At the intersection of healthcare access and the delivery of equitable care, Dr. Martin Luther King Jr. never understated the reality of health disparity in American medical systems. In his words from 1966, speaking out against hospital segregation still prevalent at the time, Dr. King eloquently expresses how inequitable health practices result in lived consequences for communities of color and patients whose needs often go unrecognized. A sector that couldn’t speak more true to this need of leveling medical accessibility is mental health care. 

According to the National Alliance on Mental Illness (NAMI) one in every five adults experience mental illness every year in the U.S.; as well as 17 percent of all U.S. youth ages 6 to 17. (2) While daily mental health concerns, such as mental illness, can equally affect individuals across cultural and racial groups, mental health care is built with a deeper connection to social factors surrounding an individuals’ lived environment – from education and housing to racism and discrimination. When it comes to appropriate care, regulation and treatment tools, Black and Brown women, children, men and LGBTQIA identifying individuals have been historically excluded from fair, quality mental health services.  Although, racial hate crimes and police brutality against Black and Brown communities had been experienced for decades, it has taken governing medical bodies until the past few years to formally recognize racism as a harmful social construct and not a simple biological determinant. It was not until 2020 that the American Medical Association recognized racism as a public health threat. (3) Prior to also issuing an apology statement in 2020, regarding their support of structural racism in psychiatry, the American Psychiatric Association (APA) had already reported years of data on differences in services provided to Black and Brown communities versus white communities across the U.S.; in part as a result of perpetuating stigma and the lack of competent behavioral health care available for long-term care and treatment. (4) At present, access to racially and culturally-relevant mental health practitioners for people of color (POCs) continues to lack representation nationwide. According to the Bureau of Labor Statistics data from 2019, 70% percent of social workers and 88% of mental health counselors identified as white. (5) Representation in the field of psychological services should be valued as much as establishing inclusive practices built into treatment program design, research opportunities and education

As Dr. King showed by example, there is importance in treating healthcare equity as a collaboration between social activists, policy makers, health professionals and POC as well as non-POC communities receiving services in tandem. From this mindset, the Child Health Advocacy Institute (CHAI) continues to incorporate the voices of Black and Brown community members seeking mental health care. Created from a vision for advocacy and activism in a multi-disciplinary hospital setting, CHAI innovates programs promoting inclusive community engagement, data exploration, education and policy that include social determinants of health (SDH) affecting the diversity of our patients.  

As we take this month to specially recognize Dr. King’s legacy in health activism for Black and Brown communities and CHAI’s duty to honor that legacy, we briefly reflect on how CHAI has championed Dr. King’s vision for health care justice in the D.C. and Metro area as we start 2023.  

Quick Highlights:

• It is no secret health care coverage can be financially inaccessible as recurring appointments, treatments and referrals can leave families with several bills. As the D.C. population reflects, although POC residents outnumber white residents — “44.7% are African Americans, 41.2% are Whites, and 11.9% are Latinos/Hispanics,”– the median household income for white residents averaged $149,734, or three times that of Black residents in D.C., averaging $49,652. (6,7) In an effort to balance the cost of child behavioral health care for families receiving Medicaid or other D.C. insurers, joint work by CHAI staff led by Vice President of Community Engagement, Advocacy and Government Affairs, Tonya Vidal Kinlow with the DC Health Benefit Exchange Authority (DCHBX) allowed “children covered by a standard plan on DC Health Link will only have a $5 copay, with no deductibles, for outpatient mental health visits, including specialist visits, and no limit on the number of visits” and subsequent prescription medications. (8)
• Children’s National Hospital, ending 2022 by scoring high on the Human Rights Campaign Foundation’s 2022 Healthcare Equality Index, includes CHAI’s work as a LGBTQ+ Healthcare Equality Leader. Providing continued care for our LGBTQIA identifying clients we sustain the Youth Pride Clinic, Gender Development Program and Gender and Autism Program. Clinics include services from comprehensive primary and mental health care to LGBTQ youth and young adults, free behavioral health services, peer support, and other walk-in services. In 2023, these programs will increasingly accept Medicaid and other forms of private insurance to reach LGBTQIA youth across all racial and cultural intersections. (9)
• CHAI welcomes 2023 leading cross-sector partnerships that develop conversations between health partners and diverse school districts. Key work has been done by CHAI staff in our School Health Collaborative workgroup to establish partnerships with DC Health Matters Connect, DC MAP, DC Healthy Youth and Schools Commission, DC Career and Technical Education Community Board, the DC Coordinating Council on School Behavioral Health, Montgomery County Commission on Health, Maryland Assembly on School-Based Health Care and the National Coordinating Committee on School Health and Safety. (10)
• Completed in June 2022, CHAI successfully provided the Achieving Better Collaboration (ABC) for Children webinar series, to “discuss critical health and academic challenges for children in the Washington, D.C. region,” acknowledging space to speak on disparities experienced by POC families and schools during COVID-19. (10)

As we respect the legacy of Dr. King through this month and into the New Year, CHAI seeks to follow through on our  commitment to representative and equitable community engagement, data, education and policy for our region. We embrace the New Year continuing to leverage our multidisciplinary team, honor and listen to voices of the diversity across our CHAI staff and uphold the dignity in offering appropriate services to our communities of color in the DMV.

Local resources for LGBTQIA identifying Black and Brown youth and adult residents seeking inclusive, affordable mental health care in the District as listed below:

• Black Mental Health Alliance: https://blackmentalhealth.com/about-us/ 
• Mary’s Center: https://www.maryscenter.org/behavioral-health/ 
• Whitman Walker Health: https://www.whitman-walker.org/care-program/youth-mental-health/ 
• The Women’s Center DC or VA: https://thewomenscenter.org/ 
• SMYAL: https://smyal.org/ 
• S.O.M.E (Some Others Might Eat): https://some.org/services/healthcare/behavioral-health-services/ 
• La Clinica Del Pueblo: www.lcdp.org