Marginalized Communities and Accessing Mental Health Care

Louise Hartnett
Published: 02/09/2026 | Updated: 03/19/2026
Authored by: Louise Hartnett, B.A.
Edited by: Jemma Strain, B.S. Psychology
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Although poor access to mental health care is a global phenomenon, some groups of people are more impacted than others. Not only do these groups face greater social and financial barriers to accessing care, but they also face stigma and systems that fail to understand their experiences.1 

These marginalized communities include racial and ethnic minorities, those who identify as LGBTQ+, rural and low-income families, immigrants, refugees, and indigenous populations.

To reach true equity in mental health services, we must look through a human rights lens. This calls into question what services exist, how they operate, and whether they promote principles of autonomy, choice, and true well-being.1 

This article aims to help you better understand the issues that marginalized communities can face when accessing mental health care. This includes discussing:

  • The various mental health disparities that marginalized groups can face
  • What can be done to help close these gaps
  • Where to find professional, inclusive mental health support
Women in colorful African dresses representing marginalized communities and mental health care

Barriers to Care in Marginalized Populations

The barriers faced by marginalized communities seeking mental health care are numerous. Things like stigma, misinformation, lack of inclusivity, Eurocentricity, and high costs crop up for many groups. Let’s take a look at how these factors affect different groups in more detail.

Racial and Ethnic Minority Mental Health

Evidence suggests that black and minority ethnic communities are at a disproportionately greater risk of experiencing mental health conditions than other groups.2 Further, once they are receiving care, black and minority ethnic people often experience biases and discrimination that impact their treatment.2 

A lack of cultural understanding might contribute to the underdiagnosis or misdiagnosis of people from these communities. Language and the presentation of symptoms may differ between healthcare providers and people from racial and ethnic minority groups.3 

For example, certain ethnocultural groups may describe mental distress in terms of physical symptoms. Therefore, white clinicians might misdiagnose or suggest inappropriate treatments if they don’t understand that the language being used has different meanings for people belonging to different cultures.4 

Discrimination in mental health services can be seen in the treatments offered. For instance, research finds that black and minority ethnic people are less likely to be referred to talking therapies and more likely to be given medication.2 Furthermore, African American people are more frequently diagnosed with schizophrenia compared with white people with the same symptoms.5 

Additionally, healthcare tends to take a Eurocentric approach, which doesn’t take into account how racial, cultural, and religious factors may impact illness and recovery.2 This indicates a lack of culturally competent care, which we’ll explore more later.

LGBTQ+ Mental Health Access

Lesbian, gay, bisexual, transgender, and queer people are more than twice as likely to experience a mental health condition compared to heterosexual people. They also have less social support, greater rates of poverty and unemployment, and are at a larger risk of violence than their heterosexual counterparts.6 

Further, there is a vicious cycle whereby LGBTQ+ people are at greater risk of depression and post-traumatic stress disorder, but a fear of judgment often keeps them from accessing help.7 

Many LGBTQ+ people report that stigma and discrimination prevent them from accessing healthcare, noting that they frequently experience disapproval and abuse in clinical settings.6,7

Rural and Low-Income Communities Access

A significant socioeconomic barrier to therapy and mental health care is living in a rural area. In the US, rural people experience large disparities in mental health outcomes, even though the prevalence of mental health conditions is similar to that in cities.8 For example, rural communities have a higher suicide rate than urban areas.9 

Due to a lack of trained mental health providers and reduced access to services, people living rurally receive mental health treatment less frequently.8 Plus, research finds that, compared to urban areas, rural areas have 20% fewer primary care providers.9 

The barrier of living rurally also intersects with racial and ethnic disparities. Research suggests that although stigma is a well-documented issue affecting rural communities, it’s more pronounced among racial and ethnic minorities. This could be because mistrust is so much greater in these communities, and mental health treatment is seen as less acceptable.8 

Additionally, low-income families are at greater risk of mental health conditions but are also less likely to be connected with specialized and sufficient mental health treatment.10 Children and families living in poverty face several barriers that reduce access to and engagement with services, resulting in poorer treatment outcomes. Practical barriers include long travel distances, lack of insurance, and shift work, which make it difficult for low-income families to attend appointments.10 

There are also social barriers, involving stigma. For instance, parents raising children in poverty have real fears that they’ll be labeled “crazy” and have their children taken away. These fears can cause people to rely on their own coping skills or family support networks instead of accessing services.10 

Immigrant and Refugee Mental Health Care

Early mental health care should be a priority for displaced people, as there are many migration-related stressors that can worsen mental health. Although statistics vary, about one in three asylum seekers and refugees experience high rates of depression, anxiety, and post-traumatic stress disorder (PTSD).11 

