Structural Racism, Workforce Diversity, and Mental Health Disparities: A Critical Review

The Behavioral Health Service Corps: An Innovative Model for Workforce Development

The increased prevalence of behavioral health problems in the US is intensified by the critical shortage of providers in the field. The historical failure of behavioral health specialties to attract BIPOC students and workers limits leadership, access to quality care, and the generalizability of research findings. Most workforce development programs serve only those with earned graduate degrees. This report describes a service-learning program that is successfully attracting new graduates with bachelor's degrees and culturally diverse professionals into the behavioral health workforce.

Exploring the Widening Trend in Racial and Ethnic Differences in Youth Mental Health Service Use

OBJECTIVE

The authors examined trends in racial and ethnic disparities in youth mental health treatment for internalizing and externalizing conditions in the United States from 2002 to 2019.

METHODS

Using data from the Medical Expenditure Panel Survey-Household Component, the authors analyzed trends in mental health treatment between 2002 and 2019 for youths ages 5-21 years (N=139,242). Logistic regression models predicting treatment were adjusted for age and sex and also for health status, household income, insurance coverage, and geographic region.

RESULTS

The treatment rate for internalizing conditions grew faster for White youths than for Hispanic or Black youths, and this difference tripled (from 1.6 to 5.4 percentage points) from 2002 to 2019. For externalizing conditions, the treatment rate grew twice as fast for White youths compared with Hispanic youths and 50% faster relative to Black youths. Uninsured status was significantly and negatively associated with treatment for externalizing conditions (b=-0.928, SE=0.342) but not internalizing conditions (b=-0.440, SE=0.317). Family income was most strongly linked to treatment among Hispanic youths. For internalizing conditions, adjustments for health, household income, insurance status, and region explained 18% of the treatment gap for Hispanic youths but only 6% of the gap for Black youths in 2016-2019.

CONCLUSIONS

These findings highlight widening racial and ethnic disparities in youth mental health treatment. The demographic and socioeconomic factors associated with these disparities varied by type of condition. Addressing socioeconomic determinants alone is insufficient to ensure equitable access to mental health services. Tailored approaches considering clinical, cultural, and societal needs are essential to mitigate treatment disparities.

New local health officials: health departments' newest leaders

Introduction

The purpose of this descriptive study was to compare the demographics of new and experienced local health officials (LHOs) and the rurality and size of the local health departments (LHDs) they serve.

Materials and methods

Descriptive characteristics of new LHOs and experienced LHOs were compared between two national public health workforce datasets: the 2021 Public Health Workforce Interest and Needs Survey (PH WINS) and the 2022 National Association of County and City Health Officials (NACCHO) National Profile of Local Health Departments study (Profile). The 2022 Profile study was fielded from July through September 2022 from a population of 2,512 LHDs across the US. The 2021 PH WINS survey was fielded to a nationally representative sample of state health Agency-Central Offices and LHD staff. Descriptive characteristics were computed comparing new LHOs with experienced LHOs based on work status, age, gender, race/ethnicity, education level, rurality and size of the jurisdiction.

Results

Approximately 30% of all LHOs are new (<2 years of experience) with no difference among jurisdiction sizes or rurality. Compared to experienced LHOs, a slightly greater proportion of new LHOs identified as Native American, Black, or Asian, and are younger.

Discussion

Providing professional supports to new LHOs and addressing recruitment and retention challenges facing public health leadership can help ensure that the senior executive level of the public health workforce reflects the diverse and varied populations that it serves.

Trauma, Mental Health Workforce Shortages, and Health Equity: A Crisis in Public Health

The global mental health workforce is facing a severe crisis marked by burnout, secondary trauma, compassion fatigue, and workforce shortages, with disproportionate effects on marginalized communities. This paper introduces the Integrated Workforce Trauma and Resilience (IWTR) Model, a comprehensive framework to understand and address these interconnected challenges. This study employs a conceptual, documentary analysis approach to examine the challenges faced by mental health workers, particularly trauma, burnout, and workforce shortages. By synthesizing existing qualitative and quantitative studies, the research identifies recurring themes and provides recommendations for policy reform to improve workforce sustainability and equity. Using a thematic synthesis of 75 peer-reviewed articles, conceptual papers, and policy reports published between 2020 and 2025, alongside foundational theoretical works, the IWTR Model integrates five theoretical perspectives: trauma-informed care, Conservation of Resources Theory, Intersectionality Theory, the Job Demands-Resources Model, and Organizational Justice Theory. The analysis identifies three dimensions: the impact of trauma on mental health professionals, organizational and systemic factors influencing workforce retention, and strategies to build resilience through policy and education. The findings reveal how secondary trauma, burnout, and systemic inequities interact to undermine workforce stability and access to care. The IWTR Model emphasizes that individual-level interventions will be insufficient without addressing structural issues, such as workload inequities, lack of leadership diversity, and underfunding. This model offers a roadmap for systemic reforms to strengthen workforce resilience, improve retention, and advance global equity in mental health care systems.

