The Impact of Systemic Racism on Minority Mental Health

If you are reading this, there is a good chance you already know the gravity of the subject we are going to discuss. Maybe you’ve sat in an emergency room for six, eight, or even ten hours, waiting for a psychiatric bed to open up for someone you love. Maybe you’ve watched a family member be discharged too soon because, as the staff put it, “nothing more could be done.” Maybe you are a caregiver somewhere in Los Angeles, in the San Fernando Valley, in Pacoima, in South LA, or in East LA, holding your family together while wondering who is holding you.

I know that weight. My name is Angela Padilla, and I founded FundaMental Change because my mother lived with severe bipolar and schizoaffective episodes for most of my childhood. I grew up as a daughter, a caretaker, and eventually an advocate. What I have seen and what the research now confirms is that the pain is not shared equally. For Black, Hispanic, Asian, and Indigenous families across the United States, the impact of systemic racism on mental health within minority families adds a second, often invisible, layer of harm on top of an already broken health care system.

This is the pandemic after the pandemic. And we want this to be a conversation, not a lecture. So let’s put our minds together, look at what the research actually says, and talk about what we can do about it, together.

Systemic racism creates chronic stress, racial trauma, and inequitable access to care for racial and ethnic groups across American life. Decades of research link racial discrimination to higher rates of anxiety, depression, substance use, and PTSD symptoms among Black, Hispanic, Asian, and Indigenous adults. Racism also shapes who receives an accurate diagnosis, who gets treatment, and who falls through the cracks of the health care system.

In April 2021, CDC Director Dr. Rochelle Walensky formally declared racism a serious public health threat, stating that racism “directly affects the well-being of millions of Americans” and “affects the health of our entire nation.” [1] [2] That declaration matters. It tells us this is not just a personal struggle; it is a public health crisis that calls for a public health response.

In other words, mental health among minority communities is shaped not only by biology or individual circumstance, but by the society around us.

Systemic racism, sometimes called institutional racism, describes the patterns built into schools, hospitals, housing markets, and the criminal justice system that consistently restrict opportunity and harm the well-being of people of color. This is bigger than a single insult or one bad doctor’s appointment. It is the cumulative effect of history, policy, and culture acting on a person’s brain, body, and sense of self, year after year and generation after generation.

Two mental health impacts are especially well documented.

Chronic Stress and the "Weathering" Effect

Repeated exposure to racial discrimination triggers the body’s stress response over and over again. Over time, this chronic activation wears down physical and mental health, a process researchers call weathering. The American Psychological Association, the U.S. Department of Veterans Affairs’ National Center for PTSD, and Mental Health America all recognize that ongoing exposure to racism erodes emotional well-being and contributes to anxiety, depression, chronic stress, and PTSD-like symptoms such as hypervigilance and mood changes. [3] [4] [5]

At FundaMental Change, we say it plainly: mental health is brain health. What discrimination does to the mind is no different, in principle, from what a physical injury does to the body, and it deserves the same urgency, the same compassion, and the same lack of judgment.

Racial Trauma

Racial trauma, also called race-based traumatic stress, is the emotional response to racial discrimination, racist abuse, or the sustained threat of both. Racial trauma can produce symptoms that mirror PTSD, including intrusive thoughts, hypervigilance, sleep disruption, depression, anger, and emotional numbness. According to Mental Health America, racial trauma is not itself a formal diagnostic category in the DSM-5, but the symptoms it produces are real, treatable, and deserving of culturally informed mental health care. [4]

If any of that sounds familiar, please hear us: you are not broken, and you are not alone. What you are carrying has a name, and help exists.

Poverty, the Racial Wealth Gap, and Mental Health

We cannot talk honestly about the impact of systemic racism on minority mental health without talking about money. Centuries of housing discrimination, employment discrimination, unequal access to education, and unequal access to credit have produced what researchers, the Federal Reserve, and the U.S. Department of the Treasury call the racial wealth gap. [20] According to a U.S. Treasury analysis of Federal Reserve Survey of Consumer Finances data, the median white family held $184,000 in wealth in 2019, compared to $38,000 for the median Hispanic family and $23,000 for the median Black family. [20] Brookings Institution research documents that the net worth of a typical white family is nearly ten times greater than that of a typical Black family — a gap that persists even when families earn the same income, reflecting the accumulated effects of generations of discrimination in housing, lending, and employment. [21] That gap is one of the strongest channels through which systemic racism shapes mental health today.