Although immigrants from Africa, Asia, and Latin America have equal or greater need for mental health services, studies show that they use them less than nonimmigrants.12 

Refugees and asylum seekers may be hesitant to seek mental health support due to fears that there’s no treatment, cultural values around remaining silent, and worrying that it would interfere with housing or jobs. Language differences and insurance issues can also be barriers to access.11 

Cultural factors can also act as barriers to accessing mental health care. Research identifies stigma as the most commonly reported barrier, as well as traditional beliefs.12 Traditional beliefs, such as the Iranian emphasis on spirit, may clash with medical practitioners’ emphasis on medication.12 

Indigenous Populations and Mental Health Care

2% of the US population identifies as having American Indian or Alaska Native heritage. This group has a life expectancy that’s 4.4 years below the rest of the US and the highest poverty rate of any ethnic group. Further, Indigenous American people are disproportionately affected by mental health conditions, including substance use disorders, PTSD, suicide, and attachment disorders.13 

These mental health conditions have been directly linked to the intergenerational trauma inflicted upon indigenous people through forced removal and the separation of children from their parents and cultural practices. Yet, despite high rates of mental health conditions, indigenous groups have low use rates of services.13 

Traditional healing systems, focused on balancing mind, body, and spirit, are important to indigenous communities, but are not sufficiently integrated into their healthcare. Alongside this lack of cultural competence, barriers for indigenous groups include cost, stigma, mistrust, and lack of awareness of services.13 

Improving Mental Health Equity

Removing the barriers faced by marginalized communities means moving away from a one-size-fits-all health model. Mental health services must integrate new viewpoints and approaches that recognize people’s barriers, cultures, and identities.

So, improving mental health access for underserved populations doesn’t just mean expanding services; those services must also feel relevant and safe. Below, we consider some methods of increasing access and improving the quality of care. 

Culturally Competent Therapy

The idea of cultural competence arose in reaction to systemic inequality in mental health care. It emphasizes the need for healthcare providers to be aware of and responsive to the cultural backgrounds and perspectives of the people they support.14 

Community-based mental health programs might be better at providing culturally competent care if they are created in a person-centered way. This means that the care provided respects individual needs, preferences, and values, and that the people seeking care are guiding decisions.14 

Cultural competence means that practitioners:2,14 

  • Engage with self-exploration and self-reflection about their own culture, power, stereotypes, and openness to other ways of being (cultural humility).
  • Improve their ability to recognize symptoms, as they may be expressed differently across cultural groups.
  • Have a better understanding of the cultural and religious beliefs of black and minority ethnic communities and how these may impact behaviors and beliefs around mental health.
  • Understand how the losses and traumas experienced by refugees and migrants can impact mental health.
  • Develop their approaches to be holistic and encompassing of mental health, physical health, religious beliefs, and cultural practices.
  • Honor the beliefs, customs, and values of the people they care for.

Queer-Affirmative Services

Cultural stigma impacting mental health can also be considered when improving access and treatment for the LGBTQ+ community. Care that is culturally competent for the LGBTQ+ community aims to provide targeted and equitable care that doesn’t discriminate or stigmatize.15 

Experts suggest culturally competent services will:15 

  • Understand key terms (such as “asexual,” “cisgender,” and “gender non-conforming”) and derogatory terms.
  • Understand the healthcare outcomes and life experiences that people in the LGBTQ+ community are at risk of.
  • Advertise themselves as welcoming of the LGBTQ+ community.
  • Educate practitioners to be comfortable discussing sexual practices and sexual/gender orientations.
  • Train staff on how to care for LGBTQ+ people.
  • Use inclusive language on intake and assessment forms, such as “partner” and “non-binary”.
  • Ask safeguarding questions, as the LGBTQ+ community is often subject to violence and bullying.
  • Promote the confidentiality and privacy of their procedures.
  • Check that referrals are to queer-affirmative services.

Telehealth for Underserved Populations

Although telehealth can’t transform the entire healthcare system, it’s definitely a possible solution for improving access to services for marginalized communities. Not only does it connect rural people with therapy and other treatments, but it could also be a way to avoid stigma.16 

Since people can engage with telehealth appointments privately, they can be shielded from perceived stigma when accessing services in public. So, telehealth can be a helpful option for people living rurally, as well as those belonging to minority ethnic groups and the LGBTQ+ community.16 

Learn more about the telehealth services offered by Mission Connection.

