., & Zhang, X. (2017). The Link between Depression and Chronic Pain: Neural Mechanisms in the Brain. Neural plasticity, 2017, 9724371. https://doi.org/10.1155/2017/9724371

[3] https://www.npr.org/2020/09/18/913229469/mental-health-and-police-violence-how-crisis-intervention-teams-are-failing

[4] https://www.apa.org/monitor/2021/07/emergency-responses

Untreated mental illness costs the United States up to $300 billion every year.[1] It is the leading cause of disability and the third most expensive medical condition in terms of total health spending, behind cancer and traumatic injury.

Given that one in five Americans suffers from a mental illness in a given year[3], and that the average delay between the onset of mental illness symptoms and treatment is 11 years[4], mental health screening should be considered just as important as regular medical exams.

Many physicians integrate screening to diagnose mental health conditions as part of primary care. It gives a PCP a picture of the patient’s emotional state and helps determine if symptoms they are experiencing are an indication of a mental health condition or an underlying physical health condition. Magellan Healthcare supports primary care screening and treatment with our Behavioral Health Toolkit at MagellanPCPtoolkit.com

Online screening and digital screening are two of the quickest and easiest ways to determine if a patient is experiencing symptoms of a mental health condition. A PCP may ask a patient to complete a questionnaire online before a visit, or a PCP may ask a patient to answer a few questions on a tablet or form while you they are at the office.

Based on the results, the PCP can recommend treatment options, such as digital or in-person therapy, a referral to a psychiatrist or psychologist, or a referral to the patient’s health plan’s case management team.

Early identification and intervention lead to better outcomes and can reduce long-term disabilities and prevent years of suffering.

To learn more, visit magellanhealthcare.com/mental-health. You’ll find information about mental health conditions and links to evidence-based screening tools you can do yourself. If any screener indicates a problem, consult a healthcare professional immediately.

[1] National Alliance on Mental Illness. (n.d.) FY 2018 Funding for mental health. Retrieved October 7, 2020 from https://www.nami.org/getattachment/Get-Involved/NAMI-National-Convention/Convention-Program-Schedule/Hill-Day-2017/FINAL-Hill-Day-17-Leave-Behind-Appropriations.pdf

[2] Soni, A. (2015). Top five most cCostly conditions among adults age 18 and older, 2012: Estimates for the U.S. civilian noninstitutionalized population. Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services. Retrieved September 18, 2020 from https://meps.ahrq.gov/data_files/publications/st471/stat471.shtml.

[3] Centers for Disease Control and Prevention (2018). Learn about mental health. Retrieved September 18, 2020 from https://www.cdc.gov/mentalhealth/learn/index.htm.

[4] National Alliance on Mental Illness. Mental health by the numbers. (2019, September). Retrieved September 22, 2020 from https://www.nami.org/mhstats.

Q: What is the cumulative effect on mental health of COVID-19, social distancing and now the protests/riots on African-American and other BIPOC adults, both immediately and in the long term?

A: The COVID-19 pandemic has worsened longstanding ethnicity-based healthcare disparities that have resulted in disproportionate infection, morbidity and mortality rates for BIPOC adults, specifically Black Americans. Black Americans represent approximately 11.9% of the workforce, however they make up 17% of the front-line, essential workforce that is at higher risk for contracting and transmitting the virus[1]. At a time when the pandemic has resulted in an employment loss of 17.8% among Black workers compared to 15.5% among White workers, the risk to individual health safety is compounded by the risk of occupational hazards, job loss and financial insecurity[2]. As such, the compounded crisis of police brutality and increased social awareness of protest movements and civil unrest adds an additional layer of uncertainty, worry, fear, anger and sadness. Studies show that Black Americans are more likely to develop both physical and mental consequences to prolonged exposure to the chronic stress associated with discrimination and socioeconomic status, particularly high blood pressure, asthma, diabetes, depression and anxiety[3] [4]. In the week following the release of the George Floyd police brutality video, the rate of Black Americans experiencing depressive or anxiety symptoms increased from 36% to 41%, and among Asian Americans, the rate jumped from 28% to 34%[5].

Q: Are there unique signs of mental distress in African-American and other BIPOC adults that differ from those presented by Caucasians?

