By Suzanna Chen
Unlike some individuals hidden in our overall acceptive society, mental health conditions do not discriminate based on gender, ethnic background, nor race. They can occur to anyone – as many as one in four people worldwide, according to the World Health Organization (WHO) – and currently occupies a place among the world’s leading causes of disabilities. In fact - with specific mention to African Americans and America’s non-Hispanic white population - statistics by the U.S. Centres for Disease Control and Prevention shows that these invisible illnesses occur in similar percentages within each of the two racial populations. However, while the disorders do not show racial preferences nor discriminations, significant differences still exist between the two groups in many areas, including the degree of communal acceptance and education on mental illnesses as well as the accessibility and quality of mental health care. Through factual context and analysis, we will explore the primary influencing factors behind the mental health environment in African American communities in this article.
Statistics
The following are some statistics to aid in painting a picture of the current mental health situation of African Americans.
Summary of statistics:
Overall, from the national statistics, African American adults' mental health status is more or less similar to those of the other racial groups, but they have significantly less access to professional treatment. Furthermore, the African American youths appear to be in the midst of a mental health crisis – with significantly higher percentages of suicidal attempts and ideations despite less fatality rate. Moreover, black girls seem to be affected by psychological illnesses the most.
Influential Factors
As shown in previously stated data, what mainly differentiates the mental health environment in African American communities and those of the other racial groups is not the rates of psychological illnesses. Rather, it is the accessibility and quality of professional treatment as well as the causes and types of mental illnesses.
Factors affecting the accessibility and quality of mental health care
Out of the numerous factors affecting the accessibility of mental health services for African Americans, perhaps a lesser-known yet significant one is the deep-rooted stigma surrounding psychological illnesses in Black communities. Heartbreakingly, a psychiatrist from the American Psychiatry Association reported in 2011 that even among the patients whom she deemed as severely impaired, many still refused treatment because they did not want to be one of “those people”.
So, what exactly do most African Americans think of “those people”?
A study from 2008 found that among the Black participants previously diagnosed with a mental condition, over a third still feels that “mild” psychological disorders – such as depression and anxiety – would be considered “crazy” in their social circles. Moreover, over a quarter of the study’s population felt that open discussion about mental health would not be appropriate even in intimate family settings – let alone talking about one’s struggles with a therapist, who is a stranger. The long-standing and profoundly negative views many African Americans hold towards people living with mental illnesses are especially impactful for men. Hafeez Baoku – author, director, and host of The Roommates Podcast – has described his experiences with the stigma with the words “Black men grow up in a culture that tells us ‘men are not supposed to cry,’ that we ‘should deal with problems on our own.’” The Black communities – as well as the overall society – hold a stereotypical standard of masculinity that would not allow even the slightest display of weakness. Unfortunately, needing mental health support is still considered an embarrassing showcase of personal weakness and outwards admission of family failure – as it reflects the family’s inability to handle internal problems – for many. These adverse stereotypes all come back to one detrimental factor – the lack of education surrounding mental health and illnesses. Many professionals wonder that if more were taught on the real impact of mental disorders on their victims, would we be able to change the fact that the words “crazy” and “weak” still correspond with “mental illness” in the Black communities.
