Persistent Black-White disparities in mental healthcare needs during the COVID-19 pandemic: A call for action Letter to the Editor

The letter addresses persistent racial disparities in mental healthcare needs in the United States during the COVID-19 pandemic. Prior to the pandemic, about one-fifth of U.S. adults experienced any mental illness annually, yet fewer than half received services. Non-Hispanic Whites (NHWs) were more likely to report any mental illness, while non-Hispanic Blacks (NHBs) were less likely to receive mental health services. During the pandemic, mental health problems such as depression and anxiety increased substantially, and Black Americans experienced disproportionate COVID-19-related health and economic burdens alongside heightened mental health issues. The study seeks to assess differences in unmet mental healthcare needs between NHBs and NHWs during the pandemic and examine trends over time.

Cited evidence indicates pre-pandemic disparities in mental health service use, with NHBs less likely than NHWs to receive services despite burden (Cook et al., 2019; SAMHSA, 2020; Snowden & Graaf, 2021). The pandemic exacerbated mental health problems broadly (Blanchflower & Bryson, 2022; Czeisler et al., 2020; Khubchandani et al., 2021) and disproportionately affected racial/ethnic minorities in hospitalizations and mortality (Lopez et al., 2021). Prior work highlights lower life expectancy and quality of life among NHBs and calls for addressing social determinants and access barriers (Price et al., 2013; Price et al., 2016; WHO, 2021).

The authors analyzed publicly available U.S. Census Bureau Household Pulse Survey data from phase 2 (August 19, 2020) through phase 3.4 (May 9, 2022), covering more than two million U.S. adults. They examined the proportion of non-Hispanic Black (NHB) and non-Hispanic White (NHW) adults who reported needing but not receiving mental healthcare in the preceding 4 weeks. Joinpoint regression was used to assess time trends by identifying slope and intercept, and to test for statistically significant changes over time (Kim et al., 2000). Results were summarized overall and by survey phases (phase 2: Aug–Oct 2020; phase 3: Nov 2020–May 2022).

- Across the entire period (Aug 2020–May 2022), NHBs had a higher proportion reporting unmet mental healthcare needs: 11.5% (95% CI 11.1–11.9) vs NHWs 10.6% (95% CI 10.3–10.8); p < .001. - Phase 2 (Aug–Oct 2020): NHBs 10.3% (95% CI 9.4–11.1) vs NHWs 9.6% (95% CI 9.4–9.8); p = .20 (not statistically significant). - Phase 3 (Nov 2020–May 2022): NHBs 11.7% (95% CI 11.6–12.0) vs NHWs 10.7% (95% CI 10.5–10.9); statistically significant difference favoring higher unmet need among NHBs. - Trend analysis showed a significant upward trend for NHBs in the percentage needing but not receiving care: average percentage change (APC) 1.4% (95% CI 0.7–2.2), p < .001. No significant change over time for NHWs.

Findings demonstrate persistent and widening Black-White disparities in unmet mental healthcare needs during the COVID-19 pandemic. Despite elevated mental health burden across the population, NHBs experienced greater unmet needs and an increasing trend over time, likely compounding existing disadvantages in health and socioeconomic outcomes. These results underscore the necessity for targeted public health strategies to expand access, reduce costs, improve quality, and address social determinants of mental health for NHBs and other vulnerable groups.

The analysis indicates continued and widening disparities in unmet mental healthcare needs among non-Hispanic Blacks during the COVID-19 pandemic. The authors call for action at three levels: (1) Education—public health campaigns to improve knowledge, health literacy, and destigmatize mental illness and care-seeking among NHBs, along with provider education for culturally and linguistically appropriate care; (2) Policy—greater resource allocation to enhance coverage, infrastructure, screening/treatment capacity, telehealth, training of minority mental health professionals, and community/family-based interventions; (3) Research—rigorous evaluation of existing policies and interventions for impact and scalability, and development of community-based, culturally appropriate, technology-enabled, low-cost services. Continuous surveillance is recommended to monitor mental health needs and guide tailored interventions.