What Is Intersectional Mental Health? Compounding Discrimination In Health Care

Different aspects of an individual's identity—such as gender, race, class, and sexual orientation—can shape how they experience and navigate the world around them. This concept is called intersectionality: a theory created in 1989 by legal scholar and activist Kimberlé Crenshaw to describe how different types of discrimination, such as racism and sexism, can overlap and create unique forms of oppression. 

Crenshaw emphasized that these overlapping oppressions are often overlooked in traditional systems, despite their significant impact. Here, we’ll take a closer look at intersectionality and its effects on individuals, communities, and societies and highlight the need for inclusivity-driven policies and mental health care practices. We’ll also share how culturally sensitive mental health professionals can take intersectionality into account when tailoring treatment according to each client’s unique needs. 

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Understanding intersectionality

Intersectionality can be understood as having three main types: structural, political, and representational. Researchers defined these terms in order to analyze how various social categories intersect and create unique experiences of discrimination and disadvantage. Brief definitions of each type are as follows:

• Structural: Structural intersectionality describes how social institutions and structures interact to cause discrimination and disadvantage for some. Examples of structures in this context include education, healthcare, workplaces, and the legal system.
• Political: Political intersectionality describes imbalances in how political institutions address the needs of people with intersecting identities. It highlights how political agendas and movements often prioritize one identity over others. 
• Representational: Representational intersectionality focuses on how cultural stereotypes and representations affect attitudes toward intersectionality. Often, negative depictions of specific populations can reinforce intersectional discrimination. 
  

Why is intersectionality important?

Research reveals that discrimination is growing worldwide. According to the World Justice Project's Rule of Law Index, 70% of countries reported an increase between 2021 and 2022. These statistics highlight why it's important to understand the unique ways in which marginalized groups experience oppression and discrimination. By understanding intersectionality, individuals, communities, and societies may be better equipped to challenge power structures that create and maintain inequality. 

Intersectionality in education

Intersectionality in education helps identify the ways in which people may experience discrimination at school and other academic institutions. Intersectional identities can influence one's ability to receive quality education and related opportunities. With an intersectional approach, educational systems could develop more inclusive, equitable learning environments for students, educators, and administrators alike. 

Intersectionality in the workplace

Intersectionality is necessary for fully understanding how diverse individuals may experience discrimination or bias in the workplace. It can help raise awareness of hidden forms of discrimination that might be overlooked in more superficial approaches to diversity and inclusion. Organizations can create more inclusive and equitable environments for their employees through intersectional awareness. 

Intersectionality in health care

In the US, one in five individuals report having experienced discrimination during a healthcare encounter, with most reporting multiple instances. These numbers are even higher for individuals holding multiple marginalized identities, such as queer and transgender people of color. 

Intersectionality helps identify and address disparities in availability of care and poor mental health outcomes for marginalized groups who experience discrimination and systemic biases. By acknowledging and understanding how oppression based on multiple identities can intersect, medical and mental health care professionals may be better able to provide informed, high-quality care.

The role in of intersectional mental health care in treating mental illness 

Intersectionality can help mental health professionals understand how a person's race, gender, sexual orientation, disability, socioeconomic status, and other identities interact to create unique experiences of marginalization, oppression, or privilege. This understanding is necessary for tailoring treatment plans and providing culturally relevant support that can improve therapeutic outcomes. An intersectional approach can also promote health equity by ensuring that all individuals are able to receive quality care and support, regardless of their identities. 

Examples of intersectional challenges based on race, gender, and other identities

There are many possible combinations of intersectionality. For example, Black women might face discrimination based on both their race and gender, resulting in a unique experience that goes beyond the experiences of those who are women but not Black, or Black but not women.

Another example is how a disabled LGBTQ+ person might face discrimination on multiple fronts: based on gender, sexuality, and disability status. A Black woman with a disability who identifies as transgender may experience even deeper, more complex bias and discrimination due to the intersection of these four marginalized identities.

Examples of discriminatory practices in public health care based on race, gender, and other identities

Discriminatory practices in healthcare can make it difficult for marginalized individuals to receive quality care. It can also lead to inequity in research and reinforce existing scientific bias, creating research gaps that hinder progress toward diagnosing and treating many conditions. 

Studies repeatedly indicate treatment disparities within the healthcare system. For example, research during the COVID-19 pandemic revealed that Black people were 3.57 times more likely, and individuals in Latinx populations were 1.88 times more likely, to die from COVID than their white counterparts.

People in the LGBTQ+ community—particularly those who are also individuals of color— tend to face discrimination in healthcare settings too, such as treatment refusal, harassment, and/or cultural incompetency by doctors, hospitals, and pharmacists. Such discrimination may also deter LGBTQ+ people from seeking the care they need in the future. Research suggests that both situations can result in a lack of care—with 60% of youth participating in The Trevor Project's 2022 National Survey on LGBTQ+ Youth Mental Health reporting that they wanted mental health care but were unable to receive it. 

