Behavioral Health

Behavioral health describes the individual behaviors that impact a person’s health. The term encompasses various health experiences and conditions like mental health, substance abuse, addiction, smoking, sleep issues, and diabetes management, among others.  

These health conditions are extremely prevalent today: One in five U.S. adults has experienced a mental, behavioral, or emotional disorder in the past year.

For every 10 people in a doctor’s office, seven are there seeking care for reasons related to behavioral health.

Mental health conditions such as depression and anxiety impact demographic groups differently. For instance, 17.3% of non-Hispanic Black or African-American adults in the U.S. experience mental illnesses compared to 13.9% of non-Hispanic Asian adults and 22% non-Hispanic white adults. There is also a growing youth mental health crisis in the United States, in the wake of the pandemic. Emergency room visits by teen girls for mental health conditions have increased significantly since 2020. Compared to other countries, the United States has higher death rates from mental and substance use disorders.

Substance Abuse and Addiction

Substance abuse disorders can exist simultaneously with other mental health conditions, exacerbating health problems and access to treatment services. Treatment for ongoing substance abuse issues can be long term and hard to access for many people: 

• Black individuals, who face daily racial trauma and are disproportionately impacted by mass incarceration, often deal with substance abuse stigma. This can prevent people from seeking treatment. Public health interventions that address the opioid epidemic do not account for the specific barriers, such as lack of insurance or transportation, that Black individuals experience.
• Native Americans are more likely to report substance abuse and trauma but face limited access to naloxone, stigma, and lack of education about substance use and overdose. 
• Subcultures of Asian populations also report high rates of substance use, but often go unnoticed or undiagnosed due to limited linguistic or culturally competent resources available. 
• LGBTQ populations, or individuals self-identifying as sexual minorities, have higher rates of opioid use and may have difficulty finding providers who are knowledgeable about LGBTQ issues.

Racial-based Trauma and Mental Health

Racial trauma can mirror the symptoms of PTSD and cause negative health outcomes. Black Americans have long experienced racism, bias, discrimination, and race-based violence by living under a system of white supremacy that significantly impacts people of color and their mental health. Black transgender and gender non-conforming individuals experience the highest levels of discrimination of all trans populations. Moreover, Asian Americans reported nearly 1,500 acts of Anti-Asian violence following the COVID-19 outbreak in the United States. 

White supremacy has also contributed to what is known as historical trauma, which refers to “cumulative emotional and psychological harm, as a result of group traumatic experiences, transmitted across generations within communities and families. Racial and ethnic population groups that have suffered major losses and assaults on their culture and wellbeing experience historical trauma.” Native Americans have experienced historical trauma from years of mass genocide, oppression, assimilation schools, and broken treaties, leading to PTSD in Native communities in the United States, which has severely impacted their mental health.

Another form of racial trauma that is prevalent in the U.S. is xenophobia. Xenophobia can fuel racism and discrimination against immigrant communities, especially Latinx/Hispanic immigrant communities. This population experiences decreased access to employment, medical sterilization on Hispanic/Latino women – leading to medical distrust – and anti-immigrant sentiment in the public discourse, which all contribute to declining mental health.

Investment in a robust mental healthcare system can help change these trends and address mental health as a serious issue and potentially reduce hospitalizations as well as provide care for those that need it. 

Limited access to mental healthcare services has extreme effects on the workforce.

For instance, depression accounted for $44 billion in losses to workforce productivity. Untreated mental illness could cost the workforce up to $100 billion each year in the U.S. and can lead to unemployment, disability, homelessness, incarceration, and suicide.

A Gallup poll found that nearly one in five people say their mental health is “fair” or “poor” and those employees take an average of 12 unplanned days off annually compared with 2.5 days for all other workers. 

Access to behavioral services can be expensive, with patients spending $10,836 a year on average for mental healthcare. Even with insurance, mental health services are five times more likely to be charged as out-of-network. Poverty and mental illness are cyclically linked. For instance, mental healthcare costs are very high and can exacerbate existing financial challenges for individuals and families, while at the same time, poverty is a contributing factor to a higher risk of developing mental illness. Mental healthcare costs for the United States are also exorbitant.

Investing in strong behavioral health systems can help alleviate the cycle of poverty and mental illness. With more access to resources like high-quality food, education, and employment opportunities, communities will have improved mental health and healthier livelihoods. 

Mental health treatment is by far the largest subsector of the broader mental health, sexual assault support and crisis intervention segment, attracting more than ⅓ ($12.1 billion) of the total segment dollars ($33.6 billion). The mental health treatment segment alone is almost the same size as the more than $13.9B total of the next three largest subsectors combined (community mental health centers, $7.3B; residential mental health treatment, $4.3B; psychiatric hospitals, $2.3B).

Donor investment in fighting mental health stigma by amplifying mental health storytelling and spreading awareness and education about mental illness can help strengthen behavioral health systems.

Low-income People of Color

There are significant behavioral health disparities among Black and white adults that impact long-term health outcomes and demonstrate the need for care. 

Patients who experience racial trauma, systemic racism, and oppression continue to be disenfranchised or kept in cycles of poverty and face barriers to receiving services. 

Black individuals also have  limited access to culturally competent mental health providers and are less likely to be offered either evidence-based medication therapy or psychotherapy.

Additionally, “individuals with the lowest level of socioeconomic status are estimated to be about 2 to 3 times more likely to have a mental disorder than are those with the highest level of such status.” Approximately 1 in 4 Americans reported having to choose between mental health services and basic daily necessities due to high costs and unaffordable care. An estimated 45% of psychiatrists don’t accept any form of insurance, making care extremely hard to afford out-of-pocket. Communities that have been exposed to natural disasters, are now facing both the financial and mental costs of climate change. Approximately 25% to 50% of people exposed to extreme weather are at risk of developing conditions like anxiety, depression, and suicide.

Structural Racism

Research found that Black adults report experiencing stigmatization and the minimization of their mental health issues while in treatment. There are compounding mental health disparities and issues for the Black community: 

“The increased incidence of psychological difficulties in the Black community is related to the lack of access to appropriate and culturally responsive mental health care, prejudice and racism inherent in the daily environment of Black individuals, and historical trauma enacted on the Black community by the medical field. Moreover, given that the Black community exists at the intersection of racism, classism, and health inequity, their mental health needs are often exacerbated and mostly unfulfilled.” -Columbia University Department of Psychiatry

Additionally, people of color are more likely to be uninsured and face access barriers due to high costs. Racial disparities in healthcare affordability are driven by racial inequity in healthcare coverage. For instance, Black and Latinx/Hispanic adults are uninsured at higher rates than their white counterparts and Black and Latinx/Hispanic populations disproportionately live in states that are not expanding Medicaid coverage. Other factors such as medical distrust, generational poverty, and inequity along the social determinants of health all have racist roots that have disenfranchised communities of color and made it more difficult to receive access to behavioral healthcare.

Geography: Rural and Urban Mental Healthcare Systems

Even more troubling are the existing gaps for children in rural areas trying to access mental health services.

One in five children in the U.S. lives in a county with no child psychiatrists.

While rural areas suffer from a lack of services and limited treatment options, urban cities pose higher risks for residents to develop major mental illnesses such as anxiety, psychotic, mood, or addictive disorders. Many mental healthcare systems are not built to respond to the growing impact of urbanization on our collective mental health. (I.e. increases in homelessness, violence, hate crimes, etc).