A: Though various forms of mental distress are characterized and diagnosed by commonly reported symptoms and behaviors, it is not unusual for individuals to have unique experiences that don’t look or sound the same, depending on who’s experiencing them. Additionally, cultural and spiritual norms specific to certain ethnic populations can influence the ways in which we communicate our pain, worry, sadness, anger and fear to healthcare providers, which often leads to misdiagnosis and/or ineffective treatment planning for ethnic minorities. Moreover, a 2019 study conducted by Rutgers University, indicates that Black Americans with severe depression are more likely to be misdiagnosed with Schizophrenia, which reveals significant provider bias in overemphasizing psychotic symptoms compared to mood symptoms[6] . In these instances, it appears that Black respondents’ endorsement of mistrust, hopelessness and paranoia due to extenuating sociocultural and political circumstances can result in unique clinical presentations that pose significant obstacles to understanding and healing, and that this effect is heavily influenced by the identity and implicit bias of both the patient and the provider. Ethnic minorities are also more likely to somaticize mental health symptoms, meaning they often report physical complaints like pain, fatigue or headaches, as well as sleeping difficulties as their chief complaints, rather than attributing the combination of symptoms to a mental health condition like depression or anxiety. This dichotomy often leads to further limitations in access to care, weakening of trust in the healthcare system, and escalating feelings of traumatization, oppression and isolation for marginalized demographics.

Q: How can African-American and other BIPOC adults help each other process their thoughts and emotions about the general unrest in our country?

A: It’s often said that there’s strength in numbers, and this is equally true as it relates to emotional support for marginalized communities in times of social unrest and collective trauma. Generational exposure to workplace and community discrimination is a shared experience for many ethnic minorities, and this commonality may make it easier for individuals who are feeling distress to share their thoughts with friends, family and providers who have a firsthand experience with the same issues in our society and across the world. This familiarity may also reduce mistrust within the healthcare system, if BIPOC patients feel they have an opportunity to share their feelings without judgment, misdiagnosis or repetitive traumatization and discrimination. Likewise, ethnic minorities are more likely to rely on spiritual or other cultural leaders for support and guidance in times of stress or civil unrest and are more likely to benefit from clinical behavioral health services when these alternative modalities are considered and integrated as fluidly as possible.

Q: Are there unique barriers to mental health treatment for African-American and other BIPOC adults?

A: Apart from generalized limitations in access to healthcare that have been noted for Americans across the spectrum, behavioral healthcare remains out of reach for millions of people, including those who actually have healthcare coverage. Shortages in available providers, clinics and hospitals means that there are longer wait times for appointments, and fewer resources available for maintenance of chronic mental conditions. Many mental health providers have moved to cash pay only practices, and this may serve as an obstacle for people who don’t have the disposable income available to pay out of pocket for psychotherapy or medication management. Inpatient bed shortages and the lack of long-term behavioral healthcare facilities are also shown to contribute to chronic homelessness, frequent ER visits and more interactions with the criminal justice system, which has become the largest provider of mental healthcare and boarding for chronically mentally ill patients over the last few decades[7]. Finally, stigma remains a very prominent barrier to seeking care for many ethnic minorities. In some cases individuals may fear judgment, mockery, maltreatment or discrimination due to their mental illness, while others may simply lack adequate information about the mental health field due to relatively less cultural reliance on these modalities within certain ethnic groups.

Q: What would you recommend to Caucasian individuals who want to reach out to their BIPOC friends and acquaintances and show their support, but don’t know what to say or are afraid it would not be received well?

A: In times of social division, strife and unrest, marginalized groups who are experiencing emotional distress and traumatization are likely to be concerned about safety, survival and stability. Allies and systems of support outside of ethnic peer groups can be helpful in building trust and solidarity across demographics, and this may aid in the development of healthier coping and conflict resolution strategies. It’s important that friends, family and coworkers be mindful that not every BIPOC person experiences distress or social events the same way and be open to simply listening to how the person feels first, before rushing to offer apologies or solutions that may not be indicated or helpful. MLK said that riots are the language of the unheard, and it is indeed the case that marginalized identities continue to live social and emotional experiences that so often go unnoticed, misunderstood and unaddressed by the ethnic majority. An expression of willingness to hear, care and help despite not knowing all the answers or solutions is sometimes all that’s necessary to convey empathy, sympathy and solidarity.