Poverty is not a side issue here. The Centers for Disease Control and Prevention identifies poverty as one of the key social and structural factors driving disparities in minority mental health, noting that low income limits access to mental health care and that poverty itself causes stress and can lead to mental health issues. [17] The American Psychological Association's Working Group on Stress and Health Disparities reaches the same conclusion from a different angle: compared to people with higher incomes, individuals living below the poverty level have poorer mental health, more chronic health conditions, and shorter lifespans. [18]

Black, Hispanic, and Indigenous Americans are far more likely to live in poverty than White Americans — and far more likely to live in neighborhoods where poverty is concentrated. A 2022 study using six years of national survey data found that, compared with White peers with the same mental health conditions, African Americans, Latinx adults, and American Indian/Alaska Native adults with mental illness all had greater odds of living in poverty, being unemployed, and being arrested in the past year. [19] The researchers called this the "double jeopardy" of being a member of a racial minority group and living with mental illness at the same time.

The result is a cycle that is hard to interrupt without systemic change:

Structural racism produces lower incomes and lower household wealth in minority communities.
Lower incomes mean less access to therapy, psychiatric medication, and time off work to attend appointments.
Cost is the number one barrier to mental health care across every racial and ethnic group, and that barrier falls hardest where poverty is concentrated. [6]
Chronic financial stress itself contributes to anxiety, depression, and other mental health conditions, which in turn make it harder to hold steady employment.

Children carry this forward. Growing up in poverty is associated with higher rates of mental illness later in life, and minority children are far more likely to grow up in poverty than White children. When we talk about closing racial disparities in mental health, we are also talking about closing racial disparities in income, housing, education, and opportunity. Mental health does not exist in isolation from the rest of a person's life — and our work at FundaMental Change is grounded in that truth.

Racial and Ethnic Disparities in Mental Health Care

Here is where we have to be honest. The mental health care system in the United States was not built with minority communities in mind. Decades later, the gaps still show, and the people paying the price are often those with the least room to absorb it.

Who Receives Care — and Who Does Not

A 2023 KFF Survey of Racism, Discrimination, and Health, based on responses from over 6,000 adults, found that among people who report fair or poor mental health, White adults (50%) were more likely than Black adults (39%) or Hispanic adults (36%) to say they received mental health services in the past three years. [6] In KFF’s 2022 analysis of National Health Interview Survey data, Asian adults showed the lowest mental health service utilization of any major racial and ethnic group: approximately 9% of Asian adults received counseling or prescription medication for mental health conditions in the past year, compared to 28% of White adults, 16% of Hispanic adults, and 16% of Black adults. [7]

KFF notes that reported mental illness rates remain lower among Hispanic, Black, and Asian adults compared to White adults, but cautions that mental illness among people of color may be underdiagnosed due to a lack of culturally sensitive screening tools and structural barriers to care. [6] In other words, the gap between groups is not really about who needs help; it is about who gets it.

The Barriers Behind the Numbers

Cost concerns and scheduling difficulties are the most common barriers to mental health care across all racial and ethnic groups. But Black, Hispanic, and Asian adults report disproportionately higher rates of additional barriers:

Difficulty finding a provider who understands their background and experiences (Asian adults: 55%; Black adults: 46%; White counterparts: 38%). [6]
Stigma or embarrassment about seeking treatment.
Lack of information about available mental health resources.
Fear of being misunderstood — or mistreated — by clinicians.

Awareness of the 988 Suicide and Crisis Lifeline, the national mental health hotline launched in 2022, remains low overall. As of summer 2023, only about one in five adults (18%) reported hearing “a lot” or “some” about 988, with lower awareness among Black (16%), Hispanic (11%), and Asian (13%) adults compared with White adults (21%). [6] If you have never heard of 988 until this article, you are in the majority, and that, in itself, is a problem we have to fix together.

Negative Experiences Compound the Problem

Adults who report being treated unfairly or disrespected by a health care provider are twice as likely as those without such experiences to say they went without needed mental health care. [6] For Black, Hispanic, Indigenous Americans (AIAN), and Asian adults who consistently report higher levels of unfair treatment than their White counterparts, this creates a self-reinforcing cycle: past harm discourages future help-seeking, which allows mental health conditions to worsen. This is exactly the kind of systemic dynamic we exist to interrupt.

