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Access to mental health treatment is essential for improving the lives of individuals and the communities they live in. The risk of suicide, substance abuse, family conflict, employment issues, and legal issues can all be lowered by improving access to this resource. Despite all of the benefits associated with mental health care, access to mental health care fails to reach the people and communities that need it most. “Poverty is a common experience for many children and families in the United States” (Hodgkinson & Lewin, 2017). “Living in a poor or low-income household has been linked to poor health and increased risk for mental health problems in both children and adults that can persist across the life span” (Hodgkinson & Lewin, 2017). In the U.S. the rate of poverty is greater than many industrialized nations (Hodgkinson & Lewin, 2017). Because of this, there is a rising demand to develop mental health care models that are tailored to the needs of those vulnerable people and communities who are disproportionately affected by poverty (Hodgkinson & Lewin, 2017).

                The lack of access to mental health treatment in the U.S. is especially marginalizing for people from low-income communities. This is partially because the majority of people from low-income communities in the U.S. who are disproportionately affected by poverty are people of color. “Although the largest number of poor and low-income children are white, minority children are disproportionately affected, particularly African American, American Indian, and Hispanic children” (Hodgkinson & Lewin, 2017). People of color living in poverty in the U.S. are the most likely people to be referred to mental health agencies for services, even though they are the least likely people to receive mental health services. “Currently, African American males lead all other race and gender groups in incarceration rates, new HIV infections, homicide deaths, poverty rates, and diagnosed learning disorders. Often the complex pathways that lead African American young men to negative outcomes include missed opportunities by both schools and community agencies to intervene with problematic behaviors at earlier ages” (Tucker & Dixon, 2009). This is often due to the fact that because many young African Americans in the inner city live below the poverty line, they are more exposed to dangerous levels of lead. Exposure to lead increases the likelihood of developing ADHD. “Boys are diagnosed with ADHD almost twice as often as girls across all races, and those who are non-white (both Hispanic and African American) are the most often diagnosed of all groups” (Tucker & Dixon, 2009). “Also, because African American youth can experience significant delays between symptom onset and initiation of services, the array of ADHD symptoms seems to be more severe than in other race and gender groups” (Tucker & Dixon, 2009).

Not only do families in rural areas have to travel long distances to access mental health services, but low-income families in general are up against many other barriers that impede their access to mental health services. “The effects of these barriers are exacerbated by the daily stressors and demands of living in poverty that can keep families from prioritizing mental health needs” (Hodgkinson & Lewin, 2017). One of the barriers to effective treatment for young African American men from low-income communities after they are enrolled in mental health services is bias in their assessment. “lack of insurance or type of ‘carve out’ and quantity of mental health services provided under managed care plans can prevent children and families from accessing needed mental health care services” (Hodgkinson & Lewin, 2017). Living in poverty, while dealing with the stigma of seeking mental health care can be enough to keep families from seeking mental health services leading to more self-doubt, blame, and self-loathing. On top of this mental health clinic hours are normally during the day which does not provide accommodation for people with low-wage shift positions.

Everybody needs access to mental health services, and there are a growing number of programs aiming to address some of the issues which effect low-income communities the most. Some of those solutions have already been implemented, and utilized successfully to address those issues effecting low-income communities. “Integrated behavioral health care within the patient-centered medical home (PCMH) is a particularly promising strategy to reduce barriers and increase access to mental health care across pediatric populations. The central characteristics of the PCMH, including a patient-centered orientation, comprehensive and coordinated team-based care, continuous access, and a system-based approach, reflect core elements that lead to improved mental health outcomes in primary care settings” (Hodgkinson & Lewin, 2017). This particular strategy can decrease the stigma associated with receiving mental health services as well as “facilitate better communication and collaboration between medical and behavioral health providers” (Hodgkinson & Lewin, 2017). Another solution to tackling the lack of access to mental health services is “Care coordination” (Hodgkinson & Lewin, 2017). “Care coordination involves the organization of patient care activities, often facilitated by information exchange between clinicians involved in a patient’s care, ensuring that services provided across settings (eg, school and primary care) are well coordinated” (Hodgkinson & Lewin, 2017).