Another reason that contributes to the reluctance of African Americans to accept professional treatment is the financial strain it would put on many families and individuals.The broken and corrupt U.S. healthcare system has been a dystopian nightmare for those without insurances, and its commodification – such as the continually rising pharmaceutical costs – further intensifies the racial and ethnic disparities in health care access. While the uninsured population consists of members from all ethnic and age groups, people of colour – mainly African Americans and Hispanics who constitute merely 43 percent of the overall population – make up a disproportional 30 percent of the uninsured. Also, above 80 percent of the uninsured were living below the Federal Poverty Level, and members of the Black communities contribute a startling 27 percent of this population. While there are federally-funded healthcare programs such as Medicare and Medicaid, they primarily serve to support the elders, the children, and the physically disabled. In 2010, President Obama introduced the Patient Protection and Affordable Care Act (ACA) – better-known as the “Obamacare” – to expand the federal healthcare support to cover all adults with income below 138 percent of the Federal Poverty Level. Within the effective dates of this act, members of the Black communities made up 22 percent of all receivers of the governmental support, though they still constituted about 16 percent of the uninsured. Unfortunately, the ACA was partially abolished in 2017 by President Trump, who replaced it with the American Health Care Act (AHCA). The controversial AHCA has already reduced persons covered by healthcare insurance by twenty-one million since its activation three years ago, and has disproportionately affected everyone below the Federal Poverty Level. The future looks bleak as the African Americans are already disproportionally represented in the uninsured population; the financial factor is expected to continue influencing the accessibility of mental health services for African Americans in the foreseeable future.
The last prominent factor of influence on the mental health care of the non-Hispanic Black communities is the historic prejudice within the healthcare system. It may come as a surprise – and a relief – that overt racism and discrimination are not significant issues in the current system. Instead, it is the pre-existing bias and lack of understanding of Black patients that still play essential roles in the poor qualities of mental health care for African Americans. Within the American Psychiatry Association (APA) – where the majority of psychiatrists in the U.S. gather to discuss contemporary issues and accomplishments in treatment – only 2 percent of the organization’s members are African Americans. The lack of culturally competent professionals – most likely ones from the same ethnical communities – in the field makes it difficult for Black patients to receive adequate treatment as psychotherapy and cognitive behavioral therapy require deep interpersonal connection and understanding between the patient and the psychiatrist. Also, as most current psychiatrists follow generalized and Eurocentric professional practices, the misdiagnoses rate of Black patients is alarmingly high. For example, according to diagnostic data provided by the National Alliance on Mental Illness (NAMI), African American women are likely to experience physical symptoms – such as body aches and pains – along with mental health conditions. When a professional lacks this knowledge – as most of them do – he or she is likely to not consider these symptoms as related to mental disorders, leading to less early prevention and intervention of mental illnesses. Similarly, according to a 2019 study by Rutgers University, mental health evaluators are likely to misunderstand the Black male patients’ descriptions of mood disorders or PTSD as symptoms of schizophrenia and other psychotic disorders; contributing to the fact that non-Hispanic Black men are five times more likely to be diagnosed with these disorders than non-Hispanic white males. The high rate of misdiagnoses – caused by inadequate understanding of culture and unconscious bias – lead to African Americans’ distrust in the mental health care system, further increasing their fear and reluctance to seek or stay in treatment.
Luckily, more Black psychiatrists and mental health clinicians have spoken out regarding this issue in recent years. Some of the responses they proposed include re-assessing professional practices to incorporate core values of Black culture, such as family, kinship, community, and spirituality; familiarize themselves with the living conditions of Black patients in their communities; and research the unique causes for the decline in African American patients’ mental health, such as traumatic experiences of racism. Hopefully, with these measures being taken into practice, we will be able to enhance the experiences of the Black communities in mental health services and encourage more of them to engage in professional treatments.
Please note that the above only covers three prominent causes – out of many others – for the poor accessibility and quality of treatment for African Americans. Some examples of other notable factors include the religion and spirituality of Black culture, which can play a positive role in decreasing rates of mental illnesses; the overrepresentation of the Black communities in American prisons and correctional centres; and, the inadequate mental health support provided for children in foster care – of which African Americans make up a shocking 45 percent.
Factors contributing to the causations and types of mental illnesses
Continuing on with the previously mentioned racial prejudice, we are now going to explore the factors' significance as a cause of mental illnesses among the African American population. Unfortunately, due to the lack of research, statistics on the connections between discrimination and mental health conditions is limited. However, it has been reported by many psychiatrists that racism-induced trauma has detrimental effects on their Black patients’ mental health.
