Introduction
Ethnic minorities in different nations have gone through challenging moments, which have reinforced their low-socioeconomic status in the society. This situation can be well demonstrated in the film industry. For example, consistent with the dominant stereotyped image of African-Americans in films, the 1930-1960s films depicted African-Americans as hyper-sexualised, coloured, incompetent, criminals, and child-like characters whose best role in the society was that of a servant, butler, or even a mammy.
In the UK, the problem is even exaggerated for disabled persons who belong to racial minorities. To demonstrate this issue, in the first section, the paper discusses inequalities in healthcare accessibility for Blacks with mental illness. The second section considers policy frameworks that seek to end the inequalities.
Inequalities in terms of Mental Health Accessibility among Blacks
In the UK, mental health constitutes one of the leading risk factors to disability. According to the Mental Health Foundation (2013), mental wellbeing accounts for about 23% of the total disease burden that costs the government about £105 billion annually. Brugha et al. (2004) conducted a study on the prevalence of metal health disability among Blacks. The study found that Africans had a higher risk of experiencing psychotic disorders when compared to non-Africans.
More specifically, the study found over representation of Caribbean and African men in acute service for mental health. These groups of people also had disproportionate diagnosis of serious mental disability challenges coupled with psychotic disorders. In particular, the study argued that African men had more challenges in accessing quality mental health care compared to Whites.
Health challenges associated with homelessness include ill health, fragmentation of families, intellectual disability, domestic violence, and alcohol and drug dependency associated problems. Hence, racial prejudices in economic status lead to the cyclic challenges that contribute to poor mental health among those who face such prejudices. Royal College of Psychiatrists (2010) supports this assertion by adding that mental disability in the UK correlates directly with access to economic chances in life. More disadvantaged or deprived persons are likely to suffer from mental health disability. This situation is likely to affect Blacks compared to any other race. Royal College of Psychiatrists (2010) asserts that young back people in the UK suffer more from unemployment, yet it is a contributing risk factor to depression.
Racism constitutes an important historical perspective that influences the lives of Blacks who live with mental disabilities or mental sickness in the UK and the US. However, in the case of US, Barry (2006, p.189) asserts, ‘Negative stereotypes and rejecting attitudes have decreased, but continue to occur with measurable, adverse consequences for the mental health of African-Americans’. These challenges lead to negative perceptions of authorities that have low interest in the affairs of African-Americans in their mindset. This problem is particularly serious in low socioeconomic societies where the authorities have limited resources to channel to social services that are aimed at ensuring delivery of quality care to persons with mental disabilities (Burns 2013).
Although Blacks live under conditions that constitute risk factors to mental health disabilities, various scholars confirm the existence of biasness in handling the problem of mental health in different nations, including the UK and the US. For example, various researches indicate racial biasness in the US mental health system. Cohen (2001) made a comparison of various young people who had been placed under psychiatric care and those who had been placed under the care of correctional facilities.
His results indicated similar patterns in scores for youthful behaviours, irrespective of their racial backgrounds. Nevertheless, correction facilities had 63% of their population as blacks. The psychiatric facilities had 34% of their population comprising Blacks. This finding shows clear inequalities in accessing psychical care for mentally ill Blacks. Indeed, Cohen (2001) amplifies this assertion by noting that youths in correction facilities had severe behavioural disorders. The fact that such facilities were dominated by Blacks mentally ill youths implies that these racial minorities were more prone to mental disability, yet they were not considered for admission in psychiatric centres compared to Whites.
In the case of the US, different states show evidence for discrimination of people with mental disability in care systems. For example, Kaplan and Busner (2002) studied the challenge of mental disability among racial minorities in the state of New York. The study indicated, ‘910 (62%) of the 1,474 adolescents in sample admitted to mental health establishments were Whites and only 341 (23%) were Blacks’ (Kaplan & Busner 2002, p.768).