In a personal story about a person with post-traumatic stress disorder (PTSD) and depression, some of the key difficulties facing people from low-income communities are highlighted. Trying to get help from multiple mental health facilities, this person had a hard time getting an evaluation let alone steady mental health treatment. “Not being able to hold down a job, fleeting friendships, problems with my family, not having a stable place to live, the list goes on and on. My life was slowly, but surely, falling apart right in front of my eyes. And there was nothing I could do about it but grit my teeth and try to get through it. Being poor and uninsured during most those years made it impossible for me to ever get help. And at the time, I didn’t have the resources or support system to reach out to a support group or see a low-income therapist” (NAMI). Not being able to hold down relationships and jobs are common struggles for people from low-income communities. Compounding these difficulties on top of having a mental illness can make people turn to self-medication to treat themselves. “Most days, I sat at home alone watching TV or playing video games. Other days, I sought relief from the bottle or from drugs” (NAMI). This person’s story also brings up a good point about the label associated with mental health. “Everyone around me passed it off as me being ‘crazy’ but I knew I was sick, I could feel something wrong. I knew that this was not normal. I was diagnosed with severe PTSD and bipolar disorder. I got the bipolar from one of my parents which put me in an already fragile state so the abuse I endured throughout my life made it really easy for me to develop PTSD” (NAMI). This is why early access to mental health services is so crucial for child development especially with the development of children from low-income communities.

Mental health problem is known to be caused by environmental issues, which affected a lot by social stratification. There are a lot of factors which determine social stratification, such as sex, race, social class, nationality.. and I would focus on sexual minority; gender and sexual orientation issue.
It is undeniable truth that social minorities are more likely to get mental health issues, as they experience a various discrimination. Especially it comes severe to sexual minorities; LGBTs. Those who identify themselves not as they were named to, how they are more likely to get mental issues?

I interviewed a TCC student who asked be named — I’ll call her as ‘anon.’ Anon is an international student and she has been suffering from depression and anxiety issues caused by her homophobic family. Her parents were very religious people and when they found out that their daughter was lesbian, they tried to send her to the hospital because they thought that her sexual orientation is something to be fixed. She was sick of homophobic atmosphere of her country and came to the U.S. with her dreams that it would be a better place for her, but she said she was deeply frustrated when she met her homestay host family. When they talked about Bruce Jenner, who came out as a transgender woman and is Caitlyn Jenner now, they made a big sigh and terrible comments about her. She said she didn’t feel safe there and felt terrified, because she already had a traumatic experience with her family. At the end of the interview, she added, “My dream is to be living in somewhere I feel completely safe and comfortable. That’s all I need.”

As we have seen, this society is not a safe place for LGBTs. According to “Mental Health Promotion for Gender Minority Adolescents,” “for gender minority teens, the risk of poor mental health and suicide is greatly amplified. Gender minority adolescents report higher rates of depressive symptoms, suicide attempts, and self-harm compared to their cisgender (i.e., individuals whose gender identity is congruent with their assigned sex at birth) peers (Eisenberg et al., 2017). Three recent studies of gender minority adolescents, including clinical and non-clinical samples, found similarly high rates of suicidal ideation (approximately 60%) and suicide attempts (approximately 33%) (Bechard, VanderLaan, Wood, Wasserman, & Zucker, 2017; Eisenberg et al., 2017; Veale, Watson, Peter, & Saewyc, 2017). In addition, studies demonstrate that gender minority adolescents have higher rates of depression and anxiety (Reisner, Katz-Wise, Gordon, Corliss, & Austin, 2016), eating disorders (Connolly et al., 2016), autism spectrum disorders (de Vries, Noens, Cohen-Kettenis, van Berckelaer-Onnes, & Doreleijers, 2010; van der Miesen, Hurley, & de Vries, 2016), and substance abuse (Day, Fish, Perez-Brumer, Hatzenbuehler, & Russell, 2017; Reisner, Greytak, Parsons, & Ybarra, 2015) than cisgender adolescents.”

When it come to transgender, things are even worse; according to “Mental Health and the Transgender Population,” studies have consistently shown an increased rate of SI and suicide attempts (SA) in the TGNC population, ranging anywhere from 25% to 76% ( Clements-Nolle et al., 2006 ; Grant et al., 2001; Kenagy, 2005 ; Krehely, 2009 ; Nuttbrock et al., 2010 ; Xavier, Honnold, & Bradford, n.d. ). The wide variation in rates is likely due to different definitions of SI/SA and small sample sizes in many studies. A large community survey by the National Center for Transgender Equality and the National Gay and Lesbian Task Force found a disturbingly high rate of suicide attempts, with 41% of the 6,500 TGNC respondents reporting a history of attempts ( Grant et al., 2011 ).