Misdiagnosis and Mental Health Racism

The health care system also produces disparities in diagnosis itself. A landmark 2019 Rutgers study published in the journal Psychiatric Services found that Black patients with severe depression were significantly more likely than non-Latino White patients to be misdiagnosed with schizophrenia. Researchers concluded that clinicians overemphasize the relevance of psychotic symptoms and overlook major depression symptoms in Black Americans. [8] A 2018 meta-analysis of more than 50 studies (Olbert, Nagendra, & Buck) found Black Americans are roughly 2.4 times more likely to receive a schizophrenia diagnosis than White Americans, with earlier reviews placing the ratio as high as three to four times. [9]

Misdiagnosis has real consequences. Black patients diagnosed with schizophrenia are more likely to be hospitalized, more likely to receive higher doses of antipsychotic medication, and more often prescribed older first-generation antipsychotics rather than newer second-generation drugs. [14] [15] When the diagnosis is wrong, the underlying mood disorder also goes untreated. This is mental health racism in its most concrete form, and Black psychiatric leaders have spent decades calling attention to it. The 2024 anthology Mental Health, Racism, and Contemporary Challenges of Being Black in America, edited by Dr. Donna M. Norris and Dr. Annelle B. Primm and published by American Psychiatric Association Publishing, brings together more than four decades of perspectives from the APA’s Solomon Carter Fuller Award lectures named for the first Black psychiatrist in the United States, and traces how institutional racism, public policy, and clinical bias continue to shape mental health outcomes for Black Americans. [10] Misdiagnosis is not abstract. It is a son, a daughter, a parent, a neighbor — being given the wrong label, and with it, the wrong road.

The Unique Impacts on Specific Communities

Systemic racism does not affect every community the same way. The history, culture, and socioeconomic status of each racial group shape both the experience of racism and the paths available for healing. Let’s walk through a few.

Hispanic and Latino Communities in Los Angeles

For Latino people in Los Angeles County, mental health access intersects with language, immigration status, and cultural stigma. Many Latino families hesitate to seek care out of fear of the system itself, while a shortage of bilingual Spanish-language providers remains a significant barrier. Cultural values that emphasize family privacy can delay help-seeking until a full-blown mental health crisis arrives. By then, the options are often reduced to an emergency room visit and a long, painful wait.

FundaMental Change works to provide resources to the Latino community in LA County, replacing silence with support in the languages families speak and in the neighborhoods they call home.

Black Adults and Families

Black Americans face some of the most extensively documented racial disparities in mental health. Beyond misdiagnosis, Black people often encounter cultural incompetence in clinical settings and a long history of well-founded mistrust of institutions that have caused harm. As Dr. Norris and Dr. Primm, co-editors of the leading recent anthology of Black psychiatric scholarship, have written, mental health professionals across all backgrounds must “respond to patients’ concerns about racism and discrimination and demonstrate cultural humility to ensure quality care.” [2] [10]

BIPOC youth with behavioral and mental health conditions are also more likely to be redirected into the juvenile justice system than into specialty mental health care research from the U.S. Office of Juvenile Justice and Delinquency Prevention confirms that youth of color receiving mental health services are more likely to be referred to the juvenile justice system than White youth, and once in that system, are less likely to receive mental health treatment than White youth. [11] This links racial injustice to incarceration rather than healing, and shapes mental health outcomes long before adulthood.

Asian Adults

Asian adults report some of the lowest rates of mental health service utilization among all racial groups in the U.S., yet experience real and rising levels of distress. KFF data show Asian adults are the most likely of any group to report difficulty finding a provider who understands their background and experiences. [6] Cultural attitudes toward mental illness, family expectations, racial discrimination (including the rise in anti-Asian hate incidents during and after the COVID-19 pandemic), and a scarcity of language-concordant providers all contribute to the gap.

Indigenous Americans (AIAN)

Indigenous Americans (American Indians and Alaska Natives) experience disproportionately high rates of serious mental disorders, PTSD, and substance use disorders compared to the general population. The Indian Health Service reports that AIAN adults experience serious psychological distress at 2.5 times the rate of the general U.S. population and have the highest suicide rates of any minority group within the U.S. [12] Historical trauma from forced relocation, boarding schools, and generations of cultural disruption contributes to these outcomes a reminder that trauma and oppression can be transmitted across generations, and that healing must include culture, not ignore it.

Youth Across All Minority Communities

Our young people are bearing an increasing share of this burden, and it breaks our hearts. The CDC’s 2023 Youth Risk Behavior Survey found that experiencing racism was two to three times more prevalent among students from marginalized racial and ethnic groups compared with White students, and that high school students who experienced racism showed higher rates of poor mental health, suicide risk, and substance use. [13] This is the generation we are building the future for. They are watching us right now to see whether we show up.