The experiences of culturally and linguistically diverse health practitioners in dominant culture practice: a scoping review

Increasing the proportion of culturally and linguistically diverse (CALD) health practitioners is identified as one strategy to address healthcare disparities that individuals from minority or under-represented backgrounds experience. However, professional and institutional cultures and structures are known to contribute to the challenges for CALD practitioners who work in dominant culture practice contexts. This scoping review used the theory of Legitimate Peripheral Participation to describe and interpret literature about the experiences of CALD health practitioners in view of informing strategies to increase their representation. A systematised search was conducted across four allied health, medicine and nursing databases. Following abstract and full text screening, articles which fit the inclusion criteria (n = 124) proceeded to data extraction. Categories relating to the experiences of practitioners were extracted, and three themes were identified that were subsequently theoretically interpreted: Discrimination, Consequences and Hierarchy. Discrimination functioned as a barrier to CALD practitioners being legitimised and able to participate equally in healthcare practice, retaining their position at the periphery of the practice community; Consequences reinforced this peripheral position and further impeded legitimation and participation; and Hierarchy was maintained through structures that reinforced and reproduced these barriers. The findings summarise how these barriers are reinforced through the intersections of professional and racial hierarchies, and highlight a need for strategies to address discrimination and structures that marginalise CALD practitioners' identity, practices and participation in their health professional communities.

The Impact of the COVID-19 Pandemic on the Mental Health of African, Caribbean, and Black (ACB) People in Canada

The COVID-19 pandemic disproportionately affected African, Caribbean, and Black (ACB) people in Canada. Despite higher SARS-CoV-2 exposure risks, likelihood of being quarantined, and risk of severe disease outcomes, little is known about the pandemic's effects on this community's mental health. This study aims to identify factors associated with changes in ACB Canadians' mental health during the pandemic and provide guidance for improved access to mental health resources. Data was collected from May to July 2021 using a cross-sectional, national, online survey. Eligible participants for this community-based study were ACB adults residing in Canada. Survey measures included demographics, pandemic-related experiences, mental health status, and access to mental health services. Bivariate analyses and multinomial logistic regression examined associations between variables. Among the 1,556 participants, 25.4% reported improved mental health and 33.1% reported worsened mental health since the pandemic's onset. Improved mental health was associated with younger age, receiving at least one pandemic-related benefit, and living in a home that became safer. In contrast, worsened mental health was associated with younger age, working less, the pandemic having a major impact on ability to pay bills, not receiving pandemic-related benefits, home becoming less safe, and increased substance use. Barriers to accessing mental health services included difficulty getting an appointment, cost, pandemic measures, and lack of culturally competent care. These insights underscore the positive impact of pandemic-related emergency relief, the challenges in accessing mental health services, and the gaps in culturally competent mental health care.

Factors related to help-seeking and service utilization for professional mental healthcare among young people: An umbrella review

The aim of this umbrella review is to summarize evidence on factors that influence help-seeking and service utilization for professional mental healthcare among young people ages 0-30. The CINAHL, Cochrane, Epistemonikos, MEDLINE, PsycINFO, PubMed, and Web of Science databases were searched in December 2023 for systematic reviews in English. The search yielded 26 eligible reviews, all of which are medium or high quality. Primary study overlap was rare. Using an established framework, we organize intrapersonal (n = 37), interpersonal (n = 14), institutional (n = 9), community (n = 7), and public policy (n = 6) factors. The most frequently reviewed factor at each level is trust of professionals (intrapersonal), close others' support for treatment (interpersonal), cost (institutional), availability (community), and insurance (public policy). Stigma is widely referenced (18 reviews) and classified as multi-dimensional. Narrative synthesis reveals population-specific variability (e.g., rural, racial/ethnic minority, refugees, immigrants) in the importance of many factors. To develop interventions and healthcare systems sensitive to young people's needs, we recommend promoting stigma-reduction campaigns, and targeting trustworthiness, affordability, anonymity, accessibility, and mental health literacy. Identifying commonalities and differences across populations and contexts assists in the design of nuanced and efficient treatment delivery systems for young people, who are at a critical time for their mental health.