[1] https://www.epi.org/publication/black-workers-covid/

[2] https://www.epi.org/publication/black-workers-covid/

[3] https://www.ajmc.com/focus-of-the-week/high-levels-of-chronic-stress-high-blood-pressure-linked-in-african-americans#:~:text=African%20Americans%20who%20report%20high%20levels%20of%20chronic,serving%20as%20possible%20catalysts%2C%20according%20to%20study%20findings.

[4] https://www.washingtonpost.com/health/2020/06/12/mental-health-george-floyd-census/?arc404=true

[5] https://www.washingtonpost.com/health/2020/06/12/mental-health-george-floyd-census/?arc404=true

[6] https://ps.psychiatryonline.org/doi/10.1176/appi.ps.201800223

[7] https://www.theatlantic.com/politics/archive/2015/06/americas-largest-mental-hospital-is-a-jail/395012/#:~:text=As%20sheriff%2C%20Dart%20is%20also%20responsible%20for%20Cook,considered%20the%20largest%20mental-health%20facility%20in%20the%20nation

More people are being exposed to infection as the number of COVID-19 cases continue to grow, resulting in an increased need for quarantines. The fear, stress and stigma associated with being quarantined can be damaging to one’s mental health.

The differences between isolation, quarantine and social distancing

The U.S. Centers for Disease Control and Prevention (CDC) defines medical isolation, quarantine and social distancing as follows:

Isolation – The separation of a person or group of people confirmed or suspected to be infected with COVID-19, and potentially infectious, from those who are not infected. This can prevent spread of the virus. Isolation for public health purposes may be voluntary or compelled by federal, state, or local public health order.

Quarantine – The separation of individuals who have had close contact with a COVID-19 case, but are not showing symptoms, to determine whether they develop symptoms of the disease. This keeps the person from potentially spreading the virus in the community. Quarantine for COVID-19 should last for a period of 14 days in a room with a door. If symptoms develop during the 14-day period, the individual should be placed under isolation and evaluated for COVID-19.

Social Distancing – The act of remaining out of congregate settings, avoiding mass gatherings and maintaining distance (approximately 6 feet, or 2 meters) from others when possible. Social distancing strategies can be applied on an individual level (e.g., avoiding physical contact), a group level (e.g., canceling group activities where individuals will be in close contact), and an operational level (e.g., rearranging desks in an office to increase distance between workers).

 Emotional impact of quarantine

The simple act of being quarantined can be distressing. When people are quarantined, they:

• Can be completely separated from loved ones
• Lose their freedom of movement
• Don’t know if they will show symptoms or not
• Don’t know how the disease may affect them
• Have no understanding of how long they will be separated
• Experience boredom and have too much time to worry about the situation

People who have been quarantined have reported or shown a high prevalence of symptoms of psychological distress and disorder. Symptoms reported include emotional disturbance, confusion, depression, stress, irritability, insomnia and post-traumatic stress symptoms. In addition, the stigma surrounding those in quarantine can lead people to feel rejected and/or avoid seeking help.

How to reduce the negative effects on mental health

• Seek trusted information sources. COVID-19 information and news is everywhere, and it’s hard to know what’s true. Follow news from the World Health Organization, the CDC and your state health department. Stay away from suspect information that well-intentioned people may share on social media. If you have specific questions about your situation, call your doctor.
• Make sure you have adequate supplies. Make your experience as tolerable as possible. Make sure you have basic supplies such as food, water and medicine for the duration of the quarantine period. Many communities have stores or services that will deliver essential items to your door, so keep a list in case you need anything.
• Make the most of your downtime. As noted above, isolation, boredom and stigma negatively impact mental health. Call old friends you haven’t talked to. Catch up on your reading, do crossword puzzles or play electronic games. Listen to music. Organize those piles of paper you haven’t gotten to. If you can, work remotely.
• Keep a journal, blog or vlog about your experience. Writing down your feelings and experiences, or talking about them, can be cathartic for some people. And if you are comfortable sharing it, your journal can be helpful for other people in the same situation.
• Don’t be afraid to reach out. Talk to a neighbor or two and let them know of your situation so they can help. Find others who are going through the same thing or have been in your shoes before. Talking to someone who knows what you’re going through can help you feel less alone.
• Focus on how you are helping. Remind yourself that your isolation, while difficult to bear, is truly helping contain the spread of disease and potentially saving lives.

If you find yourself feeling overly sad, angry or anxious, contact a behavioral health professional. They can conduct appointments over the phone and provide helpful advice.

