Mental illness is a leading cause of disability and premature mortality globally, disproportionately affecting marginalized populations. Even before the COVID-19 pandemic, significant disparities existed in the US, with NHBs less likely to receive mental health services despite similar or higher rates of mental illness compared to NHWs. The pandemic exacerbated these issues, leading to a substantial increase in mental health challenges across the population, but particularly impacting racial and ethnic minorities. This study focuses on the gap in access to mental healthcare for NHBs and NHWs during the pandemic, investigating whether pre-existing disparities were worsened and if any changes occurred over time. This is crucial because persistent unmet needs could further negatively impact health outcomes and exacerbate already existing health inequalities.

Existing research demonstrates a substantial burden of mental illness in the US, with less than half of those needing services actually receiving them. Pre-pandemic data revealed disparities, with NHWs more likely to report mental illness but NHBs less likely to receive care. The COVID-19 pandemic amplified mental health challenges, with increased rates of anxiety and depression reported. Studies have shown that minority groups, including Black Americans, experienced a disproportionate burden of COVID-19-related health issues and mental health consequences, including higher rates of anxiety, depression, substance abuse, and suicidal ideation. However, there was a lack of data specifically addressing the disparity in access to mental health services during the pandemic, which prompted this analysis.

The researchers used data from the publicly available Household Pulse Survey, phases 2 (August 19, 2020) to 3.4 (May 9, 2022). This survey included data for over two million adult Americans. The study investigated the proportion of NHB and NHW adults who needed but did not receive mental health care in the four weeks preceding the survey date. Joinpoint regression analysis was employed to examine trends in unmet mental healthcare needs over time for both groups. This statistical method allowed for the identification of significant changes in the slope and intercept of the trends, providing insights into the magnitude and direction of change in unmet need over time. Confidence intervals were calculated to account for uncertainty in the estimates.

The analysis revealed that throughout the study period (August 2020 – May 2022), NHBs (11.5%, 95% CI [11.1, 11.9]) were significantly more likely to report needing but not receiving mental healthcare than NHWs (10.6%, 95% CI [10.3, 10.8]) (p < .001). While there was no significant difference between groups during phase 2 (August-October 2020), a significant disparity emerged in phase 3 (November 2020-May 2022), with NHBs demonstrating a higher percentage of unmet needs. Notably, a significant upward trend (average percentage change of 1.4%, 95% CI [0.7, 2.2], p < .001) was observed in the proportion of NHBs who needed but did not receive mental health care over the entire study period. No such significant trend was observed for NHWs. This persistent and widening gap highlights a critical need for intervention.

The findings confirm that existing racial disparities in mental healthcare access worsened during the COVID-19 pandemic. The significant and persistent difference in unmet mental health needs between NHBs and NHWs underscores the urgency for action. The increasing trend of unmet needs among NHBs, while no such trend was noted in NHWs, is concerning and suggests that interventions implemented during the pandemic were insufficient to address the unique challenges faced by the NHB community. These results strongly support the need for targeted interventions that consider the social determinants of health and cultural contexts that influence help-seeking behaviors among NHB populations.

This analysis highlights the persistent and widening racial disparities in access to mental healthcare for NHBs. Addressing this requires a multi-pronged approach involving educational initiatives to reduce stigma and improve health literacy, policy changes to increase resource allocation and improve access, and focused research on culturally appropriate and cost-effective mental healthcare services. Continuous data collection and surveillance are crucial to monitor progress and inform future interventions.

The study relies on self-reported data from the Household Pulse Survey, which may be subject to recall bias and underreporting of mental health needs. The cross-sectional nature of the data limits the ability to establish causal relationships. Further research using longitudinal data and qualitative methods is needed to gain a deeper understanding of the underlying factors contributing to these disparities and to evaluate the effectiveness of interventions.