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Racial Disparities in Mental Health Care

February 15th, 2022


13.4% of the US population is made up of African-Americans, with 16% of them reporting having a mental illness, which is roughly 7 million people. Historically, African-Americans experience trauma and violence more often than others. These exposures have impacted the mental health and emotional well-being of Black People, who face a history of racial disparities in mental health care research, treatment, diagnosis and provider bias.

George Floyd and Breonna Taylor sparked national awareness of the racial divide we continue to witness. Racism is an issue that permeates and influences how Black People and other Persons of Color are viewed and treated in the United States. Take the time to imagine being a person of color watching videos of a man of color murdered by force in the street while under police restraint. Imagine that it is the middle of the night, you are asleep in bed, and then suddenly you’re awakened to bullets piercing your body, instantly causing your death. Were their crimes so severe to evoke such extreme measures that caused their deaths?

The path of least resistance response to protesters on what is known as the “violent insurrection” on January 6, 2021, in comparison to the treatment of unarmed, peaceful protesters at Black Lives Matter Marches, is another example of the injustice Black People in this country continue to face.

In addition to these events, there are layers of trauma individually, situationally, institutionally, and systemically endured atop of the recent trauma of COVID-19, elements of poverty, and police brutality. All of these elements aid to the mistrust that so many Black Americans face in this present day.

Processing and dealing with the complex layers of racial disparities in mental health care pose complexities that should be unpacked in a safe environment such as therapy.

Historical Implications of Racism in Mental Health

Historical Implications of Racism in Mental Health

Mental health professionals and pioneers have more white representation and credits than people of color in the field. As a result, interventions are often not geared towards people of color or welcoming of cultural differences. This can lead to provider bias and stereotyping that impacts the level of care people of color receive.

To speak on the disparities, it is important to explore historically how this came to be. In the United States, scientific racism was used to justify slavery to appease the moral opposition to the Atlantic slave trade. Black Men were described as having "primitive psychological organization," making them “uniquely fitted for bondage.”

Benjamin Rush often referred to as the “Father of American Psychiatry” and a signer of the Declaration of Independence described “Negroes as suffering from an affliction called Negritude”. This “disorder” was thought to be a mild form of leprosy in which the only cure was to become white. Ironically, Rush was a leading mental health reformer and co-founder of the first anti-slavery society in America.

Rush did observe, however, that “the Africans become insane, we are told, in some instances, soon after they enter upon the toils of perpetual slavery in the West Indies.” Slave owners there had asked Willie Lynch, the man whose name the term “lynching” comes from, to come to teach his methods after experiencing issues controlling their slaves. Willie Lynch used a simple but drastic method: Keep the slave psychologically dependent on the slave owner and physically strong to work and breed.

Another term “Drapetomania” defined by Samuel Cartwright, known as the “Professor of Negro Diseases” at the University of Louisiana, is a mental illness that causes Black Slaves to flee from captivity. He documented this condition as a direct consequence of slave masters becoming too close or comfortable with their slaves and seeing them as equals.

He said the cure for this was to treat them as children and keep them in a submissive state, so they don’t try to escape. As recently watched in the 2007 movie The Great Debaters, Denzel Washington’s character describes this simply as, “keep the body, take the mind.” Treatment included “whipping the devil out of them” as a preventative measure if the warning sign of “sulky and dissatisfied without cause” was present. Remedies also included the removal of big toes to make running physically impossible.

Cartwright also described “dysaesthesia aethiopica,” an alleged mental illness that suggested laziness, “rascality” and “disrespect for the master’s property” among slaves. Undoubtedly, whipping was prescribed as a treatment. Furthermore, according to Cartwright, dysaesthesia aethiopica was more prevalent among “free negroes.”

The claim that those who were free suffered mental illness at higher rates than those who were enslaved was the thinking of Cartwright. The U.S. census made the same claim, and this was used as a political weapon against abolitionists, although the claim was found to be based on flawed statistics. Even at the turn of the 20th century, leading academic Psychiatrists claimed that “negroes” were “psychologically unfit” for freedom. As late as 1914, drapetomania was listed in the Practical Medical Dictionary.

Mental Illness and Over Criminalization

Mental Illness and Over Criminalization

Furthermore, after slavery was abolished, Southern states embraced the criminal justice system as a means of racial control. “Black codes” led to the imprisonment of unprecedented numbers of Black Men, women, and children, who were returned to slavery-like conditions through forced labor and convict leasing that continued into the 20th century.

The Black Psyche was recorded as unwell and criminal. This profile led to the justification of Jim Crow laws, police brutality against members of the civil rights movement, and the mass incarceration of Black People we see today.

African-Americans make up about 13% of the population, but nearly 40% of the prison and jail population. Evidence shows they are less likely to be identified and diagnosed with a mental health disorder. As a result, Blacks are criminalized more for having symptoms of mental health. They then go without adequate treatment once incarcerated, putting African-Americans at a greater risk for a lifetime of mental health struggles and therefore, criminalization.

