"People of color, particularly African Americans, feel the stigma more keenly. In a race-conscious society, some don't want to be perceived as having yet another deficit."
- Bebe Moore Campbell
New York Times best-selling author, advocate, and journalist
July is Bebe Moore Campbell Minority Mental Health Awareness month, dedicated to increasing public awareness of mental illness and improving access to treatment and service, especially in diverse populations and minorities. Mental illness can affect anyone, regardless of gender, race/ethnicity, or sexual orientation. In the same way that we approach physical health, we should seek to provide mental health care, as these go hand-in-hand. In fact, individuals with a mental illness can be at an increased risk of various physical health problems such as heart disease and type 2 diabetes. On the other hand, individuals with chronic health conditions are more susceptible to mental illness. While there isn't one specific cause, genetic factors, history of trauma or abuse, drug use, and feelings of isolation can contribute to mental illness.
In recent years, mental health advocacy and awareness have been a trending topic, and every year we see improvement in the way we address these issues. However, as more and more research shows, there is still much work to be done.
According to the National Institute of Mental Health, about 46.6 million adults in the U.S. live with a mental illness as of 2017; that's nearly 20% of the total U.S. adult population. Less than 50% of those affected received mental health services, and even smaller was the proportion of minorities that received mental health services.
For example, only 30.6% of black adults with a mental illness received mental health services, compared to 48.0% of white adults. Adults that reported being two or more races have the highest prevalence of mental illness.
Lesbian, gay, and bisexual adults have a 37% prevalence of any mental illness.
What are the barriers to receiving care or treatment?
Why is there a disparity in the minority populations when it comes to mental health? Some common barriers include:
- Underinsurance (inadequate insurance coverage)
- Trouble finding reliable methods of transportation
- Communication or language barriers
- Providers that may lack cultural competence
- Discrimination and racism within healthcare settings
- The stigma that surrounds mental health
The role of a pharmacist in mental health
While pharmacy revolves around medication expertise, patient-centered care, and evidence based recommendations, this does not exclude the realm of mental health awareness. Pharmacists are often referred to as some of the most accessible members of the health care team, able to provide resources to patients in various locations in the community.
Pharmacists are crucial members of the healthcare team because they have the opportunity to make interventions through patient counseling, motivational interviewing, and providing reliable resources. This can improve adherence and even reduce patient bias regarding their new medication.
For example, several classes of antidepressant medications are associated with a delay in effects, up to 4-6 weeks. This is a perfect opportunity for counseling; discontinuation of therapy is common, since many individuals might feel that the medication is not working.
Additionally, antidepressants are associated with an increased risk of suicidal ideation in adolescents and young adults.
How A Compounded Medication May Help
Another way to provide patient-centered care and improve adherence is to compound medications specific to a patient's needs. When it comes to psychiatric medications, there is a 1 in 3 chance that the first one prescribed is not efficacious for a specific patient. It often takes trial and error, and there is no true lab value to assess how the medication is improving mental health; this is subjective and based on patient reporting. Additionally, patients can be on multiple other medications, and making sure that they do not adversely impact one another in combination is crucial.
Prescribers can come to compounding pharmacists for their expertise since they specialize in drug combinations as well as understanding drug interactions. If a patient has trouble swallowing or self-administering medications, compounding pharmacists can work with the prescriber to create a formulation that can directly impact the patient's health outcomes.
Continuing the conversation...
While the month of July is dedicated to highlighting disparities in mental health awareness and treatment, the conversation should not end here.
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“Learn About Mental Health - Mental Health - CDC.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 26 Jan. 2018, www.cdc.gov/mentalhealth/learn/index.htm
“Psychiatry Turns to Compounding Pharmacy for Expert Help in Drug-Drug Interactions.” National Custom Compounding, 15 July 2019, www.customcompounding.com.au/psychiatry-turns-to-compounding-pharmacy-for-expert-help-in-drug-drug-interactions/
“Learn About Minority Mental Health Month.” NAMI, www.nami.org/Get-Involved/Awareness-Events/Minority-Mental-Health-Awareness-Month/Learn-About-Minority-Mental-Health-Month
“Mental Illness.” National Institute of Mental Health, U.S. Department of Health and Human Services, www.nimh.nih.gov/health/statistics/mental-illness.shtml
“Bebe Moore Campbell's Biography.” The HistoryMakers, www.thehistorymakers.org/biography/bebe-moore-campbell-41
Medley, G., Lipari, R. N., Bose, J., Cribb, D. S., Kroutil, L. A., & McHenry, G. (2016, October). Sexual orientation and estimates of adult substance use and mental health: Results from the 2015 National Survey on Drug Use and Health. NSDUH Data Review. Retrieved from https://www.samhsa.gov/data/
Shushansky, Larry. “Disparities Within Minority Mental Health Care.” NAMI, 31 July 2017, www.nami.org/Blogs/NAMI-Blog/July-2017/Disparities-Within-Minority-Mental-Health-Care
“This Minority Mental Health Month, NAMI Is Raising Awareness About Mental Health in Underrepresented Communities.” NAMI, 1 July 2020, www.nami.org/Press-Media/Press-Releases/2020/This-Minority-Mental-Health-Month-NAMI-is-Raising-Awareness-About-Mental-Health-in-Underrepresent