Why do Stayers Stay? Perceptions of White and Black Long-Term Employees in a Community Mental Health Center

Previous research has focused on factors influencing turnover of employees in the mental health workforce, yet little research has explored reasons why employees stay. To facilitate retaining a diverse mental health workforce, the current study aimed to elucidate factors that contributed to employees' tenure at a community mental health center (CHMC) as well as compare these perceptions between Black and White employees. Long-term employees (7 years or more) from one urban CMHC (n = 22) completed semi-structured stayer interviews. Using emergent thematic analysis, stayer interviews revealed four major themes for why they have stayed at the organization for 7 years or more: (1) work as a calling, (2) supportive relationships, (3) opportunities for growth or meaningful contribution, and (4) organization mission's alignment with personal attributes or values. Comparison between Black and White stayer narratives revealed differences in their perceptions with work as a calling and opportunities for growth and meaningful contribution. Guided by themes derived from stayer interviews, the current study discusses theoretical (e.g., job embeddedness theory, theory of racialized organizations, self-determination theory) and practical implications (e.g., supporting job autonomy, Black voices in leadership) in an effort to improve employee retention and address structural racism within a mental health organization.

Association Between Discrimination and Depressive Symptoms Among Hispanic or Latino Adults During the COVID-19 Pandemic: Cross-Sectional Study

BACKGROUND

Discrimination and xenophobia toward Hispanic and Latino communities increased during the COVID-19 pandemic, likely inflicting significant harm on the mental health of Hispanic and Latino individuals. Pandemic-related financial and social instability has disproportionately affected Hispanic and Latino communities, potentially compounding existing disparities and worsening mental health.

OBJECTIVE

This study aims to examine the association between discrimination and depressive symptoms during the COVID-19 pandemic among a national sample of Hispanic and Latino adults.

METHODS

Data from a 116-item web-based nationally distributed survey from May 2021 to January 2022 were analyzed. The sample (N=1181) was restricted to Hispanic or Latino (Mexican or Mexican American, Puerto Rican; Cuban or Cuban American, Central or South American, and Dominican or another Hispanic or Latino ethnicity) adults. Depression symptoms were assessed using the 2-item Patient Health Questionnaire. Discrimination was assessed using the 5-item Everyday Discrimination Scale. A multinomial logistic regression with a block entry model was used to assess the relationship between discrimination and the likelihood of depressive symptoms, as well as examine how controls and covariates affected the relationship of interest.

RESULTS

Mexican or Mexican American adults comprised the largest proportion of the sample (533/1181, 45.13%), followed by Central or South American (204/1181, 17.3%), Puerto Rican (189/1181, 16%), Dominican or another Hispanic or Latino ethnicity (172/1181, 14.6%), and Cuban or Cuban American (83/1181, 7.03%). Approximately 31.26% (367/1181) of the sample had depressive symptoms. Regarding discrimination, 54.56% (634/1181) reported experiencing some form of discrimination. Compared with those who did not experience discrimination, those who experienced discrimination had almost 230% higher odds of depressive symptoms (adjusted odds ratio [AOR] 3.31, 95% CI 2.42-4.54). Also, we observed that sociodemographic factors such as age and gender were significant. Compared with participants aged 56 years and older, participants aged 18-35 years and those aged 36-55 years had increased odds of having depressive symptoms (AOR 3.83, 95% CI 2.13-6.90 and AOR 3.10, 95% CI 1.74-5.51, respectively). Women had higher odds of having depressive symptoms (AOR 1.67, 95% CI 1.23-2.30) than men. Respondents with an annual income of less than US $25,000 (AOR 2.14, 95% CI 1.34-3.41) and US $25,000 to less than US $35,000 (AOR 1.89, 95% CI 1.17-3.06) had higher odds of depressive symptoms than those with an annual income of US $50,000 to less than US $75,000.

CONCLUSIONS

Our findings provide significant importance especially when considering the compounding, numerous socioeconomic challenges stemming from the pandemic that disproportionately impact the Hispanic and Latino communities. These challenges include rising xenophobia and tensions against immigrants, inadequate access to mental health resources for Hispanic and Latino individuals, and existing hesitations toward seeking mental health services among this population. Ultimately, these findings can serve as a foundation for promoting health equity.