Adolescents who had been incarcerated in New York’s correctional centres were 56% African-Americans and 28% of the White in racial origin. The case of Maryland evidences the highest degree of discriminatory practices in addressing the challenge of mental disability among people from different racial backgrounds. For example, in Maryland, African-American children with mental disabilities are taken to juvenile jails compared to white children with similar mental problems that are mainly sent to residential centres for treatment.
During the close of the 1990s, around 130 adolescents of the white racial origin were sent to various correctional facilities in Maryland for rehabilitation compared to around 230 youths of the white racial origin who were incarcerated. Only 130 African-American youths were placed on rehabilitation while around 670 never received any physiotherapy.
In the UK, deferential treatment for persons from the Black ancestry encountering mental illness has been well documented. Such experiences are accounted for by the fact, ‘people of the African roots in the UK are more likely to be considered in need of mental health treatment and care than their White counterparts’ Mind for Better Health 2013, p.3). Sewell (2012) adds that discrimination that targets racial minorities such as Blacks in the UK has links with mental disability.
The UK Justice systems and professionals acerbate the challenge of inequality when they fail in diagnosing or providing healthcare help to people from Black racial origin. In this context, Nacro (2007, p. 11) asserts, ‘pathways that African communities take to access mental care are very often more of a coercive pathway than other communities, for example via the criminal justice system, the immigration and asylum process and the civil sectioning process’.
Inequality also manifests itself in case people from different racial backgrounds seek professional help while those from the Blacks ancestry are considered less affected compared to Whites. Consequently, the UK government has a noble responsibility of considering developing the appropriate policy frameworks to address the challenges of the prevailing mental disabilities among some minority groups. The next section considers such efforts.
Policies and Approaches taken to Address the Inequality
One of the greatest initiatives by different nations is to eliminate inequalities that have been witnessed when accessing quality mental healthcare by advocating reasonably priced care and services for all people, despite their racial backgrounds (Hafetz 2009). For example, the US Affordable Care Act purposes to guarantee equal accessibility of quality health care among all US citizens, irrespective of their racial backgrounds or their nature of disabilities.
Obamacare Facts (2012, Para.5) posits, ‘Obamacare ensures that sick people cannot be dropped from insurance, they cannot be denied health care for any pre-existing conditions, and that women cannot be charged more than men by insurance companies’. This effort guarantees no discrimination among all citizens of the United States with respect to their accessibility to quality healthcare. Therefore, through the policy initiative, African-Americans who have faced discrimination when accessing quality mental healthcare in the past because of to their low socioeconomic status stand to gain immensely.
Obamacare Facts (2012) informs that the main aim of the Affordable Care Act entails improving healthcare accessibility to communities, especially those, which have no capability to access private care. In line with this aim, it sounds imperative to claim that the Act permits American people to pay for healthcare coverage that they can afford. This provision is important since past discrimination and inequalities in accessing medical healthcare among African-Americans with mental disabilities were linked to their socioeconomic status. Therefore, they have minimal ability to afford private care or pay for costs incurred in psychiatric care centres.
The Affordable Care Act recommends all individuals who are not covered by Medicaid, healthcare plans that are sponsored by employers, Medicare, or even an insurance plan offered to the public to buy and/or precisely comply with the health insurance policies of private insurance. Failure to adhere to this requirement attracts penalties, unless such persons are members of religious sects that are not only recognised by the state, but also exempted by the internal revenue service and/or are waived in situations of financial hardship.
This requirement upholds shared responsibility. The racial orientation of African-Americans does not constitute a sect. Therefore, people, including those with mental disabilities, are eligible for the insurance scheme. The policy overhaul reform in the US healthcare systems is critical when it comes to ensuring parity in the accessibility of quality care among all people who live with disabilities, including mental illness.
In the UK, the government introduced a policy framework called ‘no health without mental health’ in 2011. This policy directive established guidelines for improving the mental health of the general population by guaranteeing access to quality mental care by all UK people (Department of Health 2011). It provides holistic approach to addressing the problem of inequalities in mental health care in different population segments by asserting that quality mental health care by all people is every UK citizen’s business.