What Racial Trauma Feels Like, And How to Recognize It

Racial trauma looks different from person to person, but common signs include:

Persistent feelings of sadness, anger, or hopelessness after experiencing racism or watching news coverage of racial injustice
Hypervigilance — feeling constantly “on guard.”
Sleep disturbances, headaches, or a racing heart after negative experiences of discrimination
Withdrawing from friends, family, or community activities
Feeling mentally distanced from traumatic events, as if watching yourself from the outside
Turning to substance use as a way to cope with chronic stress

If any of this lives in your body or your loved one’s body, we want you to know something important: asking for help is not a weakness. It is a strength. We treat a broken arm without shame. Brain health deserves the same.

Pathways Forward: Let’s Get to Work

The impact of systemic racism on minority mental health is significant. It is not permanent. Research and lived experience point to pathways that improve outcomes at every level, and every single one of us has a role to play.

For Individuals and Families

Start the conversation. Stigma loses its power the moment a trusted family member, faith leader, or friend says “me too.” You do not have to have all the answers to open the door.
Seek culturally informed care when possible. Research on patient-provider racial concordance is mixed, but a systematic review of 40 studies found it was associated with better communication across most domains for Black patients, particularly in information-giving, partnership building, and patient participation. [16] Ask questions. You are allowed to shop for a provider who sees you in full.
Know the 988 Lifeline. Call or text 988 to reach the national Suicide and Crisis Lifeline, available 24/7 with Spanish-language support.
Find a support group. Peer support — especially for caregivers — reduces isolation and helps families navigate the mental health system together. You do not have to carry this alone.

For Community and Grassroots Leaders

Build coalitions across faith, health, and education. No single organization solves systemic problems alone. Let’s put our amazing minds together.
Train the community. Mental Health First Aid and culturally adapted trainings equip everyday people to recognize warning signs early — and early matters.
Host culturally rooted events. Gatherings that include art, food, music, and language draw people who would never walk into a traditional clinic. That’s the whole point.

For Policymakers and Institutional Partners

This is where the system has to change, and we need your courage.

Invest in more psychiatric beds and sustainable funding. No family should wait six to ten hours in an emergency room for a psychiatric bed to open up. No one should be discharged prematurely because resources have run out. Mental health parity is a fundamental right.
Invest in provider diversity. The mental health care workforce remains overwhelmingly White, and this shapes who feels welcome to seek care.
Fund community-based organizations. Grassroots groups close gaps that state agencies cannot reach alone.
Measure what matters. Collect and report data disaggregated by race, ethnicity, language, and ZIP code so racial and ethnic disparities become visible — and actionable.

We are deeply grateful to the elected officials, clinicians, and community partners already on the front lines of this work. We need more of you. Let’s move the needle forward, together.

FundaMental Change is a Los Angeles County-based nonprofit committed to reducing stigma around mental illness, expanding access to quality mental health care, and supporting the caregivers who hold families together. We promote local mental health resources and services, host community events, fund scholarships, and serve as a bridge between people who need support and the organizations that provide it.

Our founder’s story is personal. Our mission is collective. And our work across the San Fernando Valley and greater Los Angeles County centers the communities most affected by the impact of systemic racism on minority mental health, with a special focus on caregivers and the Latino community.

If you or a loved one are navigating a mental health crisis, you deserve care that sees all of you — your culture, your history, and your experience included. And if you are already doing this work in your own corner of Los Angeles, we would love to know your name.

If you are in crisis right now: Call or text 988 to reach the Suicide and Crisis Lifeline. Spanish-language support is available 24/7. There is no shame in making the call.

For support groups, mental health resources, and community events in LA County: Visit fundamentalchange.life to learn how we can help you — or a loved one suffering in silence — take the next step.

To help us do this work, donations directly fund scholarships, community events, and partnerships that expand access to mental health care across Los Angeles County. Every contribution helps another family find support closer to home.

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Thank you for reading. Thank you for caring. Let’s keep moving forward together, with purpose.

FundaMental Change is a Los Angeles County-based nonprofit working to reduce stigma, improve access to quality mental health care, and support individuals and caregivers affected by mental illness. Founded by Angela Padilla — a lifelong caregiver, daughter, and advocate whose mother has lived with bipolar and schizoaffective disorders — our work is grounded in lived experience and community partnership. Mental health is brain health. And no one should walk this road alone. Learn more about our story →

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