Mental Health and Black Patients: Survival and Stigma

The Black community suffers from a high rate of mental health concerns, including anxiety, PTSD, and depression. Black people experience direct traumatic stressors (including being heavily policed or being the victims of physical and verbal attacks), indirect stressors (such as the effects of viewing the video of the killing of George Floyd and others), and intergeneration-ally transmitted stressors (from traumatic stress passed from one generation to the next).

Access and availability of mental health care
Despite these challenges, however, Black people are far less likely to seek care. Statistics show us that about 25% of African Americans seek mental health care, compared to 40% of white Americans. Unequal access to health care is one major contributor to this disparity. The lack of cultural sensitivity by health care professionals, feeling marginalized, and the reliance on family, community, and spiritual support instead of medical or psychiatric treatment are others.

The incidence of psychological difficulties in the Black community is related to the lack of availability and access to appropriate and culturally responsive mental health care, prejudice and racism inherent in the daily environment of Black individuals, and historical trauma enacted on the Black community by the medical field. Moreover, given that the Black community exists at the intersection of racism, classism, and health inequity, mental health needs are often exacerbated and mostly unaddressed and unfulfilled.

History of exploitation and stigma
In Black communities, reluctance to seek both physical and mental health care can often be attributed to a general distrust of the medical establishment. This distrust is not without merit: historically, African Americans have been misdiagnosed at higher rates than white patients, and black communities have been exploited by the U.S. government and medical community in the name of medical research. Seeking mental health care is often viewed as a weakness, running counter to possibly a survivalist mentality born from systemic oppression and chronic racism.

Dr. Martin Luther King, Jr. suffered from bouts of severe depression from his teenage years throughout adulthood. He attempted suicide three times, but refused to go into long-term treatment, even though urged to do so by his inner circle of friends and advisers. He stated that he did not want the Civil Rights movement and his work to be tainted by the stigma of mental health problems. Today, the mental health stigma remains.
Culturally responsive mental health treatment

Culturally responsive mental health treatment is one way of addressing the disparities in psychological wellbeing in the Black community. Culture, a person’s belief, norms, values, and language, plays a vital role in every aspect of our lives, including mental health. Being culturally responsive is a mental health provider’s ability to recognize and understand the role of culture, both the client and clinician’s and the ability to adapt the treatment to meet the client’s needs within their cultural framework.

When meeting with mental and medical health providers, it is essential for clients to ask questions to gain a sense of their level of cultural sensitivity. Many people often feel nervous or guilty about asking these hard questions, but providers usually expect and welcome questions as this helps them better understand the patient and what’s important to them. If they become defensive, that provides important information as well. 

Here are tips Black clients could do to seek out culturally responsive providers:
Experience and training
Ask the provider questions about their treatment approach and if they provide care that is culturally sensitive.

Awareness of intersections
Seek attention from someone who is aware and affirming of your intersecting identities (social categorizations such as race, class, and gender, that are overlapping and interdependent systems of discrimination or disadvantage) and your cultural background.

Ability of the provider to ask questions and be mindful of their own gaps in knowledge and experience

Sidebar: I have to note another statistic that I frequently discuss when I am teaching seminars on this topic. The stats are that Black clients enter therapy with a sense of optimism. Microaggressions can occur in the very context of the therapeutic space. If they remain unaddressed, most often clients will just go away rather than complain. Research also shows that people who drop out of therapy are much less likely to go back.

Additional information on research on developmental psychology and microaggressions can be found here.

(Stats included are from Department of HHS 2017; APA 2019; Mental Health America).

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