How to Improve Behavioral Health Equity

Achieving behavioral health equity is essential to ensuring that all individuals receive high-quality mental health care. Yet, persistent disparities continue to affect people across the country. These inequities are often fueled by stigma, implicit bias, and systemic barriers that hinder access to effective and culturally responsive services. As behavioral health providers, we have a critical role to play in closing these gaps.

This article explores practical strategies that providers and organizations can adopt to advance behavioral health equity. From addressing stigma and using trauma-informed care to adapting assessments and integrating services, each approach centers on meeting the unique needs of diverse populations. At the organizational and policy levels, efforts to diversify the workforce, expand access through telehealth, and promote cultural humility are reshaping how care is delivered.

By embracing these strategies, behavioral health professionals can build more inclusive, equitable systems of care — ones that recognize and respond to the lived experiences of all clients. The path to behavioral health equity begins with intentional action and a commitment to ongoing learning, reflection, and advocacy. Together, we can help ensure that no community is left behind in the pursuit of mental wellness.

How to improve behavioral health equity on an individual-level

Individual-level strategies can help address behavioral health inequities for the people that you serve. These strategies include:

• Addressing mental health stigma and bias
• Using a trauma-informed care approach
• Adapting your treatment approach

Address mental health stigma and implicit bias

Mental health stigma remains a major barrier for individuals in marginalized communities and can people from seeking the care they need. Stigma occurs when someone is judged or treated unfavorably due to a mental health condition.

Implicit bias, on the other hand, refers to automatic or unconscious attitudes that affect how we perceive and interact with others. These biases often stem from learned associations that begin early in life. For instance, some people may assume that men are inherently less nurturing. Such unconscious beliefs can result in preferential treatment of certain groups over others.

Behavioral health providers are not exempt from holding implicit biases. In fact, research shows that healthcare professionals exhibit similar levels of bias as the general population.

To counteract implicit bias, providers can use the following strategies:

• Explore: Acknowledge your own biases. Mindfulness and reflection can help reduce stress and promote intentional, respectful interactions.
• Educate: Engage in perspective-taking through books and documentaries, and evaluate clients as individuals.
• Approach: Foster an inclusive workplace with affirming messages that reflect acceptance and respect for all.

Use a trauma-informed care approach

Historically, marginalized communities have faced devaluation and unequal treatment within healthcare systems. Many individuals from these groups continue to experience discrimination and bias. A trauma-informed care approach encourages providers to see the whole person — taking into account their personal history, lived experiences, and current circumstances. This framework reframes trauma symptoms not as disorders, but as adaptive responses to overwhelming or harmful experiences. By grounding treatment in the client’s unique background, providers can foster trust and strengthen the therapeutic relationship.

The core principles of trauma-informed care include:

• Safety: Ensure clients feel secure both physically and emotionally.
• Transparency: Build trust by being open and clear about treatment decisions.
• Support: Incorporate peers or staff with shared experiences to create a supportive environment.
• Collaboration: Engage clients in shared decision-making to reduce power imbalances.
• Empowerment: Focus on the client’s strengths and resilience to promote healing and growth.
• Humility and responsiveness: Acknowledge and address the biases, stereotypes, and past traumas your clients may carry with them.

This approach creates a foundation for more equitable, empathetic, and effective behavioral health care.

Adapt treatment approaches

Research indicates that a significant number of children, adolescents, and young adults do not receive treatment for behavioral health concerns. A major contributing factor is that these conditions are often overlooked — especially among individuals from historically marginalized backgrounds. One proactive way to address this issue is to implement routine mental health screenings for all clients. This approach not only enhances early identification of those who may need additional support, but also provides a platform to challenge stigma and correct misconceptions about mental health.

To help close gaps in care, consider the following strategies to adapt your assessment process:

Adapt the assessment

During assessments, be sure to explore the client’s — and when appropriate, their family’s — perspectives on:

• Cultural beliefs and how these shape views on mental health, treatment preferences, and family involvement.
• Attitudes toward mental healthcare and willingness to engage in services.
• Intergenerational trauma and its ongoing impact on the client and family.
• Cultural identity and levels of religious or spiritual engagement.
• Social determinants of health (SDOH) and how they may be influencing the client’s well-being.

Also, inquire about family dynamics, peer relationships, and school experiences. Pay close attention to any reported experiences of discrimination or bias. It is especially important to initiate conversations around intergenerational trauma with both clients and their families.

Screen for ACEs

As part of the assessment process, it’s important to screen for adverse childhood experiences (ACEs).

The ACEs Questionnaire evaluates exposure to 10 types of childhood trauma and is a well-established, reliable, and valid tool.

