Melanie Cole, MS (Host): Welcome to Long Live Childhood, a pediatric health and wellness podcast presented by Rady Children's Health. I'm Melanie Cole. And today, we're highlighting minority mental health. Joining me is Dr. Sheila Modir, she's a pediatric psychologist at Rady Children's Health in Orange County.

Doctor, thank you so much for joining us today, and we know that data has shown that people from racial or ethnic minority groups are less likely to receive preventive health and certainly mental health care. And across the board, they've faced a disproportionate health burden. Tell us a little bit about the unique challenges that these communities have faced in terms of healthcare disparities, but specifically mental health challenges that minority communities face.

Sheila Modir, PhD: That's such a great question. And thank you, Melanie, so much for having me on this show and being able to talk about such an important topic right now in healthcare. The question that you're asking is actually a critical issue in healthcare overall. Actually, back in 2020, I had co-written an article with Dr. Sabrina Lue about healthcare and COVID-19. And I wanted to first kind of talk about that, because I think it's a great example of our current understanding of healthcare and minority mental health in general. Because with COVID, there was a slogan at the time that had come out that had said, you know, "We're all in this together." Because COVID was supposed to be this great equalizer where it was possible for almost anyone to contract or be affected by the virus.

But instead, the reality that we saw was that was not the case. There was a disproportionate negative impact on communities of color across the nation. Research had found that Black Americans had a higher COVID mortality rate than any other racial group in the us with early reporting that Black communities had up to 33% of all the collective deaths. And many Black and Latino communities were lacking well-resourced hospitals, available testing and housing that allowed for safe social distancing, and being able to quarantine. You know, being able to quarantine really was a privilege. And undocumented populations were worried about getting tested. Because if you remember, at that time, we actually were all going in somewhere to get tested. There wasn't those like at-home kits. And then, a lot of people were not eligible for many of the stimulus benefits that other Americans received.

So, what is important to ultimately remember is that these disparities are not simply due to individual choices, but they're deeply rooted in historical, social, and systemic factors. And even when we talk, so that was really healthcare. But if we're really focusing on mental health, we have to take into consideration socioeconomic factors, access to care and what that can look like in communities that have higher poverty rates than average.

There's other things like lack of insurance as a significant barrier to accessing timely and appropriate care. And even things that we tend to take for granted or overlook, like being able to drive to your appointments or have childcare to be able to attend a therapy session. Sometimes that can feel impossible if you don't have access to those resources.

So, these are just larger systemic challenges that are related to healthcare and can trickle down to mental health. And if we get even more into the nuances from systems to even more personal factors, we can talk about all day about mistrust about the healthcare system, mental health included; communication barriers, you know, if you're coming from different languages, being able to talk to a provider about how you're feeling; lack of cultural competency, implicit bias, stereotyping. These are all things that impact minority mental health overall.

Melanie Cole, MS: That was an excellent review and overview. And you got to many of my questions before I asked them, because culture influences the way mental health is perceived so much. And in certain cultures, as you said, it's not something that they think about. They think they can handle it within the community or within the family. When you see that, if you were to think of minority cultures that specifically really, they assume mental health concerns, would we be looking at the Hispanic community. And by minority groups, we're also talking the LGBT community as well. And so if we think of all these different groups, how is culture influencing them?

Sheila Modir, PhD: I think that's a important thing to really look at when we're talking about this group, because it can be in a lot of different ways. I mean, first, we can talk about stigma. I think that that could be across the board, across any culture that we're looking at. But specifically, in many minority cultures, there is a strong stigma associated with mental health and mental illness. Really, a lot of collectivistic groups, they heal together and one person really struggling could make it feel like that individual and that family is failing or they're expressing some sort of weakness. And it could be seen as a source of shame for the family if they have a mental health issue. So, it can lead to someone hiding their challenges or delaying treatment. And their symptoms can eventually turn more severe.

We can also look at culture in the expression of how distress and emotions are expressed. So, we're talking about how sometimes anxiety and sadness often comes up in a primary care setting for minority communities, because it feels more like a stomach ache or a headache or fatigue, constantly sleeping because there are so many physical manifestations of depression and anxiety, for example. So, a healthcare provider, a PCP is usually the one in some communities to be the first to hear about these things.

And then, you know, you're talking about, in certain cultures, could the family be the one to help heal them? Because a lot of families are like, "Let's keep this internally. Let's just talk about it collectively. Let's honor our family's privacy and not have a stranger on the outside, like a mental health professional, hear all of these personal things about us." You know, so, there's that piece of things that also creates this barrier.

And culture is such a beautiful thing. At the same time, it can serve as a protective factor too. So, you know, it could be that you're getting a lot more support through culture. It could be that there are some spiritual things that you can rely on due to your culture or there are types of healing methods that, you know, Western medicine doesn't have. So, culture is definitely multifaceted. But there are times that, when you are really needing the help, it can serve as a barrier.

And I think at the same time we have to think about the history of certain communities with the healthcare settings and the systems in place. Like for example, if we're looking at with Black families, like there is an understandable reluctance to seek mental health therapy due to this longstanding history of discrimination, racism, and mistreatment in the Black community in the hands of providers. So really, there is that piece of things where culture can be a protective factor, but it also can sometimes act as a barrier for getting the emotional support that we need.

Melanie Cole, MS: I hear you. And I think, in so many cultures, including the Asian community and others, they have that-- not distrust of Western medicine, but the feeling that over these years of discrimination and such. Will they be treated fairly? Will they get the kind of care that is required? And when we're talking about mental health, I mean, across the board, all of us, this is an epidemic right now, and especially with our kiddos, we are seeing this mental health epidemic in our teens and tweens. And it's very hard to find providers. So when we think of minority communities, I know how hard it was for me to find one for my daughter, so I can't even imagine with people without access to this good insurance or healthcare situations all around them.