Trauma in the African American community can come in many forms. The most direct trauma resulting from racism is the individual trauma caused by discriminative actions – such as physical and verbal abuse. Many African Americans also experience complex trauma, in which racially discriminative trauma experienced by the former generations causes traumatic memories for the current generation. For example, when an older family member suffers from a traumatic memory of sexual abuse, they might - due to the lack of access to professional help – develop unhealthy coping strategies, such as substance abuse and tendencies of domestic violence, which are highly likely to cause traumatic experiences for their children as well. The decline in African American youths’ mental health is partially due to this inherited trauma. The rate of complex trauma also correlates with the accessibility of mental health care, as a previous trauma will be less likely to further affect a family member if resolved under professional treatment. Other common forms of trauma are experienced by the community as a whole rather than solely affecting an individual or a family. These include collective trauma, in which traumatic experiences that affected a large population continues to be transmitted transgenerationally; historical trauma, in which both contemporary and historical racism fuse to remind modern-day African Americans of their dehumanization and devaluation; and cultural trauma, in which the collective traumas of the past have long-lasting adverse effects on the cultural identities of the future generations.
The trauma experienced by the African American communities is so severe and widely recognized that it has been given the specific name of Racial Battle Fatigue (RBF) – referencing the “battle fatigue syndrome”, now called PTSD – by the famous race theorist William Smith. Although, since RBF is not a professionally recognized term, we still refer to the African Americans’ struggles with trauma as PTSD. Many researchers, including Smith, claim that untreated RBF or PTSD contribute to chronic behavioural and mental conditions – including anxiety, increased usage of profanity, insomnia or stressful dreams, rapid mood swings, difficulty thinking or speaking coherently, and social withdrawal – as well as physical symptoms – such as headaches, trembling, chronic pain in healed injuries, elevated blood pressure, and rapid heartbeat and breathing. It is disheartening that PTSD is among the most common types of mental illnesses – alongside depression and anxiety – in the African American communities.
The inability to function due to unresolved trauma also caused increased impoverishment within Black populations. In addition to the high rates of poverty and homelessness, the lack of proper public assistance contributes to high percentages of substance use disorders and incarceration rates. As well, people living in poverty are likely to have unhealthy eating habits – as energy-dense yet nutritionally incomplete foods cost less – which contributes to the high percentage of obesity and eating disorders, particularly binge eating disorder (BED), in the African American communities. Moreover, the malfunctioning family environments under poverty also resulted in large numbers of African American children in foster care; and adults who grew up in foster care are shown to be particularly vulnerable to several mental illnesses including PTSD, depression, social phobia and anxiety, generalized anxiety disorder, panic disorder, and substance use disorders.
In addition, as many might be interested, it has indeed been recognized on a national level that police brutality – including false arrests, stop and frisk, and excessive use of force – contributes to increased mental illness rates among African Americans. The tension between the police and the Black community negatively affects how both parties perceive each other – leading to African Americans’ fear and resentment towards the police and the officers’ increased hypersensitivity towards their potential criminals. However, quoted from a 2018 CNN interview with the Black music icon Jay-Z, “As scared as Black folks are of cops, we are even more scared of therapy.” Many members of the Black communities recognize that treating the trauma is equally as important – if not more essential – than preventing the trauma from happening in the first place. So, while we are all fighting against racial prejudice-based police brutality, we should also make mental health treatments more accessible for African Americans.
Conclusion
In summary, while the overall rates of mental illnesses are similar to those of other racial groups, African Americans’ mental health is uniquely affected by the primary factors of trauma induced by racial discrimination, long-lasting stigmatization of mental illnesses, inadequate treatments due to lack of culturally competent professionals, and financial inability to receive treatment. There are still many more factors not discussed in the article, including the overrepresentation of the Black communities in prisons. Information regarding these related yet unexplored topics will be given in the list of recommended readings below. Lastly, it should be recognized and appreciated that professionals in the fields of psychology and psychiatry are working towards formalizing more effective treatment practices for their Black patients. While professional reformations are being made, there are many supportive, public resources specifically aiming to support people of colour. If one would like to be involved in supporting their acquaintances of colour on mental health issues, there is no better way than to be educated more on mental illness and wellness in general. Some useful resources for people of colour and general mental health self-education are included in a list below.