Environmental Factors of Racial Disparities in Mental Health Care

Many Blacks in the community express having considered therapy. However, representation of Black mental health providers is low, therefore the number of those who attend therapy is low as well. Those seeking help often face the risk of persistent and chronic symptomatology awaiting services to address mental health issues.

It is important to also note environmental factors further impact these existing mental health concerns (poverty, crime, lack of employment, resource deserts, inadequate healthcare, etc). Finally, the stigma of admitting symptoms prevents honest conversations about psychological, emotional, and mental health concerns.

According to the Health and Human Services Office of Minority Health, Black Adults in the U.S. are more likely than White Adults to report persistent symptoms of emotional distress, such as sadness, hopelessness, and feeling like everything is an effort. Black Adults living below the poverty line are more than twice as likely to report serious psychological distress than those with more financial security.

Despite the need, only one in three Black Adults who need mental health care receive it. According to the American Psychiatric Association’s Mental Health Facts for African Americans Guide, they are also:

  • Less likely to receive guideline-consistent care
  • Less frequently included in research
  • More likely to use emergency rooms or primary care (rather than mental health specialists)

In my experience as a therapist, in meetings with patients who are Black, they often talk about the struggles and barriers they have encountered. They often express feeling relieved to have found someone of the same race, as they feel they are better able to relate and be themselves. They also say they feel exhausted from the confines of attempting to address underlying issues they have buried for years.

The Black Community typically seeks help from local churches as a source of guidance and support. They often realize there are more issues to address with a professional but often feel that the process of finding adequate mental health care presents too many challenges. Today, Black People continue to be negatively impacted by prejudice and discrimination that impacts the care they receive. Due to this, Black People continue to encounter negative experiences when they seek treatment.

Inadequacy in Care

Providers can have biases both consciously and unconsciously that can drive how they treat Black People. A lack of cultural competence in mental health providers can result in inadequate care and misdiagnoses.

Somatic complaints can be the result of depression or anxiety but providers in the field may overlook this as a mental health symptom. Black or African American Men are 4 times more likely to be diagnosed with Schizophrenia. One possible reason for these racial disparities in the mental health care field could be the cultural mistrust African Americans resemble that can appear to be paranoia, and be diagnosed as Schizophrenia. Psychotic symptoms are often overemphasized in evaluations, and other causes like severe depression, substance abuse, or trauma are overlooked.

Culturally Competent Care 

Culturally Competent Care

As therapists, we are taught that unless the patient brings up religion or spirituality, it is not the responsibility of the therapist to insert this topic into their session. However, in Black Communities, faith is often needed and viewed as a source of strength and direction. More often than not, before going to seek mental health services, Black People go to pastoral counseling to help them navigate the troubles they struggle with.

It is still considered “crazy” for a person to seek mental health assistance in many communities. Many times, the Black identified individuals may be concerned about how they will be perceived if they seek mental health treatment. Assessments do not typically include conversations that allow for patients to openly explore this. Allowing room for conversations around how they believe mental health is viewed by others can dispel misconceptions Black People may come with.

Being mindful that every shade of black, does not mean that all Black People share the same experience. It is important not to generalize based on skin tones alone. Ask and not assume in all aspects of getting to know people is the best way you can keep biases, we all have, out of communications when establishing rapport and trust.

Microaggressions are a “comment or action that subtly and often unconsciously or unintentionally expresses a prejudiced attitude toward a member of a marginalized group (such as a racial minority)”. For example, comments like “You are so pretty for a big girl”, or “You speak so eloquently” are examples of microaggressions. Microaggressions are artfully covert ways of insinuating a derogatory, hostile, or negative message that heightens suspicion in those they are directed at.

Ask yourself, “Is this a question I would ask someone who is in the majority? Would I ask this if they were male, thinner, heterosexual, or White?” These questions can be hurtful, harmful, and dangerous towards the minority.

In times of slavery, spirituals were sung, which led many of them to freedom. Religion and spirituality are a big part of the heritage and culture of many Black People. Therapists should incorporate questions within intake that allow for discussion around how religious aspects play a part in their lives.

Ignoring this fact can potentially dismiss a large segment of a Black Person’s network. It can also silence communication about their involvement in the church or belief in their chosen religion. Being open to discussing religion, helps them to feel they do not have to withhold parts of who they are because of the taboo attached to talking about religion or spirituality on a larger scale.

Making sure the patient feels comfortable asking questions about your training and experience working with Blacks or People of Color can help decrease some of the mistrust African-Americans have when they finally engage in services. How we show up as therapists to African-Americans and People of Color, is just as important as the interventions we provide. Ultimately, these factors combined help on the path to overcoming racial disparities in mental health care.

Written By: Lovea Smith, LCPC, Director of Clinical Therapy, Loop

Clarity Clinic

At Clarity Clinic, we have highly trained staff who specialize in therapy and psychiatry services. To learn more about how we can support your mental health, call Clarity Clinic on (312) 815-9660 or schedule an appointment today.

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