According to the Child Mind Institute, “half of all mental illness occurs before the age of 14, and 75 percent by the age of 24.” The most common mental health disorders among within this demographic are “anxiety disorders, depression, and attention deficit hyperactivity disorder (ADHD).” They note that young people may “also struggle with bipolar disorder, schizophrenia, and borderline personality disorder.” For seven straight years, anxiety has been the top condition among college students seeking mental health services, noted The Chronicle of Higher Education. And nearly a quarter of those students said anxiety affects their academic performance. In 2016, nearly two-thirds of college students reported “overwhelming anxiety,” which is up from 50 percent just five years earlier, according to the National College Health Assessment. This trend is taking place concurrently with significant demographic shifts on college campuses. Therefore, admission professionals should aim to understand the intersection between minority populations and mental health, barriers to treatment, and forms of support within the profession. Moreover, how do college admission professionals, support these students in dismantling the stigma so that they can receive the care they deserve?
The authors, both women of color who presented on mental health in minority student populations at NACAC’s most recent Guiding the Way to Inclusion, have witnessed and experienced barriers to mental health—and how important the proper support is for minority students.
Khala Granville Ashaolu has had her own struggle with mental health and eventually got the support she needed. She said, “I was first diagnosed with depression and anxiety disorder in college. My admission counselor, a woman of color, noticed some changes in my behavior and my inability to follow through on work assignments. After a thoughtful conversation, she recommended and scheduled an appointment on my behalf to the health services center on campus. I was fortunate that my introduction to mental health care was through two women of color. I believe this provided me a safe space to explore my anxiety and depression.”
In her role as an adviser for the Latinx Student Union, Kariny Contreras-Nuñez noticed in students patterns of hesitancy to pursue mental health counseling. There were several instances where students experiencing symptoms of anxiety and depression continued to struggle academically, but were reluctant to see a counselor. In all cases the sentiment stemmed from a deeply rooted stigma perpetuated by cultural misconceptions, distrust in mental health care providers, as well as familial and religious pressures. Dismantling these preconceived notions occurred over several one-on-one conversations where Contreras-Nuñez shared the benefits she gained from counseling sessions in her undergraduate years.
Barriers to Mental Health Care
Race and ethnicity serve as a frame of reference that influences our understanding of the world. Race and ethnicity’s role, as it pertains to mental health, influences the manifestation of symptoms, forms of communication, perceptions of mental illness, stigmatization, family and community support, interactions with mental health care professionals, and resources for treatment.
Social and Cultural
Numerous factors, including language, misdiagnosis, stigma, and societal norms, significantly affect how minorities seek mental health treatment in the US. For example, in the 2007 article “Federal Civil Rights Policy and Mental Health Treatment Access for Persons with Limited English,” the authors argue that people with limited English proficiency have limited access to mental health care and difficulty benefiting from therapy. Language mistranslations can also lead to misdiagnoses by mental health care professionals.
“Strength over Silence,” a video series published in 2018 by National Alliance on Mental Illness (NAMI), features stories from the black and Latinx communities. A common thread among these featured stories is the hesitancy to seek help. This hesitancy is evident in the low percentage of minority populations that seeks help. For example, the University of Wisconsin–Madison Health Services found that while over 40 percent of white Americans seek mental health services, less than one-quarter of black Americans seek psychiatric health care.
The primary motivator of said hesitancy is that mental health is perceived to be a ‘white person’s problem.’ When a family is struggling to put food on the table - mental health is not considered a pressing issue; it is seen as an inconvenience. Furthermore, if one does seek help, the community may further stigmatize the individual, treating their mental health as a deficiency on their part.
Political and Economic
Lack of proper health insurance, systemic distrust, and legal status are critical factors in the relationship between minority populations and access to mental health. In Dwayne Proctor’s article, “Where Mental Health and Social Justice Meet,” he posited, “the biggest systemic-level barriers that many black people face are access and community.”
According to the 2016 US Census data, the Latinx community had the highest uninsured rate at 16 percent, with blacks at 10.5 percent, and Asian Americans at 7.6 percent. By comparison, non-Hispanic whites had the lowest uninsured rate of 6.3 percent. Lack of insurance or under-insurance, compounded with the high cost of health care in America, is a significant deterrent to care for minorities.