But also, there are a lot of journals that found out family acceptance is the key for lgbt adolescents and young adults to avoid mental health and stay in the healthy life. In “Family Acceptance in Adolescence and the Health of LGBT Young Adults”, a recent study assessed the relationship between family rejection in adolescence and the health of LGBT young adults (Ryan, Huebner, Diaz, & Sanchez, 2009). That study showed clear associations between parental rejecting behaviors during adolescence and the use of illegal drugs, depression, attempted suicide, and sexual health risk by LGBT young adults. It means that the family or the society accepts those minorities and embrace them, mental health issues that a lot of minorities had to be through could be disappear. Social acceptance is the important message for the mental health issues, and if the society could be more open, we could save the people who didn’t have to be passed away. The legislation of a strong anti-discrimination law can prevent discrimination too. In many countries, a lot of LGBTs are not protected by law. In U.S, they are officially protected by law but still too much discrimination is out there. Schools, public organizations could be helpful by making strong rules against discrimination.

What is PTSD?

PTSD stands for Post-Traumatic Stress disorder. It’s the mental health condition that happened when a person experience or witness the traumatic event. For example, experienced into terrible car accident, experienced abusive in children hood or unexpected loss the love one (Mayo, 2019).

The symptoms that happen from the traumatic events that patients went through in their life effect their diary routine. The symptoms following:

• Re-experience symptoms such as flashback or nightmare.
• Avoidance symptoms. The patients avoid talking, going to places, or meeting people that remind them of the traumatic event.
• Arousal and reactivity symptoms including difficulty sleeping and anger issue. Some patient might be very easy to startle or feel tense.
• Cognition and mood symptoms. Patients might lose their memories about the important part of the traumatic events. Furthermore, having negative though about themselves and people around them as well.

The lack of sleeping cause person to lose their ability to work moreover, avoidance and cognition and mood symptoms may cause the patients to lose the connection between themselves and family or friends. Likewise, some patients cannot live their life happily and they solve it by drinking which later a person become alcoholic. Furthermore, many patients’ life can be forever change because of Post-Traumatic Stress disorder.

This diagnose could happens to anyone especially, people that work or live in the environment that have a lot of risk to experience the traumatic events such as war veterans. At the war, veterans have to risk their life almost every day therefore, they experience and witness seeing their friends hurt or even death body. In other words, their environment causes PTSD. The studied show that male and people in age around 35-64 are tends to experience PTSD more than others (Sripada, 2017). Some of veterans who deployed to Iraq and Afghanistan experiences Post-Traumatic Stress disorder then became homeless because they did not receive enough support after the events (DeAngelis, 2003). For example, Herold Noel had served in the U.S. Army’s 3rd Infantry Division at Baghdad. Herold was struggle with Post Traumatic Stress Disorder. His mental health was an issue for him to started new job and support his family. Herold Noel slowly became homeless “He started living out of the back of his jeep when most of his clothes and all of his military medals were stolen at a homeless shelter” (Cosgrove-Mather, 2005).

It is heartbreaking to realize the individuals who risk their life and being separate from family to serve for our country in the danger zone experienced PTSD that changed their life forever. However, many of them did not receive the treatment that they should be receive from sacrificed for our nation “When the war in Vietnam washed up the first wave of veterans in need of shelter — the Department of Veteran Affairs had no homeless programs at all.” (Cosgrove-Mather, 2005). Even though, nowadays may have better program to help homeless veterans but the amount of these program still cannot cover all of veterans that needed help. (Cosgrove-Mather, 2005).