When reviewing the results, involve both the client and caregiver as appropriate based on the youth’s age. Approach the conversation with empathy and without judgment to strengthen the therapeutic relationship and foster a collaborative care process. Additional best practices include:

• Discuss strategies to help manage and reduce stress linked to ACEs.
• Connect current physical or emotional health concerns to the client’s ACEs history.
• Normalize the experience by explaining that many individuals in the U.S. have encountered ACEs.
• Involve the client and caregiver in joint treatment planning.

Be sure to also screen for broader community-based adverse experiences, which can significantly impact well-being. These may include:

• Exposure to neighborhood violence
• Experiences of discrimination
• Substandard housing conditions
• Food insecurity
• Foster care involvement

Periodically re-administer the ACEs Questionnaire to capture any changes in the client’s life and to ensure alignment with their evolving treatment needs.

Screen with the CRAFFT

Screening for substance use disorders is a critical component of a comprehensive behavioral health assessment. One of the most widely used and validated tools for this purpose is the CRAFFT screening tool, which is specifically designed for youth between the ages of 12 and 21. Named for the key words in its six-item questionnaire, the CRAFFT effectively identifies both high-risk alcohol consumption and other potentially harmful substance use behaviors.

By incorporating this tool into routine assessments, providers can better detect early signs of substance use and tailor interventions that support healthier outcomes for young clients.

How to improve behavioral health equity on an organizational-level strategies

At the organizational level, it’s essential to implement universal screening for symptoms of mental illness across all clients. Additionally, provide mental health educational materials in multiple languages, prioritizing those most commonly spoken within your community. Ensure that these resources are readily accessible and that materials intended for children and youth are written at an appropriate reading level to support comprehension.

Distribute educational content through various touchpoints, including after-visit summaries, client portals, waiting areas, and exam rooms, to reinforce understanding and encourage engagement.

To further advance equity, organizations should actively work to recruit and hire behavioral health professionals from historically marginalized backgrounds — particularly those who reflect the communities they serve. This approach not only improves cultural relevance but also helps build trust and rapport with clients.

Be culturally humble

Cultural humility involves recognizing how a person’s cultural background shapes their mental health experiences and outcomes. It also means applying this understanding to deliver more culturally responsive and respectful care. Participating in cultural humility training is essential for developing this skill. Additionally, you can support organizational change by sharing your knowledge and helping to educate colleagues.

Cultural humility is grounded in three core principles:

• A continuous process of self-reflection and critical self-evaluation.
• A commitment to addressing power imbalances in the provider-client relationship.
• The ability to form meaningful partnerships with communities and advocate for systemic change.

By embracing these principles, providers can foster more inclusive, equitable care environments that truly respect and respond to each client’s lived experience.

Provide integrated care

Individuals from marginalized communities often encounter significant barriers when seeking care. These challenges may include navigating complex healthcare systems, limited access to reliable transportation, and a shortage of mental health providers. Integrated care offers a powerful solution to help reduce these obstacles.

As a best practice model, integrated care brings together evidence-based medical and behavioral health services within a single point of access. This approach can be implemented in various settings and is designed to provide coordinated, comprehensive treatment for co-occurring mental health, substance use, and physical health conditions.

Integrated health systems are uniquely equipped to address the full spectrum of a person’s health needs in one location. Moreover, research published in Administration and Policy in Mental Health found that individuals receiving care through integrated primary care models experienced lower overall healthcare costs compared to those in traditional care environments. This cost efficiency is especially valuable for underserved populations, many of whom face financial constraints and limited access to quality care.

Offer services via telehealth

Telehealth has significantly improved access to behavioral health services, making it easier for clients to connect with care, including specialized support such as telepsychiatry. This expanded access is especially critical for individuals in rural areas or those facing transportation challenges.

Telehealth offers several key benefits, including:

• Enhanced continuity of care
• Reduced healthcare costs
• Minimal disruption to work or school due to the elimination of travel
• Lower stigma, as services can be accessed privately from home

When offering telehealth, it’s important to discuss with clients and their caregivers whether they have the technology and internet access needed to participate. Some may lack reliable devices or connectivity. In these cases, work with clients to find alternative solutions — such as identifying free, private spaces in the community, like local libraries.

Macro-level strategies

At the policy level, both federal and state governments are advancing reforms to improve behavioral healthcare across the U.S. These initiatives aim to expand access — particularly within historically marginalized communities — through community-based settings like schools and health centers.

Four national strategies are currently being prioritized:

• Broaden access to equitable behavioral healthcare
• Enhance behavioral health integration in primary care
• Increase the diversity of the behavioral health workforce
• Improve Medicaid reimbursement and early identification of children in need of care