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Why behavioral health care remains a struggle for some Tennesseans

Originally published in The Tennessean, February 2023

Many Black Americans are at increased risk for depression, stress and anxiety. However, the idea of seeking behavioral health services like therapy and medication may not receive a warm reception in some African-American families.

This is especially true for many people raised in communities who for many reasons have historically “toughed it out” or only sought solace in religion, regardless of their health struggles. I firmly believe that religion and health care can harmoniously exist.

While prayer and meditation are good, a person may not be able to address their behavioral health solely through these practices.

And we can’t overstate the effect that racial injustice has had and continues to have on behavioral health. As we recently honored Black History Month, we must examine the history and continued stigmatization of behavioral health care in many Black communities.

This is just one reason why we incorporated behavioral health into our first annual health equity report and we’ll continue to expand that section over time.

The physical/behavioral health connection

Good behavioral health is important on its own. But it’s also important to recognize that behavioral health can affect the ability to effectively manage physical health problems.  The goal is to be well in mind, body and spirit.

Consider a diabetic who may experience depression or anxiety with the need for substantial lifestyle changes. If they’re not emotionally equipped to properly manage their diet or blood sugar, the challenge of keeping their diabetes in control is exacerbated.

We found that in the five years before the COVID-19 pandemic, most measures of substance abuse and behavioral health among adult Tennesseans worsened.

  • Nearly 1 in 5 adult Tennesseans had a mental illness in 2019, and almost 8% had depression.
  • The rate of drug overdose among Black Tennesseans rose by over 270% compared to about 58% for White residents since 2014.

That second statistic is particularly sobering. As we took a deeper dive into our data, we found that among our commercial plan members who identify as Black and are diagnosed with depression, only about 47% take antidepressants. This compares to nearly 61% in our White commercial membership. This shows we have an opportunity to help educate our neighbors about all behavioral health treatment options.  

Ensuring behavioral health care opportunities for all

At BlueCross, we understand that racial biases and inequities have led to disparities in housing, income, nutrition options, and access to health care. Transportation barriers, childcare, location and employment can make the pursuit of health care daunting and even compound stressors that contribute to behavioral health issues.

Not only can accessing behavioral health care be challenging but finding a therapist with whom a patient feels comfortable takes effort.

Those in need of behavioral health services should talk with their primary care providers (PCPs). They may be able to provide support and can make referrals when appropriate. Health plan websites or mobile apps can provide valuable insights as to what services are covered and the providers offering those services. Health plans also have behavioral health teams available for assistance.

Telehealth may be a good option for care as it offers increased flexibility for scheduling appointments and eliminates transportation-related barriers. And for those still grappling with stigma, telehealth can offer additional privacy over a waiting room. 

For those who don’t have a PCP or health insurance, a Blue of Tennessee medical center can also provide guidance for walk-ins interested in behavioral health care.

Culturally competent health care should be a common goal for providers and insurers. We must be intentional about it. We all benefit from a better understanding of the unique behavioral health challenges that our neighbors face.

About Dr. Andrea Willis, SVP, Chief Medical Officer

A photo of the authorDr. Willis ensures that all clinical initiatives and quality endeavors support the needs of our members, and contribute to the overall health and well-being of our communities.

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