Breaking the Code of Silence: Black Americans and Mental Health

Because of stigma, lack of access and several other factors, only one quarter of Black Americans seek mental health care. Understanding these reasons is the first step toward making a change.

Cost and Availability

People living in rural areas or underserved neighborhoods have difficulty seeking adequate providers close to them. Furthermore, accessing care can be expensive because of the price of services and travel costs. Many Black Americans lack access to quality providers due to ever-increasing costs, even with insurance coverage. According to the American Psychological Association, African Americans are more likely to use emergency medical services than their white counterparts, likely due to being underinsured.

Crippling Stigma

Given the history of African Americans in the United States in regards to slavery, collective cultural resiliency is particularly strong and in some ways a great disadvantage when it comes to accessing mental health services.Additionally, some African Americans have a hard time discussing mental health issues because their emotional conditions are often seen as “white issues.” There is still much cultural stigma around any acknowledgement of emotional conditions that are seen as a sign of weakness.

The Impact of the Tuskegee Experiment

Racism is still prevalent, making many people of color afraid of accepting mental health assistance. Experiences such as the Tuskegee Experiment mark an important cultural collective trauma that persists in African American consciousness today.

In 1932, researchers at the Tuskegee Institute — in collaboration with the Public Health Service —  began a study known as the “Tuskegee Study of Untreated Syphilis in the Negro Male.” This study included 399 men who were diagnosed with syphilis and 201 men in the control group.At the time, even more African Americans lacked adequate health care. White researchers and local doctors promised the men clinic visits, treatment, and medication to manage and ultimately cure their conditions. What participants did not realize was the facilitators lied to them.The men were studied longer than they expected and many died as a result. Researchers intentionally didn’t treat them with penicillin, which emerged in 1945 as a cure for syphilis. It wasn’t until the 1960s, when black researchers began to work at the Tuskegee Institute, that the illusion of treatment crumbled and the story of maltreatment hit the Associated Press. Social worker and epidemiologist, Peter Buxton – also known as Peter Buxtun — has been credited as the whistleblower who broke the story to the press.

Alternative Sources of Support

Due to historical atrocities like slavery and the Tuskegee experiment, Black Americans have a history of accessing local spiritual and religious communities for much-needed emotional and mental support. Churches and religious fellowship have been at the heart of Black survival in the United States. Religious organizations served as organizing centers during the Civil Rights movement of the 1960s and many Black Americans continue to utilize pastoral services as a means for not only spiritual enlightenment but also for everyday guidance.

Lack of Competent Providers

Trust is critical to developing a relationship with a therapist with whom you will ultimately discuss all your hopes and fears. Many Black Americans have interacted with mental health providers and medical personnel that lack a nuanced understanding of issues faced by communities of color. This creates an environment of distrust.Fortunately, now more than ever, graduate schools and therapist training programs are helping therapists in-training gain more experience in treating diverse populations. These programs are also helping therapists uncover their hidden biases and prejudices about Black Americans and other marginalized groups. Providers are now a lot more equipped in addressing the needs of communities of color.Black Americans can be assured that therapists of all ethnicities and backgrounds are dedicating themselves to develop a deeper understanding of the needs and barriers that Black Americans face when engaging in therapy. If you are having a tough time and want support, don’t suffer in silence.If you are in NY/NYC and interested in services with me, please visit Viva to submit an inquiry.

This post was originally published at the Talkspace blog.

An Open Letter to Yankees Ace CC Sabathia

Thank you.

Gratitude was my first reaction to the news that came on October 5, 2015 when you released a statement announcing that you would be entering rehab for alcohol abuse.  After my initial shock and surprise at the announcement, all I could think of was how grateful I was that you made such a public declaration.  While I can only imagine the range of emotions you must have felt to be so publicly vulnerable, I am so thankful that you have chosen to use your status to bring attention to such a devastating issue as substance abuse.  Your family must be so proud of you for stepping up to the plate once again and taking control of what I can only imagine has been a very troubling time in all your lives.

I write “thank you” because I think we will feel the impact of your announcement for years to come. Your vulnerability offers many men an example of how even the strongest of us face difficult times.  As an athlete in our modern era of what seems to be full of overgrown adolescents, you have shown us an example of what courage, authenticity and maturity looks like.  And it is doubly important that you have done this as a Black man.In many communities of color, mental health and substance abuse issues are often swept under the rug.

More often than not, these issues are thought of as "White people problems". I imagine that even with your example, there will still be many who think you are somehow removed from Blackness because you have chosen to seek treatment.  It is a sad reality that we live in.  Thankfully, you have chosen to do what is best for both you and your family.  With that action, you have given many Black men an example of what a strong man looks like. And with less than 9% of all folks who are challenged by alcohol abuse seeking treatment, you taking responsibility for your alcohol abuse speaks volumes.

It is hard for Black men to show vulnerability. As boys we were taught that anger and frustration are the only ways to be a “real man”. As we grow up and mature, we are faced with challenges in relationships that require us to be more present, more open, and more vulnerable. As adults, we can no longer hide in the “tough guy”  paradigm of masculinity. But many of us do. Many of us take on the burden of being a strong man, which we often forget means that we must also be vulnerable and loving to our spouses and families, demonstrate courage and take responsibility for our actions. When challenges cross our paths we often adopt that "we real cool" stance that author Bell Hooks so eloquently wrote about.  This allows us to maintain a façade of enduring strength.

Meanwhile, on the inside we battle our own obstacles in silence. That's what makes your statement so powerful for so many of us. Not only are you an example for people struggling with substance abuse issues, you show all of us what taking responsibility looks like. You show all of us how to embody strength and vulnerability. Your status as a Yankees ace and a public figure means that your declaration has reached so many who have been touched by addiction.As a Yankees fan, I have admired your work on the field. You are a gifted athlete.  Your performance and statistics document your achievements very well.  However, I have to say that I don't think I've ever been in more awe of you as a man than the day you released your public statement of your impending treatment for alcohol abuse.  As a mental health counselor I work with people struggling with addiction. I work with many men who are struggling to live authentic lives in a culture that says that they cannot be vulnerable and that they cannot falter. The pressure to live up to such an incredible standard can be debilitating. Alcohol becomes an escape and a socially acceptable refuge.According to the National Institute of Mental Health, over 6 million men in the United States suffer from depression each year.  According to the Center for Disease Control, men consistently experience higher rates of alcohol related deaths than women in the United States every year. It is estimated that alcohol may be a factor in 50% of suicides. And with people of color accessing mental health services in lower rates than our White counterparts, your statement provides an example of a Black man seeking care. I have no doubt that your journey will serve as a beacon of hope for other men who may be struggling with similar issues.

I am inspired by your honesty and I think that while you face your challenges head on, you've given us the opportunity to pause and take stock of where we are within ourselves. I know I have and I thank you for that.

I'm sure many other people will too.