Additionally, gender stereotypes can affect the quality of healthcare one receives. For example, a 2018 study suggests differences in how doctors view men with chronic pain versus women with chronic pain, often minimizing women's experiences as "emotional" or "hysterical." The same study reports that doctors were more likely to attribute a woman's pain to a mental health condition than a physical condition.  

Public health consequences of discrimination

Discrimination can affect public health in several ways, creating a "ripple effect" that exacerbates disparities. For example, discrimination can lead to inequalities in healthcare availability and utilization, which may foster mistrust of healthcare providers and deter individuals from seeking medical care, further impacting their health. 

Discrimination can also influence health behaviors. For example, previous studies have indicated that discrimination is linked to an increased risk of substance use disorders (SUD). 

Additionally, research suggests that consistent exposure to structural racism, such as racial discrimination and poverty, can put individuals at greater risk for chronic diseases like hypertension, diabetes, and cardiovascular disease as well as premature aging. 

The intersectional mental health consequences of multiple marginalizations

The intersection of multiple marginalized identities can worsen negative mental health outcomes for people facing systemic inequalities, social stigma, and economic disparities. Marginalized individuals are often exposed to chronic stressors, such as prejudice and microaggressions, which can lead to anxiety, depression, and other mental health consequences. Such individuals might also have limited ability to receive healthcare, further compounding mental health challenges. 

Mental health research highlights how intersectional marginalization can impact specific populations. For example, studies suggest that individuals with multiple marginalized identities may experience longer post-traumatic amnesia and more severe traumatic brain injuries compared to those with fewer marginalization factors. 

Progress toward equitable and inclusive mental health care

There are ways in which the mental health system could address inequality and promote more inclusive care. One example is cultivating clinical environments where all individuals feel valued, respected, and empowered, regardless of their mental health status or background. Here are some other examples of how organizations and clinicians could promote equitability in the mental health care system:

• Identifying and dismantling barriers to healthcare availability, such as geographic location, financial constraints, and cultural differences
• Engaging in cultural competency training to understand diverse cultural backgrounds, beliefs, and values
• Developing mental health services and treatments tailored to be culturally sensitive and appropriate
• Understanding mental illness stigma and what it can look like across various cultures
• Recognizing and addressing the impacts of trauma on the mental health and well-being of marginalized populations
• Researching and tracking statistics on mental healthcare availability, utilization, and outcomes to identify disparities and inform improvements
  

How you can fight discrimination and support mental health care for every race, gender, and identity

To help reduce mental health disparities, you might educate yourself on concepts like intersectionality and learn about how certain populations are marginalized in the system. You may help dismantle mental illness stigma and other types through open conversations about mental health and by advocating for mental health education. You might also advocate for policies and funding that support equitable availability of mental healthcare for all. On a grassroots level, consider collaborating with local organizations led by those with marginalized identities which serve diverse populations. Additionally, you could offer support to individuals advocating for their own mental health needs and rights. 

Intersectional approaches to treating mental illness

Mental health professionals using intersectional treatment approaches recognize that mental health challenges can be significantly impacted by broader systemic structures. As such, examples of intersectional approaches to mental health care can include but aren't limited to:

• Racial justice-informed therapy: addresses the impacts of racism on mental health, providing support that honors client experiences and challenges
• Anti-oppressive therapy: challenges systemic oppression and promotes social justice by creating a safe space for marginalized individuals to explore their experiences and develop positive coping mechanisms
• Queer-affirming therapy: supports the identities and experiences of LGBTQ+ individuals, providing a safe space for exploration and healing
• Culturally-informed therapy: considers the impact of cultural beliefs and practices on mental health, including how different cultures can influence a person's understanding of mental health and their willingness to seek treatment
• Comprehensive therapeutic approaches: involve collaboration with community organizations, grassroots initiatives, and other relevant stakeholders to address the social and structural factors that impact mental health 

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Finding healing through intersectional care

Although intersectional therapy can be helpful for people experiencing mental health challenges like trauma, depression, and anxiety, some encounter obstacles to receiving treatment. For example, location may limit availability, financial circumstances might make therapy unaffordable, and people with unconventional or busy schedules may not have time to attend in-office sessions. In some cases, internet-delivered therapy may remove some of these barriers. 

Online therapy platforms like BetterHelp connect users to a vast pool of mental health professionals, some of whom may be trained to use culturally competent, intersectional approaches to therapy. Individuals can then attend virtual sessions from the comfort of home at times that suit their needs—and sometimes for a lower cost than in-person therapy without insurance. 

Research on digital mental health (DMH) interventions is ongoing. However, existing reviews in publications like Current Treatment Options in Psychiatry suggest that DMH interventions designed with a culturally sensitive, intersectional approach can be effective in addressing the mental health needs of those in marginalized populations.