Furthermore, there are high levels of systemic distrust within the communities of color. This distrust is due to numerous ethical violations by health professionals and the US government throughout American history. One extraordinary example is the Tuskegee Syphilis Trials. This involved the study 600 black men, 301 of which unknowingly had syphilis, where the true purpose of the study remained concealed and those infected were never given adequate treatment for their disease.
Lastly, legal status—or lack thereof—is a deterrent to mental health care for immigrant populations due to fear, limited resources, stigmatization, and vulnerability to exploitation, according to “Mental Health of Undocumented Mexican Immigrants,” published in 2005. A chapter in Mental Health: Culture, Race and Ethnicity, published by the Office of the Surgeon General Center for Mental Health Services and the National Institute of Mental Health, focuses on the Latinx community. It cites two prominent studies the Epidemiologic Catchment Area Study and the National Comorbidity Study that found that US-born Latinx have a higher likelihood of developing mental health issues than their internationally born counterparts. Several other articles reached the same conclusion, including the “Prevalence of Mental Illness in Immigrant and Non-immigrant U.S. Latino Groups,” published in 2008. However, it should be noted, that the researchers did not intentionally account for the undocumented immigrant population in their samples. Additionally, the ECA and NCS studies only included English-speaking participants. Although the population is hard to capture, we suggest further research on this topic.
Religion and faith are seamlessly woven into the social fabric of minority communities. House of worship are often central meeting locations. The role of the church is an important one—as it is in locations of communal gatherings where groups establish social norms.
“When our churches teach us that we can pray it all away... they keep us from getting the care we need, and the intergenerational trauma continues,” added Proctor. While many black churches provide health screenings, discussion of mental health are generally reserved more financially resourced or college-educated congregations. Additionally, local spiritual healers, misguided healing, and deliverance services sometimes uphold troubling theologies about mental health treatment. Within the Latinx community, the church can take the place of the mental health care professional.
Jasmin Pierre, a mental health advocate in New Orleans, argued that church in the black community can reinforce stigmatization of mental health issues for those affected. However, in her experiences as a black woman of faith struggling with mental health she speaks of the monumental role her pastor has played in her recovery process. She encourages religious leaders to learn about mental health instead of dismissing the concerns through religiosity.
Supporting Students as Admission and Counseling Professionals
For incoming students, we most often learn about student mental health struggles through the college admission essay. As more of these experiences are shared, college admission teams need to create procedures for handling this type of sensitive information. Organizations may choose a variety of interventions, such as reaching out to students directly or working with school counselors to learn more about a student’s background. They may also refer students to campus support services or work with residence life.
As we work with students, it is relevant to note that they may be hesitant to seek help and communicate their struggles with mental health counselors. It is essential as professionals that we model conversations around mental health by paying attention to behaviors, providing structured check-ins, and creating space to destigmatize mental health conversations in the workplace.
High school counselors and collegiate professionals need to collaborate with their administration to support student mental health. Many schools have hired professional mental health therapists, created restorative justice programs, or worked with community organizations to bring therapy dogs and teach yoga on campus. Although many universities offer mental health services, the number of sessions if often limited and the wait time can exceed six months. If a student is in this predicament, encourage them to consider trusted off-campus counseling service that offers therapy on a sliding scale.
Also encourage minority students to gauge their therapists’ cultural competency. The Case for Cultural Competency in Psychotherapeutic Interventions offers insight into cultural competency practices adapted to the health care profession. As we advise students, we must be aware that many schools lack culturally competent and diverse mental health professionals. These barriers further complicate treatment for students of color. Encourage students to ask their therapists question regarding their cultural responsiveness and knowledge of ethnic/racial specific influences and stressors specific to race/ethnicity.
To summarize, barriers to mental health treatment stem from social/cultural, political, economic, and theological frames of reference unique to marginalized groups. As we guide diverse students through the admission process and beyond, we should consider and implement methods of support as they transition from applicant, to a matriculated student, and through graduation. Our experiences as women of color, who used our alma mater’s counseling services, helped us support students and destigmatize mental health treatment in our families and communities. We hope that this discussion will inspire others to do the same.
Khala Granville Ashaolu is senior associate director of admissions at Indiana University Bloomington and Kariny Contreras-Nuñez is senior assistant director of admissions at Purdue University (IN).
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