Reorienting the focus from an individual to a community-level lens to improve the pathways through care for early psychosis in the United States

The implementation of coordinated specialty care in the U.S. over the past decade has led to the improvements of clinical and functional outcomes among individuals in the early stages of psychosis. While there have been advancements in the delivery of early intervention services for psychosis, it has almost exclusively focused on short-term change at the individual level. In light of these advancements, research has identified gaps in access to care and delivery of services that are driven by different levels of determinants and have the biggest impact on historically excluded groups (e.g., ethnoracial minoritized communities). Interventions or efforts that place an emphasis on community level (structural or sociocultural) factors and how they may influence pathways to care and through care, specifically for those who have been historically excluded, have largely been missing from the design, dissemination and implementation of early psychosis services. The present paper uses a structural violence framework to review current evidence related to pathways to care for early psychosis and the physical/built environment and conditions (e.g., urbanicity, residential instability) and formal and informal community resources. Suggestions on future directions are also provided, that focus on enriching communities and creating sustainable change that spans from pathways leading to care to 'recovery.' In all, this lays the groundwork for a proposed paradigm shift in research and practice that encompasses the need for an emphasis on structural competency and community-driven approaches.

A Practical Guide to Implementing Holistic Review during Surgery Resident Selection

Provider workforce diversity is a key component of improving healthcare quality and addressing healthcare disparities. Furthermore, the traditional approach of "score-centered" application metrics do not consistently correlate with meeting milestones in surgery, nor do they adequately predict a surgical resident's clinical strength and operative abilities. We present here an adaptable process by which surgical residency programs can identify their values and incorporate holistic review into their resident selection process to improve resident selection and physician workforce diversity.

Racial and Ethnic Disparities in COVID-19-Related Stressor Exposure and Adverse Mental Health Outcomes Among Health Care Workers

OBJECTIVE

Racial and ethnic disparities in exposure to COVID-19-related stressors, pandemic-related distress, and adverse mental health outcomes were assessed among health care workers in the Bronx, New York, during the first wave of the pandemic.

METHODS

The authors analyzed survey data from 992 health care workers using adjusted logistic regression models to assess differential prevalence of outcomes by race/ethnicity and their interactions.

RESULTS

Compared with their White colleagues, Latinx, Black, Asian, and multiracial/other health care workers reported significantly higher exposure to multiple COVID-19-related stressors: redeployment, fear of being sick, lack of autonomy at work, and inadequate access to personal protective equipment. Endorsing a greater number of COVID-19-related stressors was associated with pandemic-related distress in all groups and with adverse mental health outcomes in some groups; it was not related to hazardous alcohol use in any of the groups. These associations were not significantly different between racial and ethnic groups. Latinx health care workers had significantly higher probabilities of pandemic-related distress and posttraumatic stress than White colleagues. Despite greater exposure to COVID-19-related stressors, Black, Asian, and multiracial/other health care workers had the same, if not lower, prevalence of adverse mental health outcomes. Conversely, White health care workers had a higher adjusted prevalence of moderate to severe anxiety compared with Asian colleagues and greater hazardous alcohol use compared with all other groups.

CONCLUSIONS

Health care workers from racial and ethnic minority groups reported increased exposure to COVID-19-related stressors, suggestive of structural racism in the health care workforce. These results underscore the need for increased support for health care workers and interventions aimed at mitigating disparities in vocational exposure to risk and stress.

Narratives of heritage and legacy: Child and adolescent mental health trainees portrayed

Objectives

We sought to embellish a child and adolescent mental health space by creating and displaying a large painting imbued with meaning and symbolism specific to the field. In it, we featured a broad array of trainees in the disciplines of child psychiatry, psychology, and social work. We used the portraiture sessions as opportunities for participants to reflect on their professional trajectories and developmental progression.

Methods

The lead author painted Heritage and Legacy, a 6 × 4 ft oil painting of 15 trainees (8 women), between February 2020 and December 2022. Each studio sitting lasted approximately four hours and included an in-depth interview that was recorded and transcribed for qualitative analysis. We used narrative inquiry as our analytic approach, a method that attends to unique stories and aims to make meaning out of individuals' life experiences.

Results

We organized our analytic framework chronologically: (1) Heritage (past influences); (2) Becoming (the current process of professionalization); and (3) Legacy (reflections about the future). Through these life stages, we consider findings from three complementary vantage points: (1) the unique methodology of using a collective portrait as the basis for a qualitative study using narrative inquiry; (2) the participants' individual and collective trajectories of professionalization and professional identity formation; and (3) their transitions and legacy-including through mentorship and generativity, as much as through concrete objects and places, such as the oil painting itself and the space in which it will permanently reside.

Conclusions

The lengthy process of creating an oil canvas depicting a multidisciplinary group of professionals in training proved a powerful vehicle for self-reflection by those portrayed. It has yielded insights of broader relevance to the training and education of the next generation of practitioners.