People who cannot access the mental health care services they believe they need are said to have unmet mental health care needs. Numerous potential causes for this gap between need and services have been previously studied – from costs and stigma to access and accessibility. However, new research published in the journal HSR by Alang et al indicates that factors outside the health care system, in particular exposure to police brutality, can also contribute.
In the article, “Police brutality and unmet need for mental health care,” Alang and colleagues find that people who are exposed to policy brutality are also likely to experience unmet needs for mental health care. In addition to demonstrating that the causes of unmet mental health care go beyond factors like cost and access, the authors also show that the connection persists even when the victims of police brutality agree that such actions were necessary.
Speaking to the research’s potential impact, the authors state, “Given that police brutality is associated with greater odds of unmet need for mental health care, identifying and addressing barriers to psychiatric care that might be common among populations disproportionately experiencing police brutality is important for reducing unmet need and improving mental health status.”
The authors are clear that these aren’t causal relationships – policy brutality does not by itself cause unmet needs - rather they illustrate how interactions with one social system affect trust and belonging in other systems. In doing so, they present research that is both nuanced and layered, also considering the effects of racism, respect, and trust. Read the full article here.
In an accompanying commentary, Glasser et al. provide important historical and theoretical context for the findings. The commentary further discusses the role of institutional racism and its impact on trust between people and institutions:
“…for racialized minorities -- negative experiences in institutional settings likely reinforce the notions that institutions in general are not intended for them and cannot be trusted, and that they need to be hypervigilant or ‘on guard’ in these surroundings. The origins of this dynamic appear deep seated and embedded within the larger framework of structural racism, which has differentially restricted Black people’s access to goods, services and opportunities…”
Considering the ways that historic experiences and context shape the way individuals perceive the world, the commentary similarly concludes that what erodes trust in one space – police brutality – can have implications in other settings, like health care. People who are mistreated and disrespected in one social context are therefore likely to distrust and avoid other, similarly structured environments, particularly when there are histories of systemic racism that link the two. The study by Alang et al and accompanying commentary are important for clinicians and researchers to consider when attempting to address existing health disparities in access to and use of health care services. Both appear in the current issue of HSR.