Thank you for reading, and I hope you have gained useful insights and information on this increasingly important topic.
Useful mental health resources (websites and apps)
For people of colour:
(Please note that these are not emergency resources! If you have urgent mental health concerns, please contact emergency response workers.)
Description: “BEAM” is an organization with the mission of removing barriers that Black people experience getting access to or staying connected with emotional health care and healing through education, training, advocacy and the creative arts.
Description: “Black Mental Wellness” aims to provide access to evidence-based information and resources about mental health and behavioral health topics from a Black perspective, as well as training opportunities for students and professionals.
Description: “Black Men Heal” is a Philadelphia-based organization that addresses the financial issue by providing limited and selective free mental health service opportunities for Black men.
Description: “Black Zen” aims to remove any and all social and financial barriers that restrict Black and brown communities from discovering the benefits of meditation, and to make all communities feel included and seen in the wellness space.
Description: The “Boris Lawrence Henson Foundation” is a non-profit organization committed to changing the perception of mental illness in the African American community by encouraging those who suffer with these debilitating illnesses to get the help they need. During COVID-19, they have launched the Free Virtual Therapy Support Campaign to provide Individuals with life-changing stressors and anxiety due to the troubling events of this unprecedented time with up to five individual sessions.
Description: “Dive in Well” is a Los Angeles based health and wellness organization that provides both online and offline platforms – drawing from the salon model - for change-makers to share their ideas and destigmatize mental health therapy.
Description: The article “A Growing List of Black Mental Health Resources” by Melissa Kimble on Ebony Magazine provides a list of Black-owned and focused mental health resources organized by state.
Description: “Elevate” is an inspirational living and self-care mobile application that provides guidance and inspiration to overcome adversity, a place to set goals, and a community forum to connect with others.
Description: “Inclusive Therapists” is an online database of professional therapists who are trained to address racial trauma and provide culturally sensitive care.
Description: “Liberate Meditation” is a mobile meditation app dedicated to people of colour, with dozens of guided meditations to ease anxiety, find gratitude, heal internalized racism and micro-aggressions and celebrate Blackness.
Description: The “Loveland Foundation” provides a therapy fund for Black women and girls who need financial assistance when seeking mental health therapy.
Description: “Melanin and Mental Health” aims to connect individuals with culturally competent clinicians committed to serving the mental health needs of Black & Hispanic communities.
Description: “Sista Afya Community Mental Wellness” aims to fulfill the mission of sustaining Black women’s mental wellness through building community, sharing information, and connecting Black women to quality mental wellness services.
Description: “Therapy for Black Girls” is a virtual space developed to present mental health topics in a way that feels more accessible and relevant.
Description: “The Extraordinary Negroes” is a platform featuring podcasts that delve into humorous explorations of pop culture, current events, and relevant issues within the Black community.
Description: "The Safe Place" Is a Minority Mental Health App aiming to bring more awareness, education, and hope with its wide range of useful features - including Black mental health statistics, inspirational Black quotes, self-care tips, mental health videos and podcast, mental health articles, and open forum discussions.
General resources:
(These are based in the U.S. but are also applicable for international audience)
Description: The “American Psychiatric Association” or “APA” is the largest psychiatric organization in the world, as well as the main platform of communication for psychiatrists and trainee psychiatrists in the United States. The website provides general information on mental illnesses, self-help tips for professionals, as well as treatment options.
Description: “Mental Health America” is the nation’s leading community-based non-profit dedicated to addressing the needs of those living with mental illness and promoting mental wellness. The website contains statistics, blogs, podcasts, and webinars on the topics of mental wellness and recovery from mental illnesses. Links to resources of professional mental health services are also available.
