Minorities report lower levels of stress than white adults.

People of color and all those whose lives have been marginalized by those in power experience life differently from those whose lives have not been devalued. They experience overt racism and bigotry far too often, which leads to a mental health burden that is deeper than what others may face.   

Racism is a mental health issue because racism causes trauma. And trauma paints a direct line to mental illnesses, which need to be taken seriously.

Past trauma is prominently mentioned as the reason that people experience serious mental health conditions today. But obvious forms of racism and bigotry are just the tip of the iceberg when it comes to racial trauma.

Every day, people of color experience far more subtle traumas:

• People who avoid them and their neighborhoods out of ignorance and fear;
• Banks and credit companies who won’t lend them money or do so only at higher interest rates;
• Mass incarceration of their peers;
• School curricula that ignore or minimize their contributions to our shared history; and
• Racial profiling.

Types of Racism

Researchers have identified several different types of racism. 

Racism: A broad term describing the combination of race-based prejudice and power. Without the power differential (one person/group/institution has more power than another), “racism” is just prejudice and carries less weight and fewer consequences.

Systemic/Structural Racism: Systemic/Structural racism has three components: history, culture, and institutions/policy. Historical racism provides the framework for current racism. Any structure built on a foundation (history) of racism will be a racist structure. Culture, which is ever-present in our day to day lives is what allows racism to be accepted, normalized, and perpetuated. Institutions and policies make up the fundamental relationships and rules across society, which reinforces racism and give it societal legitimacy (which makes it so hard to dismantle). 

Interpersonal Racism: Racism that happens between individual people. When individual beliefs or prejudices become actions toward others.

Institutional Racism: Institutional racism occurs within and between institutions. Institutional racism is discriminatory treatment, unfair policies, and inequitable opportunities and impacts, based on race, produced and perpetuated by institutions (schools, mass media, etc.). Individuals within institutions take on the power of the institution when they act in ways that advantage and disadvantage people, based on race.

Internalized Racism: When racism and white supremacy affect the minds of Black, Indigenous and People of Color (BIPOC) to the point where they begin to believe that they are inferior because of their own race. This can sometimes lead to “inter-racial hostility” in which BIPOC treat other BIPOC in a way that mirrors how white racists might treat them. Another way internalized racism can manifest is by BIPOC accepting and internalizing Eurocentric ideals and values.

“Reverse Racism”: This term is in quotes to emphasize that it’s a made-up term that shouldn’t carry any actual value. It was a term created by and for white people who want to perpetuate racism by denying their privilege in all its forms and by claiming that fighting to improve the lives of BIPOC is somehow “racist” against white people. MHA considers this term invalid because racism in any form depends on the presence of a power differential. White people have historically always fallen on the powerful side rather than the powerless side. Reverse racism is therefore impossible, as long as we live in a society that perpetuates white supremacy.

Oppression: The use of power (by a system/institution/group/individual) to dominate over another OR the refusal of a system/institution/group/individual who possesses this power to challenge that domination.

Racial Trauma: Simply, traumatization that results from experiencing racism in any of its many forms. Importantly, this doesn’t have to be one major isolated event, but rather it can result from an accumulation of experiences like daily subtle acts of discrimination or microaggressions.

Racism in Mental Health Services

Misdiagnosis of schizophrenia: When treating Black/African American clients, clinicians tend to overemphasize the relevance of psychotic symptoms and overlook symptoms of major depression compared to when they are treating clients with other racial or ethnic backgrounds. For this reason, Black men in particular are greatly over-diagnosed with schizophrenia—they are four times more likely to be diagnosed with schizophrenia than their white male counterparts. Furthermore, Black people in general are significantly more likely to be diagnosed with schizophrenia alone when a mood disorder is also present than white people. Schizophrenia is a disorder that (by definition) must be diagnosed by exclusion, meaning that the symptoms of it can’t be explained by another psychiatric disorder (like a mood disorder). Therefore, the fact that Black people end up with schizophrenia diagnoses without a mood disorder diagnosis despite the clinical presence of a mood disorder means that these symptoms are being ignored, and explains in large part why the diagnosis rate of schizophrenia is so much higher in Black populations than white.

BIPOC Youth: BIPOC youth with behavioral and mental health conditions are more likely to be directed to the juvenile justice system than to specialty care institutions compared to non-Latinx white youth. This is likely because BIPOC youth are much more likely to end up in the juvenile justice system as a result of higher rates of harsh disciplinary suspension and expulsion practices against BIPOC youth in schools compared to white youth.

Racism and Individual Mental Health

Depression is the most commonly reported condition across BIPOC. Additionally, racial trauma can increase the risk of BIPOC meeting the criteria for PTSD. Importantly, stress plays a crucial role in how racism affects both physical and mental health. Stress hormones are released during stressful situations and research has shown that both the experience of and the observation of racial discrimination is stressful for children and adults who identify as BIPOC. The frequent presence of these stress hormones can lead to physical conditions like high blood pressure and heart disease, as well as mental health conditions like depression,  anxiety, and overall poor health outcomes. Discrimination is typically something that occurs frequently and as a result, creates a sustained level of stress and stress hormones in those who are the most likely to experience this discrimination (BIPOC).

