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Column: Achieving intersectional mental health care


DTH Photo Illustration. "Listen, Support, Navigate", or LSN for short, is a program that's part of UNC's recently launched Heels Care Network, a collection of support resources for students. 

Recently, a friend told me about how her psychologist struggled to provide proper advice that catered to her unique family dynamic.

When she discussed her mother’s lack of respect for certain boundaries, the psychologist’s solution was to simply “cut the toxicity out of her life.”

My friend decided after the session that it would be better to mend this relationship on her own, rather than pursue therapy further.

Too often, clinical psychologists engage in “victim-blaming” when their client cannot take a course of action that will immediately ease their mental distress.

Consider, for instance, an individual who must decide between cutting off an abusive family member at the risk of facing homelessness and financial insecurity. Common situations such as this one show how “choice” is often a privilege — one that more professionals need to recognize before prescribing advice that does not work for a patient’s unique situation.

Modern data confirms that few practitioners demonstrate cultural competence. In a report published in 2016, the Cecil G. Sheps Center for Health Services Research estimated that 87.1 percent of licensed active psychologists in North Carolina are white.

And while the clinical psychology workforce has seen recent increases in racial and gender diversity, mental health resources continue to remain inaccessible for those who need them the most.

The problem is partly rooted in the ways psychologists are trained to “help” patients. In a study analyzing the relationship between social class, mental health and therapy, researchers reported that the field “has been dominated by middle-class values of liberal individualism and personal choice.”

These principles have merit, but failing to recognize how social and economic deprivation may negatively affect one’s mental health leads to problematic consequences for those seeking professional help.

In reality, gender, sexual orientation, race and socioeconomic status are deeply related to an individual’s well-being. Therapists must avoid separating issues about one’s identity from their mental health because the two are not mutually exclusive.

Instead, professionals who come from a privileged background should seek to understand diverse experiences which may differ from their own, so that their client does not bear the emotional burden of their limitations.

Not only does cultural incompetence result in prohibitive barriers for vulnerable populations, but it also disincentives many from pursuing therapy even when resources are available. The numbers speak volumes regarding these disparities: 

  • Despite being more likely than white people to experience chronic psychological distress, only one in three Black adults who need mental health care receive it. 
  • LGBTQ+ individuals are more than two times more likely than cisgender, heterosexual people to experience at least one mental disorder in their lifetime.
  • Women are just as likely to experience depression as men, yet physicians are much more likely to diagnose women and prescribe them psychotropic medications. 
  • Nationwide, 39 percent of Americans cite costs, limited time and inability to access medicinal treatment as the leading reasons why they choose not to pursue therapy.

Stigmas, discrimination and disparate insurance coverage prevent millions from attaining life-saving health care, particularly those who belong to underrepresented communities. Fortunately, UNC has taken a lead role in funding accessible and intersectional mental health resources.

This fall, the UNC System received over $981,000 in grants, with each school receiving between $50,000 and $100,000. The funding was awarded to improve mental health resources for students as many transitioned to college life in the midst of the pandemic.

In October, UNC launched the UWill program, a telehealth service that allows students to quickly access licensed therapists at zero cost. This resource was a helpful addition to existing Counseling and Psychological Services resources, which faced overwhelming demand as the school year progressed.

"We are always working to create a culture of care and compassion at Carolina," Campus Health Executive Director Ken Pittman said in a statement. "A culture where everyone not only feels a sense of belonging, but also feels supported on every level of their wellbeing."

The University’s recent investment in telehealth is just one of many ways it can help close gaps in access to mental health resources.

The Carolina Collaborative for Resilience established a pilot plan last year to connect students with Resilience Coaches. Its mission is to offer mental health services for diverse students who seek identity-affirming guidance.

As society begins to transition to “post” pandemic life, the demand for identity-affirming psychologists has never been higher. Intersectionality should be at the forefront of the University's agenda, especially within the context of its academic curricula and psychology workforce. 

UNC — guided by the notion that therapy is a human right — must continue allocating resources toward meeting diverse needs until each member of its community feels unconditionally seen and heard. 

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