The policy frameworks suggest that prevention is the best-preferred approach to addressing the prevalence of mental health illnesses among different population segments, including the Blacks. Therefore, it is necessary to address the underlying risk factors. Through the policy, the UK government targeted to achieve true parity in terms of access to evidence-based medical treatment for mental illnesses for all people by mid-2015.
Apart from health policy frameworks that advocate equality for people with mental disabilities, including Blacks, nations such as the US and the UK adopt human rights-based approaches to addressing the problem. Burns (2013) reveals that mental healthcare and mental disabilities have been neglected for long in discourses of health, equality, and human rights. This situation attracts immense attention by the UK government, considering that mental disabilities influence an excess of 8% of the total global population (Burns 2013). Indeed, the UK government recognises how people with mental disabilities encounter interlinked incidences of inequality coupled with discrimination in the society.
For example, structural factors, including poverty and homelessness are important risk factors that fuel mental disability. Therefore, in addressing the challenge, the UK government considers the best approaches as those that address various structural factors that may expose populations to a higher risk of mental disability. The approaches are based on the concepts of universality of human rights.
In the US, the Pete Domenici Act on mental health equity demonstrates government’s commitment to eliminating any disparity in accessing mental health care. The Act became a law in 2008. Barry (2006, p.187) asserts that the legislation ‘introduced parity for mental health coverage for the first time in a large group health insurance plans’. In a theoretical manner, the Act eroded any limitation imposed by health issuers on patients who had substance abuse conditions or mental disability.
Hence, patients cannot pay more in cash for the treatment of mental disability compared to persons who suffer from other medical conditions. This plan has assured those who campaign for health parity among all citizens, including people who live with mental disability such as the African-American minority groups that the historic discriminations discussed before in case of Maryland will not recur in the future. However, challenges remain when it comes to the flexibility that the Act offers to medical insurers.
Pete Domenici Act on mental health equity permits healthcare insurers to select the type and nature of mental health condition they want to cover. Burns (2013, p.11) states that the Act permits issuers to ‘define for what conditions coverage is ‘medically necessary’ and to gain exemption from the law if providing mental health and substance use coverage increases their costs by 2% or more in the first year or by 1% or more in subsequent years’. Some mental disabilities such as schizophrenia demand the provision of various services among them psychosocial support and rehabilitation through occupational services. Nevertheless, the Act does not provide room for these necessary services.
Through human rights-based approaches, the UK recognises the need to resolve inequalities in accessing quality mental illness care. Alongside government efforts, campaigns have been initiated by ‘Time to Change, and a national anti-stigma campaign, coordinated by MIND and Rethink Mental Illness, and funded by the Department of Health and Big Lottery Fund’ (Mind for Better Health 2013, p.5).
These campaigns focus on reducing discrimination when treating Blacks and other racial minorities who suffer from mental illness within UK’s health care facilities. They also focus on ending stigma associated with discriminatory practices or historical perceptions about the capabilities of Blacks who experience a high unemployment rate and other socioeconomic disadvantages that constitute risk factors to suffering from mental illnesses.
Conclusion
Minorities suffer from different challenges in the process of interacting with the entire population in any given society. This situation has been the case for Blacks in the United States and the United Kingdom since time immemorial. They have experienced discrimination when accessing social goods, including education and healthcare. However, minorities who live with disabilities have experienced even more challenges.
Blacks have suffered from low placement in support centres. They have also experienced challenges in securing health insurance for mental disabilities, especially those that involve substance abuse conditions. Recognising the challenges of inequality when accessing health care, the US government responded through various policies among them the Affordable Care Act of 2010 and the Pete Domenici Act on mental health equity in 2008. The UK also responded by enacting policy frameworks that ensured parity in evidence-based mental care accessibility for all people.
References
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