This post was updated May 27 at 9:14 p.m.

UCLA researchers found that children from racial and ethnic minority backgrounds, especially those without access to primary care, are disproportionately less likely to receive mental health care.

In a January study, researchers analyzed data from the 2019 National Health Interview Survey, which is collected annually by the National Center for Health Statistics, said Dr. Thomas Elliott, the study’s first author. Researchers found that children from marginalized backgrounds were less likely to receive treatment because of systemic disparities, including a lack of mental health clinicians in minority communities, insurance barriers or culturally uninformed providers.

Elliott, a general pediatrician and postdoctoral fellow at the National Clinician Scholars Program at UCLA, said he became interested in disparities in pediatric mental health during his residency.

The causes of these disparities include insurance accessibility, geographical setting and family income, Elliott said. For example, higher family incomes were associated with a greater likelihood of receiving mental health treatment, as these families are more likely to be able to pay out of pocket for mental health services, according to the study.

“Our system does not have the supports in terms of socioeconomic barriers to care, such as transportation, such as food insecurity, housing insecurity. Things of that nature also play into mental health,” he said. “It’s not just about getting to the clinic and getting your treatment, but it’s also about, ‘What did your life look like in an overall sense?’”

Racial and ethnic disparities also exist in terms of delays and limitations in access to health care, which can be further compounded by linguistic barriers, added Dr. Eraka Bath, the vice chair of Justice, Equity, Diversity and Inclusion at the UCLA Neuropsychiatric Institute in the David Geffen School of Medicine. Various professional organizations, such as the American Medical Association and the National Institutes of Health, have recognized racism as a national public health issue in the United States, she added.

“Racism is a health issue and a public health issue and impacts people’s health, from the microcellular level to a larger scale and across generations,” Bath said. “It impacts their access. It impacts what type of treatment they receive, if any. It impacts how providers interact with patients.”

For children – especially those who are minorities – there are not enough child psychiatrists, child psychologists and mental health professionals, Bath said.

Disparities in access to care also exacerbate existing inequities that marginalized communities face, such as intergenerational poverty, said Dr. Rebecca Dudovitz, associate professor in general pediatrics at the School of Medicine.

“We know that children with mental health problems are much more likely to have chronic absenteeism, are much less likely to graduate from high school, less likely to go on to college and succeed in college,” she said. “That makes it harder to get a high-paying job or a job where you can earn a living wage, which makes it very difficult to escape poverty.”

Children are at a critical developmental stage and can struggle with school performance and social relationships, which can lead to unhealthy behaviors such as substance abuse that can derail a child’s healthy developmental trajectory, Dudovitz said.

Other factors affecting access to treatment are less obvious, Dudovitz said. For example, she said children who are non-U.S. citizens have much lower rates of accessing care than children who are citizens.

While one would expect to see fewer mental health issues in those from higher-income families, there is not a strong relationship between family income and mental well-being, she said.

One limitation of the study’s findings is that the data was based on parents’ reports of their child’s mental health, making it subject to recall bias, according to the study. Additionally, the study noted that the data was collected before the COVID-19 pandemic, meaning it likely underestimated the prevalence of mental health concerns as reports of child mental health needs increased during the pandemic.

Elliott said he hopes people will not be discouraged by the study’s results but instead see it as an opportunity to improve. The study should be a call to action for researchers, heads of centers and state departments to work on the mental health crisis, he added.

“These are big, challenging problems, and I think there’s not a simple solution,” Dudovitz said. “But part of what I love about being a pediatrician is that children have incredible capacity for growth and resilience, and I truly believe that if we provide them with the support they need at this time, we will see an incredible capacity for thriving and success.”

A majority of previous research was not centered on the experiences of children and families from marginalized communities, Dudovitz said. Researchers should study these groups more and try to find the solutions they are asking for, she added.

In the future, scientists need to move beyond nationally representative data to outreaching and learning within marginalized communities, Elliott said. He added that this is necessary to understand what these communities need and how to support them through this mental health crisis.

“We really are in a crisis point in our country, and so we need medical solutions. We need policy solutions. We need school-based solutions. We need community-based solutions,” Dudovitz said. “We need it all, because there’s no one solution that’s going to work for every child.”