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Underserved Populations

Underserved populations are populations that have experienced health disparities in obtaining the mental health treatment they need. They may receive fewer services, encounter barriers to accessing them, lack familiarity with them, or face a shortage of mental health providers.


In Texas, the following populations are vulnerable to experiencing health disparities:

  • Rural Populations: Rural populations face a shortage of available mental healthcare personnel and long distances from local mental and behavioral health authorities.  Further, due to the long distances between the interacting systems that comprise a mental health crisis system, difficulties emerge in coordinating an efficient crisis response. 

    • Rural Texans had a 33% higher suicide mortality rate compared to urban Texans.[1]

    • Among rural adults, 65% cited embarrassment and 63% cited stigma as barriers to seeking help.[2]

  • Older Adults: Mental health problems among older adults tend to be under-identified by both providers and the adult themselves. Further, stigma surrounding obtaining mental health care can prevent older adults from seeking out resources.

    • Over 1 in 5 patients older than 60 have a mental or neurological disorder.[3]

    • Suicide rates in the US were highest among adults ages 85+ at 20.86 per 100,000. The rates among adults ages 75-84 were second highest at 18.43 per 100,000.[4]

  • People with language needs: Language barriers can prevent Texans from learning of mental health resources like 988, preventing them from seeking out needed care. Further, proper communication between provider and patient is critical in crisis stabilization; hence language barriers can harm the quality of crisis response. 

    • According to census data, more than a third of Texans speak languages other than English.[5]

    • Limited English Proficiency (LEP) individuals with mental disorders are significantly less likely to identify a need for mental health services, endure untreated disorders for longer periods of time, and use fewer mental healthcare services.[6]

  • Deaf and Hard of Hearing: Limited numbers of ASL interpreters available for deaf and hard of hearing populations can weaken their ability to gain effective crisis care. While 988 text functions are available for deaf and hard-of-hearing populations, not all 988 call centers have texting capabilities, thus decreasing deaf and hard-of-hearing populations’ ability to access a local call center. 

    • Deaf people suffer from mental health issues about twice as much as the general population.[7]

    • Only 2 to 10% of Deaf and hard of hearing people with mental illness receive care.[8]

  • BIPOC: Black, indigenous, and people of color populations are more susceptible to mental health problems yet less likely to obtain services. The prejudice and discrimination this population experiences contribute significantly to this disparity.

    • 17% of Black people in the US live with a mental illness. Suicide rates have risen among the population, and suicidal thoughts increased from 6% to 9.5% from 2008 to 2018. [9]

    • Native and indigenous populations experience serious distress 2.5x more than the general American population.42

    • 8.9 million Latinx in the US live with a mental illness.42

    • Mental health disorders among Asian Americans and Pacific Islanders rose from 2.9% to 5.6% from 2008 to 2018.42

  • People with disabilities: Social stigma and ableism increase the mental health needs of people with disabilities. Further, health providers tend to lump mental health needs with disability symptoms, leading to a failure to recognize mental health needs and refer people with disabilities to an appropriate mental health provider.

    • Adults with disabilities report frequent mental distress 5 times as often compared to adults without disabilities.[10]

    • 32.9% of adults with disabilities experience frequent mental distress.

  • People with lower incomes: People with lower incomes have limited access to mental health services due to factors like affordability, distance from clinics, and work hours incompatible with clinic hours. 

    • Low-income people are 7x more likely to be in serious psychological distress compared to high-income people.[11]

    • Low-income people with chronic conditions are 1.33x more likely to have a behavioral health condition compared to people with moderate incomes.[12]

  • LGBTQ+: Discrimination, in addition to rejection by family members, bullying, and violence contribute to LGBTQ+ populations’ risk of experiencing mental health problems.

    • LGB adults are 2x more likely and transgender adults are 4x more likely than heterosexual and cisgender adults respectively to experience a mental health condition.[13]

    • 40% of transgender adults have attempted suicide, a rate 8x higher than that of the general American population.46

    • 10% of LGBTQ+ individuals postponed or failed to receive mental health care due to disrespect or discrimination from providers.[14]

    • 61% of the LGBTQ community has depression, 45% PTSD, and 36% anxiety.47



[1] All Texas Access Report Part 1: Background - 2020

[2] Rural Stress Polling Presentation 

[3] Mental Health of Older Adults

[4] American Foundation for Suicide Prevention - Suicide Statistics 

[5] Texas Quick Facts 

[6] English language proficiency and mental health service use among Latino and Asian Americans with mental disorders

[7] Factors Associated With Social Interactions Between Deaf Children and Their Hearing Peers: A Systematic Literature Review

[8] Mental Health in the Deaf and Hard of Hearing Community 

[9] BIPOC community mental health facts

[10] The Mental Health of People with Disabilities 

[11] Why Even Healthy Low-Income People Have Greater Health Risks Than Higher-Income People

[12] Income Disparities in the Prevalence, Severity, and Costs of Co-Occurring Chronic and Behavioral Health Conditions 

[13] Identity and Cultural Dimensions - LGBTQI 

[14] Mental health challenges in the LGBTQ community 

Critical Steps to Improve Communication with Underserved Populations Through 988

1. Improving 988 Text Function

Text offers a higher level of privacy than a call, making it critical for underserved populations whose communities may have a stigma toward mental health. Further, multiple underserved populations have been shown to utilize texts more than calls, conveying that this format is more accessible to them. The National Association for Mental Illness has reported that people of color text at a higher rate than white individuals.48 Further, low-income households send double the number of texts of high-income households.48 Additionally, people who are hard-of-hearing or deaf find text to be more accessible and practical.[1] Given the critical role text plays in reaching underserved populations, it is concerning that only one National Suicide Prevention Line center in Texas, Integral Care, has the ability to support texting. Funding must be devoted to the improvement of Texas NSPL centers to ensure that all the centers have the infrastructure and the number of staff necessary to provide text services.

2. Increasing Cultural Competency

Cultural competency is critical to establishing a space where underserved BIPOC and LEP people in crisis feel safe to trust their counselor and share their crisis. It requires counselors to understand and respect beliefs and attitudes that differ across cultures and communicate in a way that embodies this respect. In order to produce a culturally competent workforce of crisis counselors, it is necessary to have cultural competency training available at NSPL centers. Further, in order to improve outreach and promotion of 988, using culturally aware marketing strategies is necessary. 



[1] FCC Fact Sheet Implementation of the National Suicide Hotline Improvement Act of 2018 Download

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