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.
The Impact of Legislating Discrimination
Representatives in the House and Senate in Tennessee have moved to implement Bill 1840 (Amended Senate Bill 1556) which has far-reaching consequences for consumers seeking mental health services in the state. This marks an ongoing trend of anti-LGBT and so-called "religious freedom" efforts across the United States.
With increased visibility often comes increased hate and backlash. Many states have started to bring up bills to vote based on fear and ignorance under the guise of religious freedom. Most notable as of late are Mississippi and North Carolina's so-called "bathroom bills". Both are based on the egregious and uninformed notion that trans people are sexual predators who will sexually prey on women and children in public restrooms (favor for such bills ignores the potential of male victims altogether). Never mind that most sexual abusers are known to the victim and have regular access to the people that they abuse. According to the U.S. Department of Justice's 2013 National Crime Victimization Study 82% of sexual assaults were perpetrated by a non-stranger. Given that, it seems like there's no real need for so-called bathroom/locker room "protection".
Recently, Tennessee decided to allow professional counselors to deny services to consumers whose views oppose the counselor's own "sincerely held principles" (originally worded "religious beliefs"). This bill, to my understanding, has been given to the governor for approval. You wouldn't want to work with a counselor who doesn't support who you are or your identity, right? Sure. But what if your options were limited and you needed help now? Where would you turn?This kind of legislation may pose a bigger problem than you think. Here are some startling statistics to consider:
In 2014, approximately 43 million Americans lived with a diagnosable mental illness (SAMHSA, 2014).
The economic impact of untreated mental illness in any given year in the United States is in excess of 100 Billion Dollars (NAMI, 2006).
As of 2010, approximately 246,000 adults live with serious mental illness in the state of Tennessee (NAMI State Advocacy 2010).
According to McIntosh (2009) 874 Tennesseans died by suicide in 2006 (NAMI State Advocacy 2010).
According to "Grading the States 2009: A Report on America's Health Care System for Adults with Serious Mental Illness", public emotional health services only treat 34% of adults in the state of Tennessee who live with serious mental illness (NAMI State Advocacy 2010).
What does this all mean? With about 20% of Americans dealing with mental health issues every year, you can imagine the impact of a bill like 1840 in Tennessee which allows for counselors to deny services based on "sincerely held principles". Many who need licensed professional help and may be living in crisis aren't being reached. Those not in crisis, with limited support options may go untreated. Legislation such as Tennessee Bill 1840 (Senate Bill 1556) only serves to add yet another barrier to those in need of support.
Consider this scenario: You're a 19-year-old young man living in small, rural Tennessee town. You've recently come to terms with your being gay and feel very isolated in your community. You have limited access to finances and transportation and your parents are unsupportive. You realize that you need someone to speak to. You reach out to a licensed counselor in your area for help because lately you have been having thoughts of suicide. You call this counselor and let him or her know what you're struggling with and they say, "I don't believe in homosexuality so I'm afraid I can't help you."' You can imagine that impact on those words on a depressed man. There is no hope that you can get the help that you need. There is no escape to your suffering, not even from a person whose mission is to help. You have may no other options.Lives are at stake here. The quality of someone's life is at stake when they're reaching out to mental health services like therapy. Without ongoing support they may continue to struggle in isolation, see their health and conditions worsen and possibly even resort to suicide. This is the impact of legalizing discrimination. It should be noted that the current version of the bill prohibits counselors from denying services to someone who is actively suicidal.
Not only does 1840 violate the ethics of most professional counseling associations, it also opens up concerns of liability and complications for issues of malpractice if laws like this stand. That's not to mention that this new proposed law would even go as far as to also bar the counselor's professional body, such as the American Counseling Association, from holding the counselor responsible for an ethics violation. Of course, you wouldn't want for a young gay man to be working with someone who doesn't "agree" with his sexuality. That's obviously not ideal for that client. However, if your options are limited and your mental health is a matter of life and death immediate support and intervention can be critical to someone who is otherwise isolated and struggling. My fear is that legalizing these kind of efforts allows for a very slippery slope in the high standard which we should hold fellow counselors. Mental health issues are a public epidemic and with bills like 1840 in Tennessee coming to fruition, I can only imagine how dire circumstances may become for so many who are struggling day in and day out to live healthier lives. Bills like these also further contribute to the ongoing stigma that many oppressed communities face, especially when trying to seek care.
With increased mainstream visibility of LGBTQ issues, it seems that some are dedicated to promoting legislation that not only promotes discrimination, but like Tennessee, limit care to those who truly need it. Please urge your local legislators to take mental health care seriously and make a conscious decision to make supportive care MORE accessible and affordable. Without our unified voices, I fear that the state of the country's mental health will only worsen and we simply can't afford that to happen.
