“This field is poorly paid and understaffed, and the only people who can enter and advance in this field are those who have the means to obtain a traditional schooling and gain the lived experience that may be more useful to them.” Not someone who has.”
Michael Appleton/Mayoral Photography Office
Brochures for several of the city’s mental health programs. CityViews represents the opinions of readers and not of City Limits. Add your voice now!
The mental health system in New York City and across the country is in crisis. But it’s not just your mindset.
More people than ever are experiencing anxiety and depression, especially since the start of the COVID-19 pandemic. Adolescents and young adults report even higher rates of major depression and symptoms of severe psychological distress. We see its effects every day in our homes and on the streets, impacting our sense of safety, well-being, and community.
Yet our mental health services are not meeting the need. In many ways, this is due to a huge underfunding of mental health workers, especially those with lived experience of truly connecting with and serving their communities.
Nationwide, 49% of people live in areas with a shortage of mental health care providers. Somewhat predictably, this disparity can occur along socio-economic lines. In New York City, the Mayor’s Office of Economic Opportunity found that mental health resources are distributed inequitably across high-income neighborhoods and are scarce in the public sector. People who have historically been excluded from resources due to systemic racism remain unable to access those services.
This has an even more significant impact on Black, Indigenous, and people of color (BIPOC), who already face worse outcomes at every stage of the health care system. White and BIPOC people face similar rates of mental health problems, but the latter’s symptoms tend to last longer and are more likely to go untreated. Black mental health patients, who present with the same symptoms as white mental health patients, are more likely to be diagnosed with severe mental health illnesses (such as schizophrenia), which can lead to greater stigma and long-lasting effects on treatment. You’re also more likely to be disconnected from the service quickly.
One reason for this growing list of adverse outcomes stands out. That is, BIPOC staff are significantly underrepresented in the behavioral health field. Although approximately 60 percent of the U.S. population identifies as non-Hispanic white, 81 percent of practicing psychologists identify as white. And while 14 percent and 19 percent of the population identify themselves as Black or Latino, respectively, only 5 percent and 8 percent of psychologists identify as such. Similar disparities exist in psychiatry.
Having a therapist who speaks your language fluently, or a social worker who grew up in the same area as you, offers an opportunity to restore some of the damaged trust in a system that has historically provided only exclusion and discrimination. produce. Physicians from diverse backgrounds also bring unique perspectives. Things like understanding biases about care that clients may have and ideas about what works for patients who haven’t responded well to practices developed with people similar to them in mind. .
Last year, as the crisis of rising service needs and lack of a diverse workforce subsided, the New York Institute for State and Local Governance set out to understand why BIPOC are underrepresented in these fields. We spoke to more than 130 ‘support professionals’ from all walks of life, including social workers, psychiatrists, psychologists, trusted messengers and community health workers, to find out why these gaps exist. I researched it and suggested a solution.
It turns out that the systemic racism that prevents people from receiving care also affects those who want to provide it. We found that BIPOC, at every stage of their schooling and careers, face barriers to entering and advancing in the mental health professions. This begins in elementary school and continues through graduate school, where students from economically marginalized communities have fewer resources to explore career paths and pay for high-stakes tests and necessary certifications. It will be.
Once in the workforce, burnout and tokenism often hinder career growth. For example, Spanish-speaking social workers we spoke to said they were paid less for the additional work they did, even though they had more caseloads because bilingual staff were in higher demand for services in their language. said he had not been paid. This led to burnout. “Now that we know the language, more is required of us,” they said. “So we’re giving ourselves less.”
A Black woman who works as one of two psychologists of color at a hospital reported feeling alone and vulnerable at work, especially when experiencing microaggressions. “Do I want to be the one to speak up? I already feel isolated,” she told us. “Why does it have to be me?”
Even if they do stay, the pervasive lack of adequate funding in many nonprofits and other organizations that provide these services means there are few opportunities for decent pay or advancement. . And if those are available, those who are considered more “qualified” will be at the top, but “qualified” often means more technical education (another expense). and does not imply real-world experience that allows helping professionals to connect more easily with clients.
Solving this requires rethinking how we build, support, and fund pipelines into the mental health professions. From our conversations, we offer recommendations for educators, organizational leaders, policymakers, and funders to do so. But one need was louder than all the others.
We, nonprofit executives, mental health leaders, policy makers, and educators, must make this field more accessible and sustainable for all people, especially people of color. As it stands, the field is poorly paid and understaffed, and the only people who can enter and advance in this field are those who have the means to pursue a traditional schooling and pursue a career path that may be more useful to them. I am not a person with experience. This is a disservice not only to the mental health workers we rely on, but also to the communities they care for.
This means supporting young people from every region and at every grade level to explore careers in mental health. This means investing in financial support for multilingual and minority undergraduate and graduate students and supporting marginalized groups to overcome systemic financial barriers. Creating incentives for mentorship for students and early career staff is beneficial for everyone, especially for first-generation students, which means helping them navigate schooling, internships, and employment. You can’t learn how to survive and thrive from a textbook.
Nonprofit and mental health leaders, as well as funders, must promote improved overall employment, advancement opportunities, and working conditions in social service providers. By encouraging flexible career paths, we can offer growth and advancement for a variety of backgrounds rather than a linear path, allowing people with work experience but fewer technical qualifications to grow into these roles. It will be. Eliminating the salary cap in the Request for Proposals would go a long way in making salaries more livable and create opportunities for people whose families don’t have other means of support.
It is clear that treating the mental health crisis in our communities is a difficult pill to swallow. But we cannot ignore or confine these issues. And we need to listen to the voices of communities who should and want to be part of the solution.
The importance of trust and understanding in mental health care, both between health care providers and their clients, health care providers and educators, employers, and supporting funders, is critical to reducing the prevalence of disease in our system. This is the key to treatment. As one Latina social worker put it: “I want to get the help I didn’t have before.”
Dr. Linda Rosell Bryant is associate dean and youth services leader at New York University’s Silver School of Social Work. Eric Brettschneider is a senior fellow at the New York Institute for State and Local Governance, an adjunct faculty member at New York University, and a former first deputy commissioner of the city’s Department of Children’s Services.
