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Isha Weerasinghe's picture

My mother was diagnosed with a mental illness years after arriving in the United States from Sri Lanka. Some of the doctors she saw believe her illness began as postpartum (maternal) depression that was unrecognized and undiagnosed years earlier. Since her diagnosis 30 years ago, my father and I have asked many questions and shared frustrations about the U.S. medical system, wondering why she was not diagnosed and treated early.

Because she came from a different culture, my mom was rarely treated with the respect and dignity she deserved in the U.S. medical system. Effectively treating her was more complex than simply seeking a provider who looked like her—a 1:1 match would not have helped. She needed to see a provider who understood her and could differentiate her needs from other women and from other women of color, including other Asian American and Pacific Islander women. I imagine my mom’s situation could have been different. Effective diagnosis and treatment cannot happen without important changes to our mental health system, which historically has not prioritized the diversity and richness of different cultures and healing practices.

For women living in low-income households, and for women of color generally, rates of maternal depression are twice as high as those of white women (25 percent vs. 12 percent). This disparity is due to such factors as fear and stigma of the health system and mental health at large, implicit bias in institutions, and a lack of understanding about what women of color need. Federal legislation like the MOMMA’s Act, introduced by Representative Robyn Kelly, could help bridge the divide between provider and patient on racism and cultural ignorance by creating regional Centers of Excellence to train providers on recognizing implicit bias and treating mothers as individuals. When systems achieve cultural respect (and in some cases, linguistic concordance), patients are more likely to trust their providers and ultimately, the system. However, there is more work to do.

Reforming Mental Health Services

Providers must fully understand the historical and cultural context that communities of color bring with them. They must be trained on patient-centered practices and place a high standard on respect for patients. My mother, like many others from different cultures, would never consider seeing a therapist. Providers need to learn about and understand effective services beyond traditional group or individual therapy. While advocates, providers, and the public must work to combat stigma in mental and behavioral health through awareness and education, providers must also promote alternative options for treatment, so that patients do not lose trust in the system.

Treatment for maternal mental health needs to be culturally responsive and inclusive of the family. Providers need tools to support mothers experiencing mental health stresses, along with their family unit.  We need to make delivery-system reforms in Medicaid to reimagine mental health service delivery, and increase access for populations in need of services. We must encourage all payers to expand reimbursement for mental health services for such non-traditional treatments as peer support and alternative therapies. To enable these types of innovations, we need parity implementation through oversight.

Because maternal mental health is a serious issue, we must implement policy and systems solutions that respond to and support women of color. The “system” must be defined beyond a medical institution, to meet mothers and parents where they are. When we see patients as individuals with distinct needs, confront implicit bias in the medical system, and reimburse for more expansive therapies, women of color will face fewer barriers to approaching or entering the mental health system.

Providing culturally relevant training for providers, implementing culturally responsive and family-inclusive treatment, and redefining the “system” beyond the formal medical institution are just a few of the steps we can take to help people like my mom feel comfortable accessing treatment and care.

This post was originally published at CLASP.

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