July 29, 2020

By Rebecca L. Toporek, Ph.D. and Ulash Thakore-Dunlap, LMFT

As individuals across the U.S. grapple with illness, the death of loved ones and the ripple effects of social isolation, the mental health system is struggling to meet the increased demand for mental health services. What is most striking, however, is the disparate impact on Black, Indigenous and Latinx communities. 

The recent SAMHSA report, “Double Jeopardy: COVID-19 and Behavioral Health Disparities for Black and Latino Communities in the U.S” highlighted the effect of poverty, housing density, stress-related health conditions, employment conditions and lack of health care during this pandemic. 
According to the report, the Black community, which comprises 13% of the total U.S. population, represents 30% of COVID-19 cases. And the Latino community, which makes up 18% of the population, accounts for 17% of COVID-19 cases. 

In additional to better health care, there needs to be more culturally competent providers to serve the mental health needs of these populations. 

What Can We Do?

There is overwhelming evidence that Black and Latinx communities have significantly lower access to mental health care, although the rates of mental illness are similar to those within the white population. Policies that limit the types of professionals covered under public health programs such as Medicare further compound the barriers to care for these communities. In fact, Medicare specifically excludes licensed professional counselors and marriage and family therapists as covered providers. 

These 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. 

It is vital to increase access to mental health care for our most vulnerable populations and address the disparities in who receives services. Mental health counselors and marriage and family therapists must be included in order to meet this workforce demand and the American Counseling Association has been advocating for this through H.R. 945 (S.286 companion bill in the Senate). 

In short, this bill provides coverage of marriage and family therapist and mental health counselor services under Medicare. It also 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 and family counselors can provide behavioral health services across the country to address these disparities. 

Counselors are in a prime position to help meet this demand given their extensive training 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 the impact of COVID-19. 


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 in 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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