Description: The “National Alliance on Mental Illness” or “NAMI” is U.S.’s leading voice of mental health that aims to provide support and education that was not previously available to those in need. The website contains detailed and professionally approved information on mental health conditions, symptoms and warning signs, and related statistics
Additional Recommended Readings:
“Racial Disparities in Psychotic Disorder Diagnosis: A review of Empirical Literature.”
By: Robert C Schwartz and David M Blankenship. <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4274585/>
“Racial Battle Fatigue: What is it and What are the Symptoms?”
By: Morgan Taylor Goodwin
<https://medium.com/racial-battle-fatigue/racial-battle-fatigue-what-is-it-and-what-are-the-symptoms-84f79f49ee1e>
“The Top 10 Most Startling Facts About People of Color and Criminal Justice in the United States.”
By: Sophia Kerby
<https://www.americanprogress.org/issues/race/news/2012/03/13/11351/the-top-10-most-startling-facts-about-people-of-color-and-criminal-justice-in-the-united-states/>
“How Therapists Drive Away Minority Clients.”
By: Monnica T Williams
<https://www.psychologytoday.com/ca/blog/culturally-speaking/201306/how-therapists-drive-away-minority-clients>
“It’s Time to Address Mental Health in the Black Community.”
By: Derrick Hollie
<https://www.huffpost.com/entry/its-time-to-address-mental-health-in-the-Black-community_b_591a0f64e4b086d2d0d8d1dd>
“Mental Health and Foster Care.”
By: Staff of Child Welfare Project, Denver office
<https://www.ncsl.org/research/human-services/mental-health-and-foster-care.aspx>
“Prevalence of Eating Disorders among Blacks in the National Survey of American Life.”
By: Jacquelyn Y. Taylor and other researchers
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“African Americans Have Limited Access to Mental and Behavioral Health Care.” American Psychological Association. Sept. 2017. Web. 14. June. 2020. <https://www.apa.org/advocacy/civil-rights/diversity/african-american-health>
“Black & African American Communities and Mental Health.” Mental Health America. n.d. Web. 14. June. 2020. <https://www.mhanational.org/issues/Black-african-american-communities-and-mental-health>
Baoku, Hafeez. “Challenging Mental Health Stigma in the Black Community.” National Alliance on Mental Health. 27. July. 2018. Web. 14. June. 2020. <https://www.nami.org/Blogs/NAMI-Blog/July-2018/Challenging-Mental-Health-Stigma-in-the-Black-Comm>
“Black/African American.” National Alliance on Mental Health. n.d. Web. 14. June. 2020. <https://www.nami.org/Your-Journey/Identity-and-Cultural-Dimensions/Black-African-American>
“How Environmental Factors Impact Mental Health.” Alliant International University. n.d. Web. 14. June. 2020. <https://www.alliant.edu/blog/how-environmental-factors-impact-mental-health>
“Mental and Behavioural Health – African Americans.” U.S. Department of Health and Human Services – Office of Minority Health. 25. Sept. 2019. Web. 14. June. 2020. <https://www.minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=24>
Goodwin, Taylor Morgan. “Racial Battle Fatigue: What is it and What are the Symptoms?” Medium. 6. Dec. 2018. Web. 14. June. 2020. <https://medium.com/racial-battle-fatigue/racial-battle-fatigue-what-is-it-and-what-are-the-symptoms-84f79f49ee1e>
NMH Communications. “Mental Disorders Affect One in Four People; Treatment Available but Not Being Used.” World Health Organization. 2001. Web. 14. June. 2020. <https://www.who.int/whr/2001/media_centre/press_release/en/>
National Survey on Drug Use and Health. “2018 NSDUH Detailed Tables.” U.S. Department of Health and Human Services – Substance Abuse and Mental Health Services Administration. 20. Aug. 2019. Web. 14. June. 2020. <https://www.samhsa.gov/data/report/2018-nsduh-detailed-tables>
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