Quick Stats

Survey Highlights

Access

Lack of insurance and lower incomes for minority adults create significant financial barriers to care.

• Overall, 31 percent of minority Americans, ages 18-64, and 14 percent of white Americans lack health insurance, with 41 percent of Korean American, 38 percent of Hispanic American, 26 percent of African American, and 23 percent of Asian American adults uninsured.
• Although minority adults and white adults, ages 18-64, have comparable rates of employment (72% v. 76%), minority adults are less likely than white adults to receive health insurance through their own employers (56% v. 66%).
• Having to pay too much for medical care is reported as a major problem by more minority group members than white adults (40% v. 26%). Chinese American adults (55%) are even more likely to report health care costs as a major problem.

Choice

Minority adults have less access to regular sources of care, and less choice in where they receive care.

• Minority adults are less likely to have a regular provider (66%), compared with 80 percent of white adults. Hispanic and Asian groups report the lowest rates of having a regular doctor or provider (58% and 60% respectively).
• Twenty-nine percent of minority adults, compared with 16 percent of white adults report having little or no choice in where they get their health care.
• For those with a choice of doctor, minority adults were more likely to say that the doctor's nationality, race, or ethnicity influenced their choice (12%) than white adults were (5%).
• Overall, 25 percent of black adults see black providers; 21 percent of Hispanic American adults see Hispanic providers, and one half of Asian American adults see Asian providers.
• Inadequate or no insurance (46%) and financial reasons (22%) were most often cited by minority adults as reasons for limited choice.Minority groups have more difficulties obtaining appropriate and needed medical care.
• In the past year, 15 percent of minority adults did not receive needed medical care, compared with 13 percent of white adults. Puerto Rican adults comprised the largest group (24%). The cost of care and lack of insurance coverage are the two major reasons cited.
• Paying too much for medical care is a major problem for 40 percent of minority adults, compared with 26 percent of white adults. Chinese American (53%) and Puerto Rican American (48%) adults are particularly affected.
• Waiting too long to seek care is a major problem for 27 percent of minority adults, compared with 16 percent of white adults. This is a special problem for those of Chinese descent (46%).
• Getting speciality care is a major problem for 18 percent of minority adults, compared with 8 percent of white adults. The problem is more acute for adults of Chinese (40%) and Puerto Rican (24%) descent.
• Only three-quarters of minority adults speak English as their primary language. Language differences present a problem for 21 percent of minority Americans in receiving health care. Of those who do not speak English as a first language, 26 percent of Hispanic adults and 22 percent of Asian American adults need an interpreter when seeking health care services.
• Getting a medical appointment was a major difficulty for 16 percent of minority adults, compared with 8 percent of white respondents Adults of Chinese (34%), Cuban (30%) and Puerto Rican (25%) origins were especially likely to have such problems.
• One in twenty adults in minority groups (5%) was refused edical care, compared with 2 percent of white adults in the past year.

Quality of Care

Although minority and white adults have similar rates of utilizing care, some minority groups were more likely to receive care in a hospital emergency room, and less likely to receive important preventive services.

• On average, white and black adults visit a doctor or medical facility five times per year, whereas Hispanic adults average four visits per year, and Asian adults average three visits per year. Among those who had been to a doctor in the past year, Puerto Rican adults (37%) were more likely than white or other minority adults to have been to the emergency room.
• Despite similar utilization rates and poorer overall health status, minority adults who visited a doctor in the last 12 month were less likely to have been hospitalized (13%), compared with white adults (17%)
• Of Americans who have visited a doctor in the past year, minority adults (29%) were less likely to receive preventive care services, such as blood pressure tests, Pap smears or cholesterol readings, compared with white adults (26%), particularly Vietnamese (47%), Mexican (39%), and Puerto Rican (38%) adults.Minority groups report more negative experiences with the health care system.
• Fifteen percent of minority adults believe they would have received better care in the previous year if they were of a different race. African American (20%) and Puerto Rican (19%) adults were most likely to feel this way.
• Almost one in ten Americans felt they were made to feel uncomfortable or treated badly when receiving health care in the prior year. For Cuban and Puerto Rican American adults, the rates were higher (19% and 14% respectively). mong minority adults who reported being treated badly, 31 percent felt such treatment was due to their race, and 48 percent felt it was due to their income levels. White Americans were most likely to attribute this to "some other reason" (30%), or to their income level (26%).
• Adults in minority groups are also slightly less likely to feel very welcome at their doctors' offices than white adults (69% v. 75%). This was particularly true of Puerto Rican American (41%) and Chinese American (37%) adults. Crowded offices, long waits, and unfriendly staff are some of the factors that contribute to this feeling.

Satisfaction

Minority groups are less satisfied with their health care services and insurance plans.

