FORT WORTH, Texas — Last fall, Daisy Sanchez spent every other night crying in her college dorm room.
Sanchez, a 2020 graduate of Fort Worth's Paschal High School at Yale University, had felt isolated and alone for a year and a half.
She never returned to campus for her high school senior year, she spent her first college semester online, and her family, most of them essential workers, struggled to navigate the mental strain of the pandemic.
A year later, finally on campus, Sanchez still felt alone, bottling up her stress and self-doubt until she ended up in tears at night.
“During the pandemic, we’ve just had to be super adaptable and flexible,” she said. “It’s hard to ask that from people all the time.”
Sanchez was worried about what her family would think about her struggles because of the historical reluctance to talk about mental health problems among Latino people compared to other populations. When she finally mustered the courage to speak up, her family’s response was supportive.
“They were like, ‘Yes, OK, well, we’ll help you with whatever you need,’” she said.
Mental health crisis grows
As the mental health crisis for children, adolescents and young adults in the U.S. has been inflamed by the pandemic, some communities of color are breaking through long-held cultural stigmas. Yet, Black and Hispanic people have substantially less access to mental health services, according to the U.S. Department of Health and Human Services.
In 2017, 13% of U.S. teenagers ages 12 to 17 said they had experienced at least one major depressive episode in the past year, up from 8% in 2007, according to Pew Research Center. For people ages 10 to 24, suicide rates increased 57% from 2007 to 2018, according to the Centers for Disease Control and Prevention.
Amid those increases, mental health services for children and adolescents have continued to be under-resourced and unable to keep up with demand, especially in Texas, Fort Worth psychiatrist Brian Dixon said.
The people who get left behind the most are young people of color, according to experts.
Black and Latino people are more likely to be at risk for depression than white people, according to the National Institute of Health. And Black and Latino communities have the lowest rates of use for mental health and substance abuse treatments, according to 2021 National Survey of Drug Use and Health data.
Cost is a barrier to services
Dixon said the lack of access to mental health care comes down to the most significant factor of inequality: a lack of money.
Therapy can range from $65 to $250 a session, according to therapist directory GoodTherapy. Psychiatric residential treatment facilities can range from $10,000 to $60,000 a month, and sober living facilities range from $3,000 to $10,000 a month, according to HealthyPlace, a mental health website by San Antonio psychiatrist Harry Croft.
Nearly 11 million Hispanic people in the U.S. live without any form of health insurance and more 3 million Black people live without health insurance, according to the U.S. Census.
Even for those who have insurance, mental health treatment has historically been unequally covered by health insurance companies, meaning people may have to pay for mental health treatment out of pocket.
In Fort Worth, 18.4% of Hispanic people and 21.3% of Black people live under the poverty line, totaling about 100,000 people in the city, according to the U.S. Census. More than 16% of Black Fort Worth residents and 33% of Hispanic residents are uninsured, more than 135,000 people, according to the U.S. Census.
The federal Mental Health Parity and Addiction Equity Act aimed to ban health insurers from making coverage for mental health more restrictive than for physical health, but federal enforcement has been elusive, and most Americans still have trouble finding parity in coverage, according to a report by the Washington Post.
Affordability of mental health care was a major factor for Sanchez and her family.
“It doesn’t make sense that I can’t afford that and that a lot of people can’t afford that,” she said.
Investment in mental health care
Dixon said people who don’t have the money to access care oftentimes are relegated to using community resources, which can be limited.
“At this point in human history, we are choosing to not invest in mental health care,” Dixon said.
But local institutions are starting or expanding programs to combat mental health issues.
The JPS Health Network plans to break ground on a psychiatric emergency clinic and a medical clinic this year and is adding a child and adolescent psychiatry fellowship program that will train psychiatrists to care for children with some of the most severe mental illnesses, according to Star-Telegram archives.
My Health My Resources Tarrant County — which runs a crisis call center and offers short-term crisis counseling —provides services for qualifying residents at no cost. Prices for addiction services, inpatient and outpatient services and early childhood intervention are assessed based on funding sources and a resident’s ability to pay.
But most programs require that people have mental health needs related to bipolar disorder, major depression and schizophrenia, areas targeted by the Department of State Health Services. Although other community resources may be offered.
College campuses feel the effects
Colleges and universities see the impact of the situation when students like Sanchez try to seek mental health treatment for the first time.
Eric Wood, director of counseling and mental health at TCU, said the 2019-2020 school year saw a 45% increase in counseling usage from students. Use increased another 48% the following year.
Many students, especially first-generation students and students of color, get access to these services for the first time in their lives when they are in college, he said.
Some school districts, including Fort Worth ISD, are trying to provide counseling services through places like the Carter-Riverside Family Resource Center.
But these initiatives can be limited without an intentional and sustainable plan to maintain and expand resources, said Becky Taylor, counseling professor at TCU.
There are other unique challenges for people of color when it comes to seeking mental health help, such as treatment centers not being located near their communities and a lack of Black and Hispanic therapists, said Wood. Language barriers among non-English speakers and legal status further limit options for finding proper care.
This is on top of the historically magnified cultural stigma against mental illness among minority communities, but experts say that’s been changing for the better in the past two years.
Dixon said Black people often look for mental health help through their institutions of faith, but, ultimately, what keeps these communities from obtaining treatment is a lack of access caused by wealth inequality.
Awareness about mental health
Despite these barriers, improving access to mental health for Hispanic people and other minority groups is possible, he said. Solving these disparities requires increased mental health awareness, he said.
“If we can ramp up production and discovery of a new vaccine for a new virus ... and get it into 100 million arms, we can help people get access to mental health care,” he said. “I don’t want anybody to think that this is an insurmountable problem.”
Providers must learn to treat patients with culturally competent care, governments at all levels need to invest in affordable and accessible health care and individuals need to speak out and be willing to have those difficult conversations, experts say.
“We all know food and clothing are priorities, but mental health needs to be up there too.” Taylor said.
Federal laws like the Helping Families in Mental Health Crisis Act of 2016 have aimed to address holes in the country’s mental health system by providing more hospital beds.
Mental health advocates praised the bill but said more needs to be done, such as increasing funding for community services, providing more access to psychiatrists and providing housing and employment services for the seriously ill.
U.S. Rep. Eddie Bernice Johnson, who co-sponsored the bill, said in a news release that during her time as a chief psychiatric nurse at the Dallas Veterans Affairs Hospital, she saw the inadequacies of the mental health system.
“Our country must re-evaluate the way we talk about and classify mental illness, in order to initiate a pragmatic and comprehensive reform of our mental healthcare system,” she said in the release.
Federal attempts to strengthen the Mental Health Parity and Addiction Equity Act may make it possible for people to get equitable mental health coverage through their insurance.
For now, many young people of color in Fort Worth are trying to focus on improving their mental well-being one day at a time.
“Therapy has given me the tools I need to approach life, especially like where I’m at right now,” Sanchez said.
