Best practices for therapists working with immigrant mental health
Summary
Clinicians should offer flexible payment options and sliding scales to promote mental health equity and access in digital care for underserved populations.
Providers can improve technology accessibility in therapy by choosing user-friendly platforms and offering technical support to clients.
Offering in-person alternatives or telephone-based sessions ensures that those with limited internet access are not excluded from treatment.
Practicing cultural competence through translated materials and diverse frameworks helps bridge the digital divide in behavioral healthcare.
Technology has revolutionized access to medical and behavioral healthcare. There are numerous mental health apps and electronic health record (EHR) platforms that make seeing a provider considerably easier and more convenient.
But while technology accessibility in therapy has expanded options for many clients, underserved populations often face barriers that leave them without meaningful access—making it essential for clinicians to know when to offer alternatives.
As clinicians, when considering mental health equity and access in digital care, we’re also contending with how to bridge the digital divide to ensure we reach underserved populations. By recognizing client needs and planning ahead, clinicians can know when to offer alternatives that ensure safe, accessible care.
What is mental health equity?
Mental health equity and access in digital care refers to ensuring that all populations have fair access to quality, culturally responsive behavioral healthcare, regardless of their social, racial, cultural, economic, or other identifying characteristics.
While technology accessibility in therapy has improved convenience, mental health equity and access in digital care still depends on devices, internet access, and technical skills.
Additionally, not everyone has the same level of access due to a range of barriers, including:
Availability of services: Geographical location and access to internet services, such as living in a rural area, can prevent access to healthcare.
Time and resources: It can be hard to find the time to search for providers that are in-network with your insurance and have availability at a mutually convenient time. Not everyone has the flexibility to attend telehealth appointments during the day, when most are available. Additionally, some people may lack access to resources, such as affordable childcare, that would enable them to take time off to attend an appointment.
Workforce shortages: Workforce shortages and limited provider availability can increase wait times and reduce options for clients, particularly in underserved communities.
Financial barriers: Increasing healthcare costs and insurance premiums can make regular therapy appointments unaffordable for clients without financial resources. In addition, the affordability of digital devices and the internet can be barriers to accessing mental healthcare.
Fragmented healthcare systems: Disconnected systems and providers working beyond capacity can make it challenging to coordinate care and provide case management for clients with more complex needs.
Social barriers: Some clients may face social stigma or experience internalized stigma for seeing a therapist instead of resolving problems themselves, which prevents them from accessing services and leaning on others when they need support.
Technical ability: Some clients find technology difficult to navigate due to limited digital literacy, disability, low prior exposure, or lack of formal education—all of which can pose significant barriers to accessing virtual care.
How to reach underserved populations
Overcoming barriers to mental health equity and access in digital care requires a multifaceted approach that may extend beyond our scope as clinicians and involves broader policy changes. However, there are ways to bridge the gap.
Here is how to reach underserved populations:
Be willing to advocate: Talk to other providers or arrange access to services and resources on the client's behalf.
Take insurance: Accepting a wide range of insurance, including state health plans, will increase access to underserved populations that may not otherwise be able to afford therapy.
Offer accessible options: Be willing to offer a range of therapy options, including shorter sessions, telehealth, talk-to-text, captioning, text customization (such as text size, scaling, and contrast), walk-and-talk therapy, and flexible scheduling.
Obtain informed consent: Explain the technology you use, risks, and limitations before the client consents to services.
Provide technical support: You can offer to demonstrate how to use your telehealth platform with the client or ensure the telehealth software you use is easy to use and provides technical support if the client encounters difficulties. Many EHR platforms offer helpful video demonstrations explaining how to access their virtual appointment and manage their documentation, which you can include in your intake paperwork or provide a link for appointment scheduling.
Flexible payment options: Offer sliding scale, pay-what-you-can, and low-cost therapy options to clients with financial barriers.
Connect clients with resources: Provide links to resources to help prospective clients get set up with Medicaid, behavioral healthcare programs, and other resources on your website.
Review service accessibility: Choose telehealth platforms and apps that meet accessibility standards and are designed with diverse users in mind.
Focusing on these steps is key to understanding how to reach underserved populations while promoting mental health equity and access in digital care.
When to offer alternatives
When technology accessibility in therapy is limited, offering in-person alternatives supports mental health equity and access in digital care.
There may also be circumstances when it is not safe, or the client does not have the privacy to access virtual treatment. In those instances, it may be more appropriate to offer in-person or telephone-based services.
You can also offer to connect clients with local resources, such as a community center with a private room, computer, and secure internet access.
There may also be circumstances when you are not the right cultural fit for a client. In these cases, prioritize transparency, seek supervision, and work to connect them with a more appropriate provider when one becomes available.
How to ensure cultural competence
Culturally competent practices are essential for promoting mental health equity and access in digital care, ensuring technology accessibility in therapy does not leave clients behind.
We can practice cultural competence by:
Seeking to understand the client’s unique perspective by asking culturally-informed questions, such as how their race, culture, identities, and faith inform how they view themselves and the issue they are seeking support with.
Providing solutions that meet their unique cultural expectations by understanding what has been helpful in therapy, what has been harmful, and how you can find ways to address blind spots and difficulties you may encounter.
Avoiding Eurocentric frameworks and overly clinical language that may not resonate with the client's cultural context.
Offering services and paperwork in the client’s language, and offering translation services where possible.
Recognizing how structural barriers have impacted the client, their well-being, and their access to resources.
Choosing apps and technologies that represent a diverse client base and meet accessibility guidelines.
Providing culturally specific resources.
Engaging in self-reflection and learning about cultural differences and how our identities shape interactions with clients. Connecting with a good supervisor and peers who challenge us is also a great way to address our blind spots.
FAQs about healthcare equity
What about language barriers?
Where possible, offer services and paperwork in the client’s native language or offer translation services.
Text-based communication or telephone therapy can be more helpful for people with limited English proficiency, allowing them to focus on conversation without visual cues.
What about cost barriers?
Addressing cost barriers can be complex. Where possible, provide access to resources and flexible and low-cost payment options.
Equity means addressing these barriers to find solutions, which might include group sessions, shorter appointments, flexible cancellation policies, and connecting them with a low or no-cost resource.
Sources
World Psychiatry: official journal of the World Psychiatric Association (WPA). Alegría, M., Nakash, O., & NeMoyer, A. (2018). Increasing equity in access to mental health care: a critical first step in improving service quality.
American Psychological Association. (2022). Opportunities for psychologists to provide evidence-based policy solutions to threats to our nation’s mental health.
Frontiers in digital health. Bunyi, J., Ringland, K. E., & Schueller, S. M. (2021). Accessibility and Digital Mental Health: Considerations for More Accessible and Equitable Mental Health Apps.
National Institutes of Mental Health. (2024). Technology and the Future of Mental Health Treatment.
World Health Organization. (n.d.). Health equity.
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