Mission Connection: Personalized Mental Health Care

At Mission Connection, our priority is to provide mental health care that is personalized and sets you up to achieve long-lasting change. With our telehealth, outpatient, inpatient, and group therapy options, there are many ways we can support you. 

Furthermore, our practice is an inclusive space. With the understanding that race, gender, sexuality, and economic factors can have huge impacts on mental health, our treatments are for everyone. We want each person who seeks our support to feel heard, respected, and welcome. Plus, if payment is a concern for you, we offer free insurance validation and sliding scale fees. 

Browse our site to learn about our different approaches or reach out today to take the first step in your treatment.

Group of people from different communities smiling and chatting after learning about marginalized communities and mental health care

References

  1. Mahomed, F. (2020). Addressing the Problem of Severe Underinvestment in Mental Health and Well-Being from a Human Rights Perspective. Health and Human Rights, 22(1), 35. https://pmc.ncbi.nlm.nih.gov/articles/PMC7348439/ 
  2. Bignall, T., et al. (2019). Racial disparities in mental health: Literature and evidence review. https://raceequalityfoundation.org.uk/wp-content/uploads/2022/10/mental-health-report-v5-2.pdf
  3. ‌American Psychiatric Association. (2017). Mental Health Disparities: Diverse Populations. https://www.psychiatry.org/getmedia/bac9c998-5b2d-4ffa-ace9-d35844b8475a/Mental-Health-Facts-for-Diverse-Populations.pdf 
  4. ‌Kirmayer, L. J. (2001). Cultural variations in the clinical presentation of depression and anxiety: implications for diagnosis and treatment. The Journal of Clinical Psychiatry, 13, 22-30 https://pubmed.ncbi.nlm.nih.gov/11434415/ 
  5. American Psychiatric Association. (2017). Mental Health Disparities: African Americans. https://www.psychiatry.org/getmedia/bc6ae47f-b0aa-4418-b045-952ede06757f/Mental-Health-Facts-for-African-Americans.pdf
  6. ‌American Psychiatric Association. (2017). Mental Health Disparities: LGBTQ. https://www.psychiatry.org/getmedia/552df1c0-57f2-4489-88fa-432182ce815a/Mental-Health-Facts-for-LGBTQ.pdf
  7. Drescher, J. (2024). Improving the approach to LGBTQ persons in mental health care settings: A clinician’s perspective. World Psychiatry, 23(2), 213–214. https://doi.org/10.1002/wps.21193 
  8. Morales, D. A., Barksdale, C. L., & Beckel-Mitchener, A. C. (2020). A Call to Action to Address Rural Mental Health Disparities. Journal of Clinical and Translational Science, 4(5), 1–20. National Library of Medicine. https://doi.org/10.1017/cts.2020.42 
  9. Mental Health America. (2024). Rural Mental Health Crisis. https://mhanational.org/resources/rural-mental-health-crisis/ 
  10. Hodgkinson, S., Godoy, L., Beers, L. S., & Lewin, A. (2017). Improving mental health access for low-income children and families in the primary care setting. Pediatrics, 139(1), 1–9. https://doi.org/10.1542/peds.2015-1175 
  11. American Psychiatric Association. (n.d.). Mental Health Facts on Refugees, Asylum-seekers, & Survivors of Forced Displacement. https://www.psychiatry.org/getmedia/9d2de01e-babc-4e04-8f01-16f3f75ff1cd/Mental-Health-Facts-for-Refugees.pdf
  12. ‌Derr, A. S. (2015). Mental Health Service Use Among Immigrants in the United States: A Systematic Review. Psychiatric Services, 67(3), 265–274. https://doi.org/10.1176/appi.ps.201500004 
  13. American Psychiatric Association. (2017). Mental Health Disparities: American Indians and Alaska Natives. https://www.psychiatry.org/getmedia/d008fb53-3566-4a0a-adac-ba1f3b88528c/Mental-Health-Facts-for-American-Indian-Alaska-Natives.pdf
  14. ‌Stubbe, D. (2020). Practicing cultural competence and cultural humility in the care of diverse patients. Focus, 18(1), 49–51. https://doi.org/10.1176/appi.focus.20190041 
  15. Bass, B., & Nagy, H. (2023, November 13). Cultural competence in the care of LGBTQ patients. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK563176/ 
  16. Negaro, S. N., Hantman, R. M., Probst, J. C., Crouch, E. L., Odahowski, C. L., Andrews, C. M., & Hung, P. (2023). Geographic variations in driving time to US mental health care, digital access to technology, and household crowdedness. Health Affairs Scholar, 1(6). https://doi.org/10.1093/haschl/qxad070