After the quarantine

You’ve stayed away from everyone for 14 days, and you’re still healthy. When you are released from quarantine, remember that social distancing may still be in force.

You might have some residual stress from being alone for so long, or you might be angry that you had to stay separated from loved ones when you weren’t contagious. It’s OK to have those feelings. If they don’t subside after a few months, talk to a behavioral health provider.

For more information and tips, visit www.MagellanHealthcare.com/COVID-19.

As we observe National Minority Mental Health Awareness Month, we sat down with Dr. Rakel Beall-Wilkins, Magellan Healthcare medical director.

 Magellan Health Insights: Dr. Beall-Wilkins, thank you for speaking with us today. Of course, everyone’s mental health is critical, but why is it important to pay particular attention to the mental health of Black, Indigenous and People of Color (BIPOC)?

Dr. Rakel Beall-Wilkins: We know that mental health conditions can be successfully treated. However, BIPOC are significantly less likely to receive treatment for mental health conditions, including substance use. And it’s reaching crisis levels, especially among our young people. For example, suicide is now the third leading cause of death among African American males who are 15-24 years old.

Magellan Health Insights: What are the barriers to BIPOC receiving high quality mental health treatment?

Dr. Rakel Beall-Wilkins: BIPOC are less likely to seek treatment, both for their physical and mental health. However, when they do reach out for assistance, they are less likely to receive consistent, high-quality treatment.

There are many contributing factors to these barriers. The high costs of care can be a deterrent. Most BIPOC in the U.S. (with the exception of Asians) have higher than average rates of poverty. BIPOC are more likely to lack insurance coverage, and may only seek emergency care, which costs more and is less effective than sustained treatment. Medications or diagnostic procedures may be viewed as too expensive. Or reliable transportation for follow-up care may not be available.

There are also what are called the social determinants of health (SDoH). These include factors such as consistent transportation, the availability of healthy food, safe and affordable housing, access to education, public safety and working conditions. BIPOC are more frequently negatively impacted by the SDoH. For example, these members are more likely to be homeless or move frequently, which interferes with maintaining consistent treatment. They may lack adequate nutrition and are at greater risk for having associated medical conditions like hypertension or diabetes.

Further, the stigma around mental health conditions, while improving, is still a deterrent to seeking treatment—for everyone. Some cultures may see it as taboo to request help or be seen as someone who needs help.

When BIPOC patients do seek treatment, there may be no one available who speaks their language. In some clinical settings I’ve been in, it could take a week to arrange for an interpreter or a therapist who was proficient in the patient’s language. They may not have a primary care physician (PCP) to help with screening for mental health conditions or provide follow-up care. In addition, the community clinics where BIPOC are more likely to receive care may be understaffed, overcrowded and have long wait times. Understaffing may lead to inadequate screening or even misdiagnosis. And, frankly, the clinic also may not be in a place where the member feels safe traveling so, they may hesitate to go in the first place or return for continued treatment.

Magellan Health Insights: How can everyone, including healthcare professionals, best support minority mental health?

Dr. Rakel Beall-Wilkins: Everyone can help eliminate stigma. Be open to talking and hearing about mental health conditions, and make it clear that you know that having a mental health condition is nothing to be ashamed of. When someone you care about is going through a difficult time, encourage them to get help, and learn ways you can support someone who coping with a mental health challenge.

As healthcare providers, we personally can help by:

• Ensuring we are taking into account each person’s wishes when referring them to other providers: We should ask every patient whether they prefer to see someone of a specific race, ethnicity, gender or sexual orientation.
• Educating ourselves to be more culturally competent and making cultural training a priority for our staff.
• Expanding our workforces with staff from various backgrounds, sexual orientations, cultures and with varied linguistic skills particularly for the unique cultures that are most prevalent in the community.
• Screening for psychiatric conditions during routine visits. Many patients will report physical symptoms instead of talking about the underlying mental health concerns. PCPs and others see many cases of mild or moderate depression during routine care, and screening every patient can help prevent costly emergency visits and admissions. Self-screening tools can also help.

Beyond what we can personally do to educate and equip ourselves and our staff, I believe that the best solutions come from an integrated, collaborative approach. Everyone can help eliminate the disparities. If we work with leaders in the community, for example in churches and schools, we can raise awareness of mental health conditions, destigmatize treatment seeking, help address the social determinants, and improve the lives of everyone in our communities.