Racial Inequality in Mental Health Care

Author: Laura Pettigrew

October 8, 2026

[Image credit: Wikimedia Commons]

Introduction

In 2024, 23.4% of United States (U.S.) adults experienced mental illness and 5.6% experienced serious mental illness. Adults who identify with two or more races have the highest rate of mental illness at 35.5%, followed by Native Americans/Alaska Natives at 25.9%, and non-Hispanic White Americans at 25.1% (National Alliance on Mental Illness, n.d.). 

Native Americans/Alaska Natives had the highest rate of suicide deaths in 2024, followed by White Americans. Suicide deaths are becoming more common among people of color (POC). From 2014 to 2024, suicide death rates increased among Black Americans by 53%, Hispanic Americans by 27%, Native Americans/Alaska Natives by 26%, and Asian Americans/Pacific Islanders by 10%. In contrast, suicide rates for White Americans during the same period increased by 5% (Saunders et al., 2026). 

Breslau et al. (2005) found that Hispanic Americans and non-Hispanic Black Americans had lower rates of psychiatric disorders than non-Hispanic White Americans. However, these disorders were more persistent for Hispanic Americans and non-Hispanic Black Americans than for non-Hispanic White Americans. The evidence makes it clear that POC experience mental health disparities.

People of color have unequal access to care

In the U.S., a survey found that 50% of White adults who reported having fair or poor mental health received mental health treatment in the past three years, compared with 39% of Black adults and 36% of Hispanic adults who reported fair or poor mental health (Panchal et al., 2024). Non-Hispanic White adolescents were also more likely to receive mental health services or psychotropic medication than their peers (Ma et al., 2025). The reasons for this disparity are complex and structural. 

Black, Hispanic, Native American/Alaska Native, and Native Hawaiian/Pacific Islander individuals under 65 in the U.S. are more likely to be uninsured than their White counterparts (Ndugga et al., 2025). Among adults with moderate to severe symptoms of depression and/or anxiety, 38% of uninsured adults received mental health care, compared with 64% of insured adults (Panchal et al., 2022). 

Hispanic, Native American/Alaska Native, Native Hawaiian/Pacific Islander, and Asian adults are also less likely than White adults to have a personal health care provider (Ndugga et al., 2025). Among adults with moderate to severe symptoms of depression/anxiety, 66% of individuals who had a regular source of outpatient care received mental health care, compared with 43% of individuals without a regular source of care (Panchal et al., 2022). 

Asian and Hispanic people are more likely to report low English proficiency (Ndugga et al., 2025). Language barriers in healthcare frequently result in lower patient satisfaction and lower quality care (Al Shamsi et al., 2020). 

Limited access to resources is another reason: although a healthy diet is linked to better mental health (Abrams, 2026), POC are more likely to live in food deserts (Brooks, 2014; Walker et al., 2010) or experience food insecurity (Ndugga et al., 2025), meaning they may be unable to access or afford healthy food options (Howard & Robertson, 2026; O'Brien & Malveaux, 2023).

Another barrier to care is the lack of mental health providers of color. In 2015, 86% of U.S. psychologists were White (Lin et al., 2018). In 2020, 10.4% of psychiatrists were Black, Hispanic, or Native American combined (O'Brien & Malveaux, 2023). A study by Moore et al. (2023) found that most Black participants reported that it was important to have a mental health provider of the same race and ethnicity, since they are better able to understand and relate to their experiences.

The overdiagnosis of schizophrenia among people of color

Schizophrenia is a serious mental health condition that affects an individual’s ability to interpret reality. Symptoms of schizophrenia include delusions, hallucinations, and disorganized behavior (World Health Organization, 2025). In the U.S., the prevalence of schizophrenia is 0.6% - 1.9% (Patel et al., 2014). 

Black Americans are two to four times more likely to be diagnosed with schizophrenia than White Americans (Herbst, 2022). This inequality is not limited to the U.S.; Nazroo et al. (2020) found similar results for Black British people and White British people. In their review of the literature, Schwartz and Blankenship (2014) also discovered that people from Black and other minority ethnic groups and White immigrants showed elevated rates of psychotic disorders in European studies. The reasons for this are unclear. 

One possible reason is that clinicians are more likely to diagnose a Black person who is experiencing psychosis with schizophrenia without ruling out other options (Herbst, 2022). Psychosis, a collection of symptoms involving a break from reality, is a core part of schizophrenia (National Institute of Mental Health, 2023). Although psychosis is central to schizophrenia, it can be caused by other mental health or medical conditions or substance use (National Health Service, n.d.). 

Even though psychosis can manifest in mood disorders like depression and bipolar disorder (Chakrabarti & Singh, 2022; MedlinePlus, n.d.), Black Americans are more likely to be misdiagnosed with schizophrenia rather than being diagnosed with possible mood disorders (Gara et al., 2012; Gara et al., 2019), even when the average severity of mood symptoms was similar between Black patients and White patients (Strakowski et al., 1996). Black and Hispanic patients with bipolar disorder are also more likely to be prescribed antipsychotics and less likely to be prescribed antidepressants and mood stabilizers than White patients with bipolar disorder (Medina et al., 2024).

