a primer: african american and black communities

African American Communities and Mental Health

"White women are stereotypically the face of mental illness. There are media representations like Blanche of A Streetcar Named Desire, Ingrid Bergman in Gaslight and even more recently, Carrie in Homeland, and Pat and Tiffany in Silver Linings Playbook. Even when it comes to the news reports of these tragic shootings recently, when it is a white male there is the immediate speculation that he is mentally ill. Yet, when Black or Latino men commit crimes, they are just that: criminals. There is a stigma that is rampant in our society towards mental illness. Yet it is worse for communities of color. Mental illness doesn't discriminate but people do. People of color in the United States battle with microaggressions, cultural/religious/ language barriers, and negative stereotypes. That compounded with a mental illness is debilitating. White individuals do not deal with the issues we face." - Dior Vargas

Although anyone can develop a mental health problem, African Americans sometimes experience more severe forms of mental health conditions due to unmet needs and other barriers.

According to the Health and Human Services Office of Minority Health, African Americans are 20% more likely to experience serious mental health problems than the general population.

  • Adult blacks living below poverty are two to three times more likely to report serious psychological distress than those living above poverty. 
  • Adult blacks are more likely to have feelings of sadness, hopelessness, and worthlessness than are adult whites.
  • And while blacks are less likely than whites to die from suicide as teenagers, black teenagers are more likely to attempt suicide than are white teenagers (8.2 percent v. 6.3 percent)
  • African Americans of all ages are more likely to be victims of serious violent crime than are non-Hispanic whites, making them more likely to meet the diagnostic criteria for post-traumatic stress disorder (PTSD).

Issues to Consider:

1. Lack of information and misunderstanding about mental health

In the African American community, many people misunderstand what a mental health condition is and don’t talk about this topic. This lack of knowledge leads many to believe that a mental health condition is a personal weakness or some sort of punishment from God.  African Americans may be reluctant to discuss mental health issues and seek treatment because of the shame and stigma associated with it.  

Many African Americans also have difficulty recognizing the signs and symptoms of mental health conditions, leading to underestimating the effects and impact of mental health conditions. Some may think of depression as “the blues” or something to snap out of. Because of the lack of information surrounding mental health issues, it’s not always clear where to find help when you may need it.

  • 63 percent of African Americans believe that depression is a personal weakness
  • Only 31% of African Americans believed that depression was a "health problem"
  • 6% believed that depression was a normal part of aging
  • 45% believed it was normal for a mother to feel depressed for at least two weeks after giving birth
  • 40% believed it was normal for a husband or wife to feel depressed for more than a year after the death of a spouse

2. Barriers to treatment

  • Denial (40%)
  • Embarrassment/shame (38%)
  • Don't want/refuse help (31%)
  • Lack of money/insurance (29%)
  • Fear (17%)
  • Lack of knowledge of treatment/problem (17%)
  • Hopelessness (12%)

3. Reluctance and Inability to Access Mental Health Services

Only about one-quarter of African Americans seek mental health care, compared to 40% of whites. Here are some reasons why:

  • Distrust and misdiagnosis. Historically, African Americans have been and continue to be negatively affected by prejudice and discrimination in the healthcare system. Misdiagnosis, inadequate treatment and lack of cultural competence by health professionals breed distrust and prevent many individuals from seeking help or staying in treatment.
  • Socioeconomic factors. According to the U.S. Census Bureau, as of 2012, 19% of African Americans had no form of health insurance. The Affordable Care Act is making it easier and more affordable to get insured.
  • A lack of African American mental health professionals. Only 3.7% of members in the American Psychiatric Association and 1.5% of members in the American Psychological Association are African American.
  • Medications. Some studies indicate that African Americans metabolize many medications more slowly than the general population, yet we are more likely to receive higher dosages. This may result in a greater chance of negative side-effects and a decreased likelihood of sticking with treatment. 
  • Provider bias and inequality of care. African Americans, especially African American women, are more likely to experience and mention physical symptoms related to mental health problems. For example, you may describe bodily aches and pains when talking about depression. A health care provider who is not culturally competent might not recognize these as symptoms of a mental health condition. Additionally, African American men are more likely to receive a misdiagnosis of schizophrenia, when expressing symptoms related to mood disorders or PTSD. In addition, African Americans of all ages are underrepresented in outpatient treatment, but overrepresented in inpatient treatment. Few African American children receive treatment in privately funded psychiatric hospitals, but many receive treatment in publicly funded residential treatment centers for emotionally disturbed youth. 

Finding the Right Provider 

Culture - a person's beliefs, norms, values and language - plays a key role in every aspect of our lives, including our mental health. Cultural competence is a doctor's ability to recognize and understand the role culture plays in treatment and to adapt to this reality to meet your needs. Unfortunately, research studies have shown lack of cultural competence in mental health care. This results in misdiagnosis and inadequate treatment. African Americans and other multiracial communities tend to receive poorer quality of care. 

If you do not feel comfortable seeking a mental health professional right away, a primary care doctor is a great place to start. The primary care doctor may be able to start the assessment process to determine if you have a mental health condition, or assist you in getting a referral. 

Unfortunately, while you may prefer finding an African American mental health professional, this is not often possible since there are a small percentage of providers. Thankfully, professionals are increasingly required to learn how to effectively treat individuals from diverse backgrounds. However, as mentioned before, many providers still lack cultural competence and do not know how to effectively treat African Americans. 

When meeting with your provider, ask questions to get a sense of their level of cultural sensitivity. Do not feel bad about asking questions. Providers should expect and welcome questions from their patients, since this helps them better understand what is important to you and your healing. Your questions give your doctor and health care team important information about you. Here are some example questions:

  • Have you treated other African Americans?
  • Have you received training in cultural competence or on African American mental health?
  • How do you see our cultural backgrounds influencing our communication and my treatment?
  • How do you plan to integrate my beliefs and practices in my treatment?

Your mental health provider will play an important role in your treatment, so make sure you can work with this person and that you communicate well together. Mention your beliefs, values, and cultural characteristics. Make sure that your provider understands them, so that they can be considered in the course of your treatment. For example, mention whether it is important for you that your family be involved in treatment. 

Learn More.

Resources

  • Capstone Institute/Center for Research on the Education of Students Placed at Risk, Howard University: http://www.capstoneinstitute.org/
  • National Black Nurses Association: http://www.nbna.org/
  • National Medical Association: http://www.nmanet.org/
  • Lee Thompson Young Foundation: http://www.leethompsonyoungfoundation.org/

Sources

  • http://quickfacts.census.gov/qfd/states/00000.html
  • “Mental Health: Culture, Race and Ethnicity Supplement” to the 1999 U.S. Surgeon General’s Report on Mental Health.
  • http://www.census.gov/prod/2010pubs/acs-11.pdf
  • http://www.census.gov/newsroom/releases/archives/2010_census/cb11-cn185.html
  • http://minorityhealth.hhs.gov/templates/content.aspx?lvl=3&lvlID=9&ID=6474
  • http://www.npr.org/2012/08/20/159376802/behind-mental-health-stigmas-in-black-communities
  • http://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/, 2012
  • http://aspe.hhs.gov/health/reports/2011/cpshealthins2011/ib.shtml#_Toc303600552