Equity in Action: Prioritizing Minority Mental Health

Dr. Christina Abby, DSW, LMSW, Clinical Programs Manager

Whether it’s stigma, underfunded programs, or the lack of diversity in the mental health field, minorities bear the brunt of health inequity, but there IS hope.

Although depression, anxiety, and other disorders are often left undiagnosed or misdiagnosed in minority communities, the fight for equitable mental health is gaining momentum:

• The National Institute of Mental Health established a Disparities Team to research mental health disparities and reduce its impact.
• The American Psychological Association is prioritizing efforts in training, developing, and diversifying the mental health workforce.
• My company, evolvedMD, is integrating behavioral health in primary care practices to expand access to high-quality care nationwide.

As minorities become the majority by 2045, it’s important we amplify our efforts to create a more fair and equitable landscape. Weaving cultural competency and routine screenings into primary care settings are key to making this a reality. Why? Fear, stigma, socioeconomic factors, and other aspects make it necessary.

Breaking Barriers Starts with Routine Screening

Mental illness is not always visible on the surface. Some minority patients will say nothing and suffer in silence due to stigma. Some will seek help, but research shows they prefer general health providers instead of mental health professionals. This makes regular screenings onsite at primary care practices the best way to identify risk and catch mental health problems early.

We’ve seen this at evolvedMD as routine screening is a staple of our enhanced Psychiatric Collaborative Care Model. Following screening, patients can see a behavioral health specialist onsite at their primary care practice – possibly in the same day rather than the typical weeks or months waitlist. This is critical to our patients’ success because we can detect and address symptoms before they become severe.

Our minority patients benefit from this approach every day, but routine screening is only part of the solution to health equity. Tools such as the PHQ-9 and GAD-7 don’t take lived experiences and cultural backgrounds into account. What can we do?

Weaving Culture and Social Context into Patient Care

The new DSM-V-TR (revised in 2022) added a comprehensive review of the impact of racism and discrimination on identifying, diagnosing, and treating mental disorders. Essentially, if we understand our patients’ lived experiences and diverse backgrounds, we’ll have a better understanding of their overall health and how to manage it.

Screening tools may not assess cultural features of an individual’s mental illness, but the Cultural Formulation Interview (CFI) can. For example, therapists can use CFI to:

• Understand cultural perceptions of cause
  • “Why do you think this is happening to you? What do others in your family, friend groups, or your community think is causing your problem?”
• Assess the role of cultural identity
  • “What are the most important aspects of your background or identity? Are there any aspects of your background or identity that make a difference to your problem?”
• Identify and understand barriers
  • “Has anything prevented you from getting the help you need?”

There is also an informant version of CFI where family members or friends can share information with the therapist about the patient’s clinical problems, life circumstances, and cultural influences.

Although it’s impossible to be 100% culturally competent 100% of the time because terminology, experiences, laws, and attitudes constantly change, CFIs better prepare therapists to understand their patients and meet their specific needs.

Double the Solution, Double the Impact

Merging routine screening and Cultural Formulation Interviews in primary care settings will enhance patient results.

At evolvedMD, we already have the main pieces in place at the practices we serve. Here’s what the process looks like, step-by-step:

1. A minority patient visits their preferred primary care practice for a routine checkup.
2. The GAD-7 and PHQ-9 are administered to screen for anxiety and depression.
3. The PCP determines behavioral health services are necessary to treat the symptoms.
4. The patient meets with an onsite clinician to begin treatment immediately.
5. The clinician conducts a biopsychosocial assessment to understand how all factors- finances, culture, and lived experiences- impact the patient’s symptoms.
6. The clinician, PCP, and psychiatric consultant collaborate to deliver comprehensive care tailored to the patient’s needs and experiences.

This One-Two Punch Enhances Trust, Satisfaction, and Clinical Outcomes

What happens when we do this? The patient feels heard and understood. It also builds trust at a time when minorities report higher levels of distrust in healthcare providers. This promotes a higher likelihood of patients following through and participating in their care planning.

Altogether, routine screening and cultural competency as part of evolvedMD’s unique approach results in increased satisfaction, enhanced clinical outcomes, and decreased return visits. More specifically, our data shows this approach achieves remission of depression over 10x faster than traditional care. It’s what everyone, minorities included, deserves to live happier and healthier lives.

Routine mental health screening coupled with cultural competency is critical to improving outcomes and achieving mental health equity for minority communities. By recognizing and addressing the unique cultural factors impacting mental health in these communities, healthcare providers including PCPs and behavioral health professionals can establish a more empathetic and effective approach to care.

Partner with evolvedMD today for a more empathetic,
effective approach to mental health care.

About Dr. Abby: Dr. Christina Abby knew from a young age that she had superpowers: being an empathetic listener, a great communicator, and someone who could ignite meaningful change by helping people. 
 
Wanting to better understand the why behind human development and behavior, she attended Alcorn State University where she earned her Bachelor’s degree in psychology. After working in community mental health for over five years, she aspired to reach even greater heights and continue her educational journey. Combining her knowledge of human behavior, work experience, and drive to empower others, she obtained a Masters in Social Work from Jackson State University and finally her Doctorate in Social Work with an emphasis in management and innovation from the University of Southern California. 
 
With over 13 years of social service experience, Dr. Abby has worked with patients of all ages from preschool-aged children to the geriatric population. Uniquely amongst her cohort, she also worked with unaccompanied refugee minors from Africa, Central America, and Asia. Before entering the world of behavioral health integration, she leveraged her social work expertise in the medical field in both hospital and dialysis settings. 

Now as Clinical Programs Manager at evolvedMD, the leader in behavioral health integration in modern primary care, Dr. Abby develops clinical and educational curricula, facilitates program implementations, leads research initiatives, and manages grants. Among her proudest accomplishments during her tenure is launching evolvedMD’s first company-wide diversity, equity, and inclusion initiative.
 
Outside of her day-to-day, Dr. Abby has presented research at the Southwestern Psychological Association Annual Conference on the perceptions of acceptable body types as well as at a National Council for Accreditation of Teacher Education site regarding students’ levels of test anxiety on mathematical subjects. In 2019, she took her advocacy efforts to Capitol Hill to discuss the importance of financial literacy for children in low-income communities with legislators. Ultimately, she is most proud of being able to wield her educational background and professional experiences to provide services to patients and families in a diverse range of settings.