In 2015, the City of New York released a report identifying mental illness as the single greatest source of disability in New York City.

According to the report, half a million adults report symptoms of depression and yet only 40 percent report that they receive treatment. Of that, minority groups and low-income individuals often experience the largest gaps in diagnosis and treatment. Statistics show that while Hispanic, Asian, Black and Native Americans are equally, if not more likely, than their white counterparts to be living with mental illness, they are significantly less likely to receive treatment. Diseases like depression and anxiety are pervasive, but often go unnoticed, unreported and untreated.

This can stem from a variety of factors. First, there is often a shortage of care, particularly culturally competent care, in areas that are predominantly non-white. Not only are there fewer mental health professionals working in these areas, but also there is often a lack of diversity among the professionals that do exist.

This can lead to another major barrier to accessing care: if doctors are not trained to have the cultural context and language skills they need to serve minority communities, it can lead to misunderstandings between doctors and their patients. According to Larke Huang, the director of the Office of Behavioral Health Equity at the Substance Abuse and Mental Health Services Administration (SAMHSA), these misunderstandings often leads to patient dropout.

Racism and prejudice also play a role in failure to diagnose or misdiagnosis among people of color. For example, black men are more likely to be diagnosed with severe mental illnesses, like paranoid schizophrenia, than their white counterparts in part due to common racial stereotypes. And other common stereotypes, such as the idea that African American patients feel less pain, not only disrupt routine medical care, but have the potential to bleed into mental health care as well.

Lastly, poverty is also a major factor to accessing mental health care in New York City. Mental illness is most prevalent in households where family income is below or just above the federal poverty line, and is almost twice as likely for adults who live 200 percent below the federal poverty line.  But these same individuals often lack the tools they need to pay for the services they require. Almost 1 million New Yorkers lacked health insurance in 2014.

So what does this mean for the future of New York? Untreated mental health problems can have long-lasting effects on both individuals and the New York City community at large. It can lead to poor job performance, low productivity, and serious physical health issues like diabetes, hypertension and cardiovascular disease.

This poses a major financial burden for the City of New York. In 2013, mental illness accounted for 25.6 percent of health care costs. It is also estimated that around $14 billion in annual productivity is lost due to depression and substance abuse or misuse. Furthermore, untreated mental illness accounts for a little over $3 billion in criminal justice system costs. All of which are shouldered, in some part, by the New York City taxpayer.

Bridging these gaps in New York City’s mental health care system is integral to the city’s overall wellness. Policy makers should be looking for ways to incentivize more culturally competent mental health professionals to practice in underserved areas, equip more primary care doctors to diagnose and treat common mental illnesses and look to schools and community centers as nexuses for treating mental illness. Without creating comprehensive policy that addresses the diverse experiences of all New Yorkers, a large part of our community will go overlooked, to everyone’s detriment.