Another possible reason for the overdiagnosis of schizophrenia is that there are environmental factors that make Black individuals more likely to develop schizophrenia (Herbst, 2022). For example, experiencing racial discrimination might increase a person’s risk of developing psychosis (Francis-Crossley et al., 2025; Lazaridou et al., 2023). 

Experiencing racism and racial trauma

Along with increasing the risk of developing psychosis, experiencing racism has significant negative psychological and physiological effects (Paradies et al., 2015; Pillai et al., 2026; Rogers, 2020). Racism is linked to post-traumatic stress disorder (PTSD), depression, suicidal ideation (Paradies et al., 2015), and substance abuse (Pillai et al., 2026). Racism is also linked to rumination, which is linked to depressive symptoms (Bernard, 2022).

Some evidence suggests that the stress of experiencing racial discrimination may also affect individuals’ brains (Hamilton et al., 2024; Paradies et al., 2015), such as decreasing connectivity in regions of the brain responsible for cognition, memory, and executive functioning (Schlossberg, 2022). Maternal racial discrimination can also negatively impact infants and children (Berry, 2021).

Encountering racism can lead to racial trauma, the harm caused by an individual witnessing racism and discrimination or experiencing it firsthand (“Racial Trauma,” n.d.; Resnick, 2022). Racial trauma can be experienced vicariously (Schumann, 2025) and by an individual or community simultaneously (Resnick, 2022). Usually, racial trauma stems from multiple incidents instead of just one (Rogers, 2023).

Although racial trauma is not an official mental illness listed in the Diagnostic and Statistical Manual of Mental Disorders, symptoms of racial trauma resemble symptoms of PTSD. For example, hypervigilance, avoidance, unwanted memories of the stressful experience, negative thoughts, and difficulty sleeping are symptoms of both PTSD (Mayo Clinic, 2024) and racial trauma (“Racial Trauma,” n.d.; Rogers, 2023; Williams et al., 2018). Racial trauma can also lead to depression, anxiety (Holmes et al., 2024), dissociation, and lowered self-esteem (Resnick, 2022). 

Conclusion

Regardless of age or economic status, racial minorities and immigrants face significant barriers to mental health care. Barriers include limited access to resources, lack of insurance, and a lack of providers of color. In addition, schizophrenia diagnosis rates are much higher among Black people than among White people. POC also face trauma in the form of racism. 

For these disparities to be addressed, many structural changes need to happen. One step that can be taken is ensuring that counselors and therapists receive training in cultural competency. Cultural competency in mental health is defined as mental health care that takes a patient’s culture, background, and lived experiences into account (Lynn, 2022). The American Psychological Association (American Psychological Association, 2017) has published guidelines highlighting the importance of cultural competency in professional psychology. Many therapists now try to improve their own cultural competency, whether through formal training and education or through self-reflection (“Culturally sensitive therapy,” n.d.). However, 81% of POC have experienced at least one racial microaggression in therapy (Hook et al., 2016), indicating that we still have a long way to go.

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Glossary

Antidepressants: Prescription medication used to treat depression.

Antipsychotics: Prescription medication used to treat psychosis.

Anxiety: Refers to a group of mental health conditions that involve excessive fear or worry.

Bipolar disorder: A mood disorder that causes mood swings.

Cultural competency: Care that considers a patient’s lived experiences and cultural background.

Depression: A mood disorder that causes persistent feelings of sadness and loss of interest.

Diagnostic and Statistical Manual of Mental Disorders: A medical reference book published by the American Psychiatric Association that defines mental health and brain-related disorders.

Disparity: A noticeable difference, usually a social or economic condition that’s unfairly unequal.

Dissociation: A lack of connection to a person’s thoughts, memory, and sense of identity.

Executive functioning: Skills used to manage everyday tasks like making plans and solving problems.

Food deserts: Geographic regions where people have limited access to healthy food.

Food insecurity: When people do not have access to safe and nutritious food.

Hypervigilance: The state of being constantly on guard and in a state of high alert.

Mental illness: A condition that affects thinking, feeling, behavior, or mood.

Microaggressions: Comments or actions that subtly and often unconsciously express prejudice toward a member of a marginalized group.

Mood disorders: A mental health condition that affects a person’s emotional state.

People of color (POC): People who belong to racial minorities.

Post-traumatic stress disorder (PTSD): A mental health condition that can develop after a traumatic event.

Psychosis: A disruption to a person’s thoughts and perceptions that make it difficult to recognize what is real.

Psychotic disorders: A type of mental health condition that causes abnormal thinking and perceptions.

Racial trauma: The emotional harm caused by experiencing racism.

Rumination: Repetitive, negative thinking or dwelling on negative feelings and distress.

Schizophrenia: A serious mental health condition that affects how people think, feel, and behave.

Serious mental illness: A mental health condition that causes serious functional impairment.

Suicidal ideation: Thoughts of ending one’s life.

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