Studies show that only 25 percent of African Americans seek mental health treatment compared to 40 percent of white Americans, according to the Arthur Ashe Institute for Urban Health, which cited data from the Centers for Disease Control and Prevention last year.
For Black History Month the Chronicle reached out to three people from within the mental health field to learn why.
One running theme among the medical professionals is a dearth of doctors who reflect the population they serve, therefore a lack of cultural competency necessary to provide help for Black folks in crisis.
“Oh my goodness,” Dr. Marilyn Fraser, CEO of the Arthur Ashe Institute, told the Chronicle. “Studies have shown that you get better health outcomes when you bond with your healthcare provider. If it’s a healthcare provider who looks like you, who shares your language, and somebody who shares certain cultural norms with you, you are more adherent to treatment and care and you do better.”
Fraser said it is unfortunate that there is a push to move away from diversity in the workforce and in healthcare, as clinicians may come with certain biases.
“People are treated differently by the way they look by certain physicians,” she said. “It is important that the workforce is diversified by people that look like you participating in your care.”
Fraser said in a New England Journal of Medicine report in 1999, four people with the same cardiovascular ailments received four different treatment options.
The difference among the patients? Gender and race.
“Each plan was different,” said Fraser. “The person who got the most treatment was the white male. The Black woman got the least in terms of treatment. That study highlighted the biases that we have and people may not be aware that culture plays in health. It is important to have those conversations. It is important to add diversity in healthcare so that we can improve health outcomes.”
For instance, instead of labeling patients noncompliant for not changing their diet, perhaps try to find out whether or not they have access to healthier food options.
Are patients not showing up to appointments because of a complete disregard for their health or because they do not have access to childcare or reliable transportation?
“We really need to include diversity in education when it comes to healthcare and also make sure the healthcare workforce is diversified and they come with the understanding of certain issues that communities of color might face,” said Fraser. “We know that mental illness and stress has so much correlation to other diseases, too, and can increase severity of certain diseases. So we try to make sure our communities that have all these things going on that they are addressing mental health as well.”
The suicide rates of people of color continue to rise, faster than those of whites, said Dr. Ayorkor Gaba, a clinical psychologist and the founder and director of the Behavioral Health Equity Advancement Lab at Teachers College at Columbia University.
Gaba’s work studies the intersection of mental health, substance use, gender, the criminal justice system and multicultural approaches to treatment.
“There has been a 58 percent increase in suicide rates amongst Black Americans between 2011 and 2021,” said the Nigerian-American researcher, who was raised in Jamaica. “In 2020, the overdose death rates increased by 44 percent for Black people in the U.S., and that is a very steep increase that we have seen when we compare those increases amongst whites, which is around 22 percent.”
Black male senior overdose rates are seven times that of their white male counterpart, said Gaba, who cited data from the Centers for Disease Control and Prevention and National Institutes of Health.
“There is a lack of culturally tailored support for that group of people,” said Gaba. “When you think about it, there are not many mental health services or campaigns that are really targeted to Black men over the age of 65.”
That age group has experienced a lot of distrust and trauma from the American healthcare system, she said.
“Also, racial trauma within our country,” said Gaba. “In people age 65 and older, there was also a surge in prescriptions for opioids that happened several years ago and that continues to happen.”
Single Black men are less likely to have access to mental health help because of lack of health insurance, but those who do and seek help are often misdiagnosed due to structural racism, said Gaba.
“They are overdiagnosed with psychotic disorders when they might not meet the criteria for those types of disorders, and also, often when they are experiencing a mental health crisis they are funneled into the criminal justice system and not into the treatment system,” she said. “There is research that shows Black men are overdiagnosed with schizophrenia and underdiagnosed with disorders like depression. We are seeing that in the literature.”
Black women are not faring better, said Gaba.
“There are a lot of studies looking at Black women and cardiovascular health and associating the poor cardiovascular health and rise in cardiovascular morbidity to undiagnosed mental health issues like depression and anxiety,” said the clinical psychologist. “Be it the workplace or the community, we are not handling stressors in healthy ways and these mental health stressors are coming out in our physical health.”
Dr. Sonia Banks, a clinical psychologist from Addisleigh Park, said Black men are hesitant to seek therapy because of the gender bias surrounding help.
“They don’t want to be seen as not strong,” said Banks. “Intimacy for men is not really taught.”
Going to less clinical settings, such as places for yoga or meditation, or the basketball court, help them to open up more.
“They do better in retreat,” said Banks.
Black women are better at acknowledging they need help, but their challenge is finding the right health provider and the cost.
“The challenge is finding a good therapist and sticking with it,” said Banks. “Therapy costs money. If you don’t have a full-time job, then what do you do after six sessions?”
Some companies give their employees up to six mental health days with their benefit packages, said Banks, who said it takes at least up to 20 sessions or about 20 hours, to get to the root of some mental health problems.
If you or someone you know is suffering from mental health issues, Banks suggested getting resources from the National Alliance on Mental Illness, the American Psychiatric Association and The Association of Black Psychologists.
Gaba suggested the Therapy for Black Girls and Therapy for Black Men websites, along with the African American Behavioral Health Center of Excellence.
The Arthur Ashe Institute has a barbershop and hair salon program under which it gets barbers and stylists to share mental health resources via a QR code in the Far Rockaway area thanks to funds secured by Assemblyman Khaleel Anderson (D-South Ozone Park). Fraser hopes to expand the program throughout the borough within the next year. To learn more, call (718) 270-3101 or visit arthurasheinstitute.org.