A view from the health care trenches: Dr. Melba Arnold

While talking recently with a colleague from NAMI Colorado, Array Parity project leader Max Maddox was introduced to Dr. Melba Arnold (left), a retired college professor and active occupational therapist in mental health and cognitive behavior. Melba’s work has spanned the practices of psychiatry, pediatrics, school-based practice, gerontology, and long-term physical rehabilitation.

Given her decades of experience working with clients of various backgrounds, Max asked Melba to share some thoughts on the mental health impacts of systemic inadequacies and racism. Here’s a conversation excerpt, which followed Max’s reference to “the insurance-doctor-client mental health pipeline, now the prison system.”

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​Melba: The change in how healthcare is provided is thought to have been influenced over time by cost-cutting measures. Many individuals with mental illness are housed in prison systems secondary to the loss of public health care that was available at least 20 years ago. The point you made about the prisons appearing to become the mental health units is a concern expressed by others as well. There is concern about the increased privatization of mental healthcare and pricing the disenfranchised out of the opportunity to receive necessary treatment.  

You’ve also mentioned African-Americans as clients in mental healthcare. In many ways, this is quite a complex topic. When you consider the economic and social disenfranchisement of the African-American community for hundreds of years to present time; the systemic racial disenfranchisement in society, including healthcare, income; merely to exist and struggle with everyday discriminative challenges ... these are major factors that influence decisions about trusting hospitalization and healthcare equity. 

Additionally, there is a paucity of information about mental health treatment options and recovery. While there has been some noticeable progress in this area, the impact has been very minimal. 

The lack of and difficulty in accessing mental health services is a nationwide health care problem that unfortunately affects the minority communities far more than it should. The need for greater funding and education at the national and community level cannot be overemphasized. 

Personally, I am engaged in start-up efforts to develop a mental health ministry through my local church. I would like to do more to expose disenfranchised communities, especially African-Americans, to the benefits of mental health intervention; to reveal the health benefits and eliminate the myths and stereotypes associated with seeking mental health services. It would be great to help eliminate the perspective of mental illness being viewed as “another strike against oneself” because of ethnicity or socio-economic status. 

"The goal is to influence all of society, especially people of color,
to perceive mental health as a 'user-friendly,' treatable illness."

​Having lived through generations of oppressive discrimination because of race, and with society’s seemingly negative attitude toward mental health … having a mental illness becomes an additional struggle for Black Americans and other people of color. The goal is to influence all of society, especially people of color, to perceive mental health as a “user-friendly,” treatable illness that is not to be treated as something to fear any more than hyper-tension, diabetes or cancer. 

The unfortunate reality and true difficulty is, among African-Americans the lack of equity is real in our society and in health care delivery. For generations, it has been a painful experience for many. So African-Americans face the challenge of having to deal with the potential mistreatment secondary to race and a diagnosis of mental illness.

Max: How do mental health professionals broaden their scope? How do we advocate effectively when there is so much stigma assigned to Black communities?

Melba: When society at large can truly embrace equity … that is my altruistic goal. If I had the answer to that question, I could change the world. 

Aside from greater funding for mental healthcare, how professionals are trained at classroom and clinical level is critical. Educating the public about the stigma assigned to mental health is also critical. Add these two factors to treating clients who happen to be African-American, Latino-American, Asian-American. …

How do we effectively advocate for everyone, when there is so much stigma being assigned to the clients? Ethics, moral decency, healthcare justice, integrity, a sense of equity and fairness, eradication of the “isms” (systemic racism, religion, gender, sexual orientation, age discrimination) society has been working at equity among these for centuries … how far do you think we have come thus far? 

If your life involves discrimination for at least two of these, the intensity of treatment and the quality of the healthcare provider are paramount to the client’s success.