There are many more bills popping up across the country with reference LGBTQ communities. Huffington Post's "Everything You Need To Know About The Wave Of 100+ Anti-LGBT Bills Pending In States" provides a lot of great insight on the status of such bills.
Black Boys Describe What it Means to Grow Up in America
There has been a lot of conversation, more so lately, about racism across the United States. Several high profile incidents have not only sparked new conversations about race, policing and institutional racism in the United States, but have also led to protesting and even rioting.
After a racially motivated hate crime in a church in South Carolina, the constituency gathered their voices to express concern over the Confederate Flag remaining on the state capitol building. The flag, seen as a symbol of separation and racism for Black Americans, was removed from the building after legislative action in July 2015. This was after a Black woman, Bree Newsome, independently removed the flag and was subsequently arrested. The removal of the flag has been met with a great deal of controversy, however, as some (mostly) White Americans have relished in the flag as a cornerstone to Southern history. However, the impact of its visibility cannot be understated, especially to Black descendants of the slaves who were traded and sold in the antebellum south.This incident as well as many others has prompted further discourse among and across racial groups, which desperately needs to continue. There must be consistent advocacy work to address and dismantle institutional racism whether it exists in our policing systems, housing systems, or economic and educational sectors. There is still a lot of work to be done.
Dismantling racial discrimination is particularly important to foster a greater sense of unity among all the nation's people but also because it has a particularly strong and insidious impact on Black Americans. These consequences are all encompassing and cover a wide range of issues for Black Americans such as:
Distorted self perception and internalized racism
Overrepresentation in the criminal system
Heightened vigilance and anxiety
Depression & psychological distress
Poorer living conditions
Less life satisfaction
Lack of access to needed resources
Limited socioeconomic mobility
A consistent pressure to be perceived as "good" or "non-threatening"
The NY Times published a video of young Black men talking about their experiences living in America which demonstrates some of the emotional consequences of growing up Black. Please see below.If you are feeling the effects of racial discrimination, please read my previous post 3 Powerful Ways to Cope with Racism. And if you're looking for some suggestions on how to be an effective ally in fighting racism, 11 Things White People Can Do to be Anti-Racist Allies via Alternet.org is a great resource.
3 Powerful Ways to Cope with Racism
Research has demonstrated that racism has a negative impact on the mental health of people of color leading to feelings of isolation, anger, depression and lower self-esteem. It goes without saying that this avoidable phenomenon needs to continue to be addressed on both the individual and societal levels.Discrimination in its many forms can be damaging to anyone and the more one experiences these prejudicial behaviors, the more difficult it can be to bounce back from its effects. While I want to be clear that those in power who create systems of racism and discrimination should be the ones dismantling them, I also want to offer some practical suggestions on coping with the effects of racism.With the election (and re-election) of President Obama and the 2013 killing of Trayvon Martin and more recently the killings of Eric Gardner and Mike Brown, the United States has experienced a resurgence of tense racial relations. At best, conversations have become increasingly difficult between groups while at worst, young men and women of color are losing their lives in racially charged incidents.Here are some basic suggestions that you, as a person of color, might use to help cope with the effects of racism:
Find solace where you feel the most comfortable
As the old saying goes, there is strength in numbers. Getting support from those who you know are sympathetic to your experiences can be extremely helpful in managing the anger and frustration of having experienced discrimination. You can reach out to friends, family members or other loved ones for consistent emotional support. You may also want to consider joining a local social or activism group (such as a local chapter of the NAACP) where you can receive support and participate in anti-racism efforts. Churches and religious institutions have historically been involved in anti-racism efforts so you may also find support and fellowship in those venues as well.
Use your voice
Experiencing discrimination in any form can be extremely isolating and racism can leave you feeling particularly marginalized given the belief by many Americans that racism no longer exists. In the moment, use your voice to call out racism whether it's when you're among friends, family members or colleagues. Take special care to evaluate the risks and benefits of confronting racism with some folks and strangers as your personal safety might also be at risk.
Join the movement
There are a significant portion of people in the United States, and in the world for that matter, that recognize that racism is still an everyday experience for many folks. Consider joining a local social justice group that addresses the impact of racism. Using your voice and personal experience to fight against bias can be a very empowering experience for you and you will also help prevent others from the feelings of isolation and humiliation that you may have experienced.It is an unfortunate reality that racism still exists and affects the lives of many people around the United States and the world. It has been noted that experiencing racism can lead to feelings of self-doubt, anger, frustration, humiliation and isolation.If you have experienced racism, the suggestions mentioned in this article might help manage those effects. If you still have difficulty with your experiences and feel that your difficulties warrant more individualized attention you may want to contact me directly or another local therapist for ongoing emotional support.