Clinical AdvisorTelemental Health Inequities Among Underserved Youth

Addressing inequities in telemental health access among underserved youth requires tackling structural racism, digital divides, and workforce diversity to ensure comprehensive mental health care.

The adoption of telemental health (TMH) has highlighted significant disparities in access to mental health services among racially minoritized youth (RMY) and underserved communities. Systemic barriers such as limited technology access, structural racism, and workforce shortages have exacerbated these inequities, particularly during the COVID-19 pandemic. This article discusses the root causes of these disparities and provides strategies to enhance TMH access through equitable practices and systemic reforms.

Key Points:

• Disparities in TMH Usage:
  • TMH usage among racially minoritized youth (RMY) decreased from 62% to 51% between 2019 and 2020, while non-RMY youth usage increased from 38% to 49%.
  • Barriers to TMH access include limited technology access, lack of digital literacy, and systemic inequities.
• Social Determinants of Health:
  • Social determinants such as education access, financial stability, and healthcare access impact TMH usage.
  • Addressing these determinants is essential for achieving health equity.
• Bias and Discrimination:
  • Implicit and interpersonal biases in healthcare settings hinder equitable care.
  • Providers’ bias training is crucial to reducing discriminatory behaviors and promoting health equity.
• Impact of Structural Racism:
  • Historical and systemic racism has led to persistent disparities in socioeconomic resources, education, and healthcare access for Black communities.
  • Addressing structural racism involves changing the health workforce’s makeup and implementing frameworks to hold healthcare systems accountable.
• Workforce Shortage and Diversity:
  • The mental health workforce lacks diversity, with only 5.7% of physicians being Black or African American.
  • Strategies to diversify the workforce include offering scholarships, auditing medical school curricula, and promoting fair hiring practices.
• Digital Divide:
  • The digital divide encompasses lack of access to technology, digital literacy, and negative emotions associated with technology use.
  • Addressing digital poverty and exclusion is critical to improving TMH access.
• Limited Evidence-Based Research:
  • Research on racism in mental healthcare is often descriptive and lacks theoretical frameworks.
  • Future studies should focus on unbiased data collection and equitable analysis.
• Call to Action:
  • Healthcare providers should take active roles in eradicating systemic inequalities.
  • Strategies include bias training, partnering with community organizations, and supporting minority businesses.

“Many young patients chose not to show up at all during the COVID-19 pandemic, which is reflected in the 53% of youth who failed to seek help either because they did not know where to go or whom they could trust.”

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