• Less than half (46%) of minority groups report being very satisfied with their overall health services, compared with 60 percent of white adults. Chinese (24%) and Korean (17%) adults are least likely to call their services very satisfactory.
• Overall, minority adults assign fewer "excellent" ratings to their doctors than white adults on providing good health care overall (53% v. 58%), treating them with dignity and respect (64% v. 71%), ensuring that they understand what they have been told (58% v. 66%), listening to their health concerns and taking them seriously (56% v. 63%), and being accessible (43% v. 51%).
• Overall, among insured adults, minority adults are about equally satisfied with their health plan or health insurance as are white adults (85% v. 83%). However, almost one in five Chinese (19%) Korean (19%), and Puerto Rican (18%) adults are very or somewhat dissatisfied with their health plans.Doctors are less trusted by minority adults, who also are more likely to use alternative medicine.
• Minority adults are less likely than white adults to follow their doctors' orders all or most of the time (84% v. 91%).
• Only 56 percent of white adults trust doctors very much to help with medical problems, compared with 52 percent of minority adults.
• Alternative types of medicine were used twice as often by minority than white Americans (25% v. 14%). About one third of adults of Chinese or Korean descent used herbal medicine in the preceding year, compared with 12 percent of white adults. And one in five Koreans (22%) used acupuncture compared to one percent of all adults. However, white Americans were twice as likely to have gone to a chiropractor in the past year than minority adults (13% v. 7%).

Quality of Life Problems

Minority populations experience more stress than white adults do.

• Minority adults report higher levels of stress than whites do. Based on indexes constructed by a variety of stress variables, 36 percent of minority adults and 26 percent of whites report "high" levels of stress¹.Chinese American and Puerto Rican adults (40%) most often report high stress.
• Problems that were felt more strongly by minority adults than by white adults concerned problems with money (25% v. 17%); problems with spouse or partner (11% v. 6%); and their family being treated badly because of their race or cultural background (5% v. less than one-half of 1%).Violence has a bigger impact on life in minority communities.
• Fear of crime or violence strongly affects minority adults (18%) more often than white adults (8%).
• Knowing someone who was a victim of violence is more common for most minority adults (18% of African Americans;, 17% of Puerto Rican Americans, and 16% of Chinese Americans v. 6% each of whites and Koreans).
• Physical assaults in the past five years were reported by 12 percent of minority adults and 9 percent of white adults.
• Of those who are currently married or living as a couple with someone, domestic abuse was reported in the last 12 months as partner "threw something" (white adults 4% v. minority adults 6%); and "partner pushed, slapped, or hit" (white adults 3% v. minority adults 5%).
• Sexual assaults were reported by similar percentages of white (6%) and minority (5%) adults and were less common among Asian American adults (1%).
• Medical attention was sought by one fifth of all adults who suffered domestic or other assaults (22%). More minority adults than white adults felt they were treated with respect (88% v. 65%), and that the doctor made them feel comfortable (79% v. 64%).

Health Habits

Minority adults exercise and maintain a healthy diet less often than white adults.

• Minority adults (26%) are more likely than white adults (20%) to report that they never exercise vigorously, or maintain a healthy diet (17% v. 11%).
• However, cigarette-smoking is reported by more white adults (26%) than minority adults (22%). Of minority adults, men are more likely to smoke than women.

Health Profile

• Minority adults are much less likely than white adults to describe their health as excellent (30% v. 41%) and more likely to describe it as fair or poor (24% v. 18%).

Demographics

Minority Americans are somewhat younger than the white population and tend to live in larger households with children. inority group members are less likely than white adults to have finished high school, and more likely to have lower incomes.

• Almost a third (31%) of minority adults compared with 21 percent of white adults are between the ages of 18 and 29.
• 61 percent of adults in minority groups, compared with 46 percent of white adults live in households with three or more people.
• More than half of adults in minority groups (53%), compared with 37 percent of white adults have children under the age of 18 in the household.
• Minority group members (24%) are twice as likely as white adults (12%) to have not finished high school.
• Three in ten minority adults (29%), compared with one in five white adults (21%) live in households with incomes of $15,000 or less. Twenty-one percent of white adults and 15 percent of minority adults have household incomes of at least $50,000.
• Twelve percent of minority adults are Medicaid beneficiaries, compared with 8 percent of white adults.
• Public assistance of some kind is received by 12 percent of adults in all minority groups, compared with 6 percent of white dults.
• Slightly fewer adults, ages 18-64, in minority groups are employed full-time (51%), compared with white adults (54%), or part-time for an employer (11% v. 9%). Minority Americans are slightly less likely than white adults to be self-employed (10% v.13%), and they are less likely to be retired (3% v. 5%)
• Nine percent of Hispanic Americans, 8 percent of African Americans, and 5 percent of Asian Americans are unemployed, compared with 4 percent of white adults.

1The stress iindex is a weighted average of responses to the question asked about how much respondents were affected by each of eleven possible sources of stress in the last year—each response of "affected strongly" were given a value of two; "affected somewhat" was assigned a value of one; all other responses were scored as zero. To fall into the "high stress" category, a respondent had to receive more than six points. Stress variables included illness or death in the family, money or work problems, fear of crime or violence in the community, loss of job or spouse's job, problems with children, knowing someone who was a victim of violence, trouble balancing work and family demands, problems with aging parents, problem with spouse, and family mistreatment because of race or cultural background.