Post-Trauma Stress disorder is unlike other mental health issues that the patients would like to share about their trauma events at the group therapy while one of the PTSD symptoms is avoidance which is some patients avoid talking or explaining about the trauma. Therefore, professional psychologist is the best solution for the patients, but the cost is also expensive. The average price is around 2,100 dollars for the first year and the price could go up to 4,100 dollars for the average price if the patients need the special treatments which some patient might cannot afford it. Since, veterans already have PTSD program such as Nation Center for PTSD. However, it is not every PTSD patient are in the military. Thus, focusing on insurance could be one of the solutions. Underwriting of the insurance should not increase the price whether if the patients have the high risk of their mental health issue or not and it should be more affordable for these patients. Besides that, patient could start the self-treatment with their every routine. For example, take time to relax such as yoga. It “can activate the body’s relaxation response and ease symptoms of PTSD” (Smith, Robinson, &Segal, 2019). Avoid alcohol and drug because these could add more problems which bring you more stress (Smith, Robinson, &Segal, 2019). Eat healthy diet, “processed food, fried food, refined starches, and sugars, which can exacerbate mood swings and cause fluctuations in your energy” (Smith, Robinson, &Segal, 2019). Lastly, get enough sleep, even though the symptom may cause some patient to have difficult time to sleep but trying to listen to calming music, watch a funny show, or read something light and make your bedroom as quiet, and dark could possible make the patients fall asleep easier. (Smith, Robinson, &Segal, 2019). Most importantly, the better family members understand the condition the less risk of patients will get worse. Therefore, having the program for patient’s family to learn about the condition with any type of mental issues will be help the patients gets better with their condition. I believe that the first treatment that people with mental health issues that is not only PTSD patients want to receive is a family first aid treatment.

Of the many factors that can lead to mental illness, stress is about as environmental of a cause as it gets. Stress could be a result of things like work, financial standings, and relationships. It is, however, important to understand that stress isn’t entirely negative. In the short run, stress is something that gets us moving. Stress is what motivates us to prepare for things like interviews and exams. It keeps us productive and on our toes, however, in extremes, stress can be the catalyst for mental illness. According to the National Institute of Mental Health, “With chronic stress, those same life-saving responses in your body can suppress immune, digestive, sleep, and reproductive systems, which may cause them to stop working normally”(“5 Things You Should Know About Stress”). In other words, stress can have effects that cover a broad range of health issues, including physical health. 

Although stress is often seen as a cause for mental health, it is also important to understand the effect in which mental health can have on one’s stress. The relationship between mental health and stress is actually cyclical in a way. According to the BioMed Research International, the mere stigma of mental illness can lead to worse effects of burnout(Mitake, T.). Burnout of course being a mental breakdown as a result of stress and exhaustion. Stigma, as they define it, “. . . is the misrecognition or unfounded recognition of individuals or groups with specific attributes”(Mitake, T.). In other words, stigma is when people place, often misplacing a belief that people have a mental illness. What this means is that the study is suggesting that the perception of mental illness is actually leading to burnout among groups and individuals.

So, what can be done about stress? It’s important for individuals to recognize long term stress so that people can work on dealing with it. According to the National Institute of Mental health, some of the signs that people can recognize include, “Difficulty sleeping, increased alcohol and other substance use, being easily angered, feeling depressed, and having low energy”(“5 Things You Should Know About Stress”). One of the ways in which people can deal with mental health is by getting exercise. Physical exercise can be extremely useful for dealing with stress, even if it’s in small periodic amounts. Another way in which individuals can deal with stress is by communicating with those who care about you. Being in touch with those that are comfortable with you communicating and bouncing your problems off of is a great way to better your mental health. Finally, sometimes it’s just a good idea to consult a professional. We often look at things like therapy as signs of weakness or flaw, however, if you can afford it, it’s always a great idea.

A lot of stress, as stated earlier, is going to be caused from one’s job. With this being said, good working conditions are extremely vital to reducing stress. In some cases, however, the working conditions are beyond poor quality. Arifa, a Bangladesh sweatshop worker, began working in sweatshops when she was 10 years old. During this time, she was working for about 100 taka a month. She has worked her way up to making 2200 taka a month for around 13-14 hours a day, but her wage is still extremely poor. As it’s stated, “After 20 years as a garment worker, Arifa earns more than Bangladesh’s minimum wage, but still less than a living wage”(“A Sweatshop Worker Tells Her Story”). On top of all of this, she has a family and they all live together in a poor quality slum. The work that she is doing isn’t just bad enough to have an effect on her mental health, but on her physical health as well. As it’s stated, “The work is exhausting and hard on her body, causing frequent pain, especially in the back”(“A Sweatshop Worker Tells Her Story”).