The twin pandemics of COVID-19 and continued racial injustice have shone a spotlight on health disparities and underscored the need for more research and outreach to better support diverse and underserved communities.
To be sure, many psychologists have been doing this work for years. But more psychologists are coming to understand how issues of diversity and health disparities are relevant to their work, and more journals are implementing procedures to make sure research addresses socioeconomic factors, says Cindy Juntunen, PhD, chair of APA’s Task Force on Developing Guidelines for Psychological Practice With Low-Income and Economically Marginalized Clients. A growing public dialogue about racial justice—and the recognition that COVID-19 disproportionately impacts underserved communities—is forcing psychologists to rethink how they reach out and interact with clients.
“For anyone who cares about these issues, progress has often felt like an uphill battle. But I see people beginning to look at these issues in new ways,” Juntunen says. “COVID-19 has in some ways increased the likelihood of reaching underserved communities because practitioners are realizing they need different ways to reach their clients.”
Some rural communities are already beginning to benefit from that realization. Rural areas have higher-than-average rates of poverty and substance use, yet the nearest mental health professional may be hundreds of miles away. Increasingly, providers are reaching these clients through telehealth—an option that accelerated suddenly in the wake of the COVID-19 pandemic. In one recent example, two managed-care organizations in rural North Carolina partnered to donate smartphones to 1,000 low-income patients to access mental health services.
Yet telehealth can’t solve all the challenges facing underserved communities. Marginalized communities often face hardships such as poverty and a history of racial trauma, which can increase the risk of mental health problems and substance use. Seeking therapy often means traveling outside one’s own community and accepting services from providers—usually White—who don’t tend to share one’s lived experiences. Those providers may not understand the nuances of what people in underserved communities need and how best to provide that care, says clinical psychologist Howard Stevenson, PhD, an expert on racial trauma at the University of Pennsylvania. “Psychology training doesn’t necessarily prepare people to be clued in to these cultural sensitivities,” he says.
Despite such challenges, a variety of psychology-based efforts are aiming to break down the barriers. The Loveland Therapy Fund, for instance, was launched in 2018 with enthusiastic crowdfunding support and provides financial assistance to Black women and girls seeking therapy nationwide. While individual treatment is valuable, reaching underserved communities often means rethinking the traditional model of one-on-one treatment, says Stevenson, who has created community-based interventions. With colleagues Loretta Jemmott, PhD, and John Jemmott, PhD, he created a program to train Black barbers in high-risk neighborhoods in violence reduction and HIV-risk reduction. The barbers educate clients organically when they come in for haircuts. Many other successful initiatives also focus on reaching people where they are. The Sources of Strength youth suicide prevention program, for example, teaches high school students to be peer leaders in changing the norms around seeking help for mental health.
But funding for such community efforts is often hard to come by, says Sherry Molock, PhD, a psychologist at The George Washington University who studies mental health and suicide prevention in Black youth and young adults. Molock argues that to advance real change, mental health professionals need bigger-picture thinking. “Even if we have a clinic on every corner, people won’t come if they don’t have stable housing or food security,” she says. “If we really want to improve mental health, we have to change the systems.” In addition to social and economic investments, that includes putting forth a stronger effort to train a more diverse psychology workforce, spending more time on these topics in the classroom, and conducting more research to adapt therapeutic models to be culturally relevant.
While the events of 2020 have focused attention on these disparities in need and access to mental health care, people in underserved groups have been painfully aware of these gaps their entire lives. Efforts to reach those groups, especially communities of color, have often seen ebbs and flows in both interest and funding. In that sense, Molock says, she hopes this most recent public awakening is more than just a trend. “This isn’t a fad,” she says. “This has to be something we’re committed to doing.”