Now, Dr. Modir, when we think of minority communities and our providers, how can healthcare providers work to break down the barriers you've talked about today and help to make mental health care more accessible for all of these communities? What are we to do?

Sheila Modir, PhD: I think one of the first things we really need to focus on is reducing stigma. Because if there is a source of discomfort, shame around seeking care, then because of the fact that there is a stigma around mental illness being maybe a personal failure or that symptoms have to be kept a secret, maybe the pressure to feel perfect on the outside because it brings internal shame to the family, really what we need to do is work to break that.

And I think that this generation has done an excellent job of doing that. But the work still continues. And where it can really lie is that there are a lot of cultural community-based or, you know, minority community-based organizations. And they really trust whether we're looking at from a spiritual standpoint or organizations that honor a specific cultural group, they have trusted community leaders within those, whether they're the religious or cultural figures or organizers that can really serve as powerful advocates for mental health and provide relevant messaging where we're turning personal weakness into building resilience or helping well-being, changing really the language and the narrative around mental health and seeking support.

I think a lot of these discussions can be brought into spaces that already exist within these communities, and really begin normalizing that discussion. And it can even be done through storytelling. If there are didactics within these community organizations, could some of the stories be about people in the community navigating mental health challenges? Because the more that we hear respected individuals in our communities talk about something like this, the less that it becomes something like negative and it becomes something normal, right? So, that's where normalizing comes in.

The other piece of things is that I work in the primary care settings a lot. And so, I see primary care providers how important their role is with a lot of these communities in talking about mental health. And I know that they have so many different things that they are trying to address within a primary care visit, but so many physicians are including discussion of mental health as a routine part of overall health. Because health is health, whether it's physical or mental, we know that they impact each other. When you're feeling sad, then you're not really doing well physically as well. So, I think being able to continue to have universal screening about mental health within these settings is extremely important. And then, ultimately, we have to continue to address these systemic barriers and this discrimination.

So, the onus is not just all on the individual to navigate these barriers to mental health or reduce stigma. But really, on the outside, I think we have to work on making mental health care more affordable, more accessible, less daunting and intimidating, and make it easier for individuals to be able to access this care when they are ready to be able to do so.

So, those are like these goals that I hope that one day we can be able to get to, but we're taking it day by day.

Melanie Cole, MS: Those were all such excellent bits of advice. And when families are looking for culturally competent mental health professionals and resources, what do you suggest they do? Because you've mentioned spiritual and community and their primary care. But again, mental health professionals are not easy to come by these days. What do you suggest to these families? But while you're thinking about that, because of the advent of telehealth, now mental health professionals from all different states can join in on this and help with televisits, even if they don't live right there in the community.

Sheila Modir, PhD: Exactly. Yeah. I think now, with telehealth, we can reach all different parts of the world and all different parts of the states. I think it's a really exciting opportunity to be able to-- especially if you have communities that speak a certain language. Let's say they only speak Spanish, but they live in an area where English is predominant and they're looking for Spanish-speaking providers, right? So now, telehealth has been able to really open a lot of doors.

I think that there's a couple of different places. Again, looking at churches, mosques, temple synagogues, there's a lot of different areas where there are community leaders or spiritual leaders that already have a list of mental health providers that they trust, that they work with personally, that you can reach out to and ask, because you're not going to be the first one to be asking for this. You know, mental health is something that everybody experiences. And it's just about people that are talking about it, that's when we are hearing about it. So, the more we talk about it, the more, again, we normalize it.

There are a lot of directories that people don't really know about. For example, within the American Psychological Association, you know, there is the Association for Black Psychologists, Asian American, Middle Eastern, Latinx, Native American, so there are LGBT. So, there's a lot of different minority groups represented within the American Psychological Association. And within those groups, there are providers and therapists that are taking in patients. So, there's websites and directories.

You know, you have websites like Psychology Today or NAMI that also have a list of different therapists that you can really filter by and try to find the ones that speak your language. And more than anything, I think, don't worry about asking for help. I think it's really important that, even with your PCP, if you're looking for a therapist, let them know, "This is the specific type of therapist that I'm looking for," like, "I want them to be a Mandarin-speaking therapist." And advocate for yourself because you want to make sure that you're getting your needs met. Because one of the things that I would hate is that somebody finally agrees to do therapy, they enter that realm, but they don't speak the same language as their therapist or they don't feel comfortable with their therapist. So, it's really about finding-- if you're finally ready to do so-- finding the right fit for you and your family.

So, I think those are some areas to begin looking at. And I think if you do have Medi-Cal, which is the insurance In California specifically, I think it's Medicaid elsewhere, there are organizations like full service partnerships programs, we have one called Project Health. And really, the goal of it is to meet families where they're at, and it's really quite incredible work. Because they meet you in the community, they find providers that, you know, usually speak your language. And they also try to find providers that have maybe similar backgrounds as the clients and patients that they're trying to serve. And they really emphasize cultural competency and advocacy. So, really looking into a full service partnership program for your family if that is something that meets your needs.

Melanie Cole, MS: Wow. You have given us great information and so much to think about. It certainly is an issue we're seeing today, but you've given us resources and tips and advice. Thank you so much for tuning in to Long Live Childhood, a pediatric health and wellness podcast, brought to you by Rady Children's Health. Together, we can keep kids happy, healthy, and thriving.

If you enjoyed today's episode, please consider downloading, subscribing, rating, and reviewing Long Live Childhood on Apple Podcast, iHeartRadio, Spotify or Pandora. Your support truly means a lot. I'm Melanie Cole. Thank you so much for joining us today. Until next time.