In his role as head of government affairs for North America at Johnson & Johnson, Courtney Billington has an up-close look at the debilitating burden of mental health disorders in the Black community. A combination of factors, including the pandemic and lack of access to care, have led to rampant health inequity.
“By 2030, depression is expected to be the leading contributor to the global burden of disease for the entire world,” Billington said. “We see a secondary pandemic happening as a result of mental health issues.”
Rates of anxiety, depression and substance use disorder have increased since the beginning of the pandemic, according to the NIH. A 2021 survey showed that nearly half of Americans experienced “recent symptoms of an anxiety or depressive disorder, and 10% of respondents felt their mental health needs were not being met,” NIH reported.
Those numbers are even higher within the Black community, according to the National Alliance on Mental Illness (NAMI). Black adults in the U.S. are more likely than white adults to report persistent emotional distress. Those symptoms are even more pronounced among Black adults living below the poverty line.
Despite the higher disease burden, Black Americans have less access to care.
“Only one in three Black adults in the United States who need mental health care actually received it. That's a startling statistic,” Billington said. “This lack of access to care is often compounded by other defects that happen systemically.”
Billington points to factors like the American criminal justice system, which “prioritizes punishment rather than treatment;” a higher uninsured rate among Black Americans; and a lack of access to culturally competent healthcare providers.
“There are not many providers within the Black community … less than 2% of all psychiatrists are Black,” Billington said. “Sometimes bias leads to different types of treatment.”
Factors like these are why Billington has spearheaded several initiatives within J&J and beyond to promote and increase access to mental health care within the Black community. Doing so also dovetails with other J&J diversity efforts, such as improving diversity within clinical trials.
“In a company like Johnson & Johnson, our strategy is focused on medical innovation. Where we look for that innovation is where there are high unmet medical needs,” he said, pointing to J&J’s portfolio and pipeline dedicated to neuropsychiatry conditions, such as schizophrenia. “This is a space of unmet medical need.”
Billington’s latest efforts to improve mental healthcare in the Black community have culminated in a new group dubbed the Health Equity Brain Trust, made up of leaders from across industry, academia and mental health advocacy organizations, as well as Black mental healthcare experts, leaders and providers. It formed in the second quarter of last year as an outgrowth of another group led by Billington called the Community Health Equity Alliance, which works at the community level in four states — California, Georgia, Texas and North Carolina — to bring equitable mental health care to Black communities.
The Community Health Equity Alliance is now led by NAMI, but Billington and his colleagues recognized that “there’s more work to be done.”
“The Brain Trust’s mission is to operationalize equity into a set of strategic actions that are focused on leadership, visibility [and] research advocacy, that ultimately will catalyze sustained community and policy impact within the black community,” he said.
“By 2030, depression is expected to be the leading contributor to the global burden of disease for the entire world. We see a secondary pandemic happening as a result of mental health issues.”
Head of government affairs for North America, Johnson & Johnson
The Brain Trust is in its early stages and is still developing metrics and objectives, but Billington hopes to build on the success of the Community Health Equity Alliance, which reached more than 2.5 million people within a year and a half with information, resources, education and tools to improve access to mental healthcare within the Black communities where they were working.
It's all part of J&J’s broader efforts around health equity.
“We're now almost four years into what we call ‘Our Race to Health Equity,’ where we committed more than $100 million to ensuring that we were doing more to erase some of the inequities and disadvantages that exist in health care,” Billington said. “Because we frankly see it as a public health threat.”