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Jul 6, 2020

Advocacy Efforts Needed to Reduce Behavioral Health Disparities Magnified During COVID-19

As individuals across the United States grapple with how to care for their health and basic needs during COVID-19, behavioral health systems are also struggling to keep up to provide adequate access and meet the increased demand for behavioral health services. The current pandemic and rapid spread of COVID-19 has highlighted the striking inequities and disparities in health and mental health care for Black, Indigenous, and People of Color (BIPOC) in the United States. 

National Minority Mental Health Month has been observed each July to bring awareness to the unique struggles that BIPOC face regarding mental health in the United States. In this blog, we briefly summarize key outcomes from the SAMHSA report, Double Jeopardy: COVID-19 and Behavioral Health Disparities for Black and Latino Communities in the U.S, discuss how these outcomes impact services particularly for our most vulnerable populations, and share ACA’s advocacy efforts on H.R. 945 to help address these disparities.

As health care organizations struggle to meet the extreme demand due to COVID-19, calls for related mental health care continues to increase. This health crisis results in direct needs as individuals, families and communities struggle to cope with illness and death of loved ones in addition to the ripple effects caused by social isolation, anxiety and depression. Most striking is the disparate impact on Black, Indigenous and Latinx communities as documented in the recent SAMHSA report that highlighted the compounded effect of poverty, housing density, stress related health conditions, employment conditions and lack of health care. According to the report, “As of April 15, 2020, case data from the CDC show that in COVID-19 cases where race was specified, Blacks, who comprise 13 percent of the total U.S. population (U.S. Census Bureau, 2018), make up 30 percent of COVID-19 cases; Latinos, who make up 18 percent of the population (U.S. Census Bureau, 2018), account for 17 percent of COVID-19 cases.” . Further, there is overwhelming evidence that Black and Latinx communities have significantly lower access to mental health care although the rates of behavioral disorders do not differ from the general population. Barriers to accessing mental health care for these communities are compounded by policies that limit the types of professionals covered under public health programs such as Medicare, which specifically excludes licensed professional counselors and marriage family therapists as covered providers. 

COVID-19 has placed numerous strains on behavioral health systems and providers, particularly as the need for services increases during these times. The current pandemic is highlighting now, more than ever, the need for more culturally competent providers to serve our diverse populations including communities of color, veterans and clients with disabilities. It is vital to increase access to mental health care for our most vulnerable populations and address the disparities in who receives service. Mental health counselors and marriage and family therapists must be included in order to meet this workforce demand and the ACA has been advocating for this through H.R. 945 (S.286 companion bill in the Senate). In short, this bill provides for coverage of marriage and family therapist and mental health counselor services under Medicare. It also excludes such services from the skilled nursing facility prospective payment system, and authorizes marriage and family therapists and mental health counselors to develop discharge plans for post-hospital services. This bill is essential in ensuring that counselors and marriage family counselors can provide behavioral health services across the country to address the disparities. 

The disparities and barriers to mental health care not only violate the professional values of the counseling profession but also constrain the ability of counselors to provide mental health care in high need communities on par with other health care professionals. Counselors are in a prime position to help meet this demand given the extensive training and licensure requirements of counseling professionals as well as their ability to learn and partner with local communities to tailor services that are accessible, culturally responsive, and cost effective. Passage of H.R. 945 will greatly increase accessibility for these communities that are so vulnerable to COVID-19 and the impact of loss of health and loved ones.


Rebecca L. Toporek, PhD. Rebecca is a counselor educator and department chair in the Department of Counseling at San Francisco State University. She writes and is involved int the community around multicultural counseling, anti-racism, advocacy and social change, as well as counselors’ role in addressing the impact of unhoused living and long term unemployment. Her most recent book, co-written with Muninder K. Ahluwalia, is “Taking Action: Creating Social Change through Strength, Solidarity, Strategy and Sustainability”.

Ulash Thakore-Dunlap, LMFT. Ulash is full-time faculty and Director of Diversity, Equity and Inclusion for the MA Counseling Psychology Program at The Wright Institute.  In addition, Ulash is the current Commissioner of The San Francisco Behavioral Health Commission and maintains a private practice in San Francisco.

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