The Problem With Race & Mental Health

By Dr. Marcia Boatman, PhD, LPC, CAADC 

When it comes to therapy, African Americans and many other people of color are more apt to discuss their feelings on a friend’s couch than a stranger’s. And some would rather hold it in and discuss nothing at all. I asked several African Americans to share their thoughts about why this community is less likely to attend therapy. The most common comments are:

• “We were raised that whatever happens in this house stays in this house. As we got older that stayed gospel”.
• “It is hard to trust people. Sharing my most private experiences with a stranger is taboo. Real help comes from full disclosure and that is not going to happen without trust."
• “My parents did not believe in going to tell someone your private business."
• “It is hard to find experienced black therapists or black physicians that are specialists in this area. The work it takes to find someone qualified who lives in your area is overwhelming."
• “There is too much stigma and too many labels associated with mental health. Black people have been given enough labels and stereotypes. Receiving mental health treatment usually results in another label and the false pretense that black people are crazy.”

Being a black mental health counselor who happens to come from a family with mental illness, I find myself on both sides of this issue. Growing up, mental health meant you had been a suffering veteran or you had a nervous breakdown. I grew up in the inner city of Detroit during the crack-cocaine epidemic. My mother died early in the AIDS epidemic. Therapy was never on the table as an option for support. If I knew a kid today who was going through what I went through, I would strongly recommend they be in therapy.  It feels awkward to say this, but I don’t know that I even knew there was someone outside of my family or friends to talk to.  There was a lot of privacy and mistrust in outside agencies because they were viewed as part of the machinery of marginalization. Below I have included some of the findings from research (Glassgow et al., 2019) conducted on the association between mental health and community disorganization along with suggestions on how to address these limitations.  I recommend you think about these points and have conversations.

• Parents are not aware that what they are experiencing with their children is considered a mental illness. We have to accept that in this melting pot of cultures, mental illness will be perceived differently. Depressive symptoms are often dealt with in the family or by talking to close friends or pastors. However, black adults, children, and adolescents do engage in self-harm and commit suicide and it is important that black people understand what balanced limits look like. In other words, at what point do you call someone?
• Why does it seem like schools are quick to diagnose black children as having behavioral issues and white children as depressed or anxious? When you hear “behavioral issues” do you think acting out and when hear depressed do you think sad? Glassgow states that “discrimination within healthcare and mental health settings, including from providers, has been associated with under-utilization of services.” Earlier we learned that a lack of culturally competent providers is an issue. We are underrepresented in the field of mental health, in the classroom, in law enforcement and numerous other places where we experience disparities.

African Americas are more likely to drop out of therapy (Mays, Jones, Delaney-Brumsey, Coles, & Cochran, 2018). It will take more awareness and time to address the issues of stigma and mistrust between the black community and mental health community. Mental health impacts us all. However, we would be remiss to overlook the cultural and historical factors for each individual. If you are considering joining this field we need you. America is becoming more diverse than ever and the mental health field must be representative of our nation. Two of the main factors I see in the anonymous comments above are trust and fear. There is also a real issue of accessibility. Here are some ideas on how to begin addressing these issues.

• Use websites like ours to locate a therapist. Each of our therapists have a bio and insurance information along with their treatment specialties. Trust is something that has to be built over time. It is acceptable to tell a therapist up front you have trust issues. You can also ask about the limits of their confidentiality. Mental health providers must adhere to HIPPA guidelines.
• I grew up with the same rules what happens in this house stays in this house. What happens when someone in the house loses their job during a bipolar manic episode that their boss assumed was anger management issues? What if someone in the house becomes addicted to drugs, or worse, commits suicide? These are things that can destroy the family that lives in the house. When the family needs help, the expectation is to do whatever it takes to preserve the family. Even if it means you choose to only work with therapists of a certain cultural or religious background. You have that right; just get the help you need for the family. There are systemic issues that need to be resolved in our country, but I would like to live my best life in this generation while I can. I believe you would like the same.
• Mental health providers have a responsibility to educate the public about mental health and treatment. Opportunities to do this include getting to know your neighbors, hosting and/or speaking at mental health and health care events, making our presence known on social media, utilizing blogs and podcasts, local churches, and newspaper and magazine articles.  Join more directories to make yourselves accessible.

  References Glassgow, A. E., Gerges, M., Atkins, M., Martin, M., Caskey, R., Sanders, K., ...Kim, S. (2019). Exploring racial disparities in mental health diagnoses and neighborhood disorganization among an urban cohort of children and adolescents with chronic medical conditions. Health Equity, 3(1):604-611. Mays, V. M., Jones, A., Delaney-Brumsey, A., Coles, C., & Cochran, S.D. (2018). Perceived discrimination in healthcare and mental health/substance abuse treatment among Blacks, Latinos, and Whites. Medical Care 55(2):173-181.