SOUTHERN INDIANA – Fet’Hanie Davis has dealt with mental health issues for most of her life.
Fet’Hanie Davis
She remembers being hospitalized for two weeks around the age of 10, at which time she couldn’t fully grasp what she was dealing with. Her symptoms — which manifest as mania and depression, and can manifest as racing thoughts and paranoia to low energy and crying — were not officially given a name until she was 22, after she’d been hospitalized additional times and struggled to find effective treatment.
Now, at 46, Davis has a better understanding of her condition. She knows what triggers her and how to cope, and has a support system of family, friends and coworkers who don’t judge or stigmatize her.
“I’m doing really good,” she said. “Not to say life hasn’t happened, but I believe it’s because I decided to invest in knowing what it was that I was dealing with and really, really tapping into myself.”
But the journey to get to where she is now hasn’t been easy for Davis. Like many other Black Americans, she didn’t grow up seeing Black representation in healthcare, and mental health issues were often stigmatized both inside and outside the Black community.
While mental health conditions occur in Black people at the same frequency or higher as white people, Black Americans face structural and community barriers to mental health care that results in dimmer outcomes when it comes to receiving treatment. As of 2021, while roughly half of white adults received mental health services, only about 40% of Black adults received care, according to the Kaiser Family Foundation.
Black mental health experts and those who live with mental health conditions told the News and Tribune how medical racism, difficulties accessing care and an ongoing need for education contribute to disadvantages in the Black community for those in need of treatment.
“There’s still a lot of old mind frames, a lot of old paradigms, a lot of old ways of thinking, and it takes time,” Davis said. “However, it has to be willingness of the people that are in power to be able to look and say ‘hey, there’s a disparity in this community around mental health. What are we doing to get in there and educate these folks on a level they can understand?’”
ACCESS TO TREATMENT
Despite the prevalence of mental health conditions in the Black community, Black people do not always have the same access to care and treatment as their white counterparts, mental health experts said.
Brittany Johnson, a therapist who works in Southern Indiana, said one of the biggest factors that impacts people of color is financial access to quality care.
“Typically, Black and Brown people are in lower socioeconomic statuses or places, and so their access is typically limited to community mental health,” she said.
Community mental health centers are facilities providing mental health services that are often supported by county, state and federal funding programs.
“While community mental health is great and serves its purpose, there isn’t always someone who maybe is culturally trained to work with people of color, or there are long wait periods,” Johnson said.
Teah Williams-Hampton, a therapist at Avenues Unlimited in Louisville, said the cost of therapy, access to insurance and a lack of representation are barriers many people of color face when it comes to receiving mental healthcare. The labor and time it takes to make appointments, fill out paperwork and meet with physicians can also be burdensome depending on a person’s lifestyle and executive functioning abilities.
The Black community’s long history with medical racism also creates distrust toward medical providers. Unethical experiments such as the Tuskegee Syphilis Study and the case of Ferguson v. the City of Charleston — two cases in which Black people sought out medical care but were involuntarily and unknowingly the subject of harmful medical experiments — have fostered anxiety over centuries. Medical racism still continues today; a study as recent as 2016 found that some white medical students still believed the false narrative that Black patients feel less pain. Other studies show that Black people are more likely to die from conditions that are treatable with quality care, receive more negative descriptors in medical records and are less likely to be referred to specialists.
While Black Americans are less likely to be treated for mental health conditions, they are more likely to be sent to jail than their white peers – four times more likely, according to a 2022 study by the Pew Research Center. Williams-Hampton said that especially for Black adolescents, mental health programs are not offered to people of color as often.
“If a kid hasn’t eaten, if a kid hasn’t seen their mama… if you send this kid to school and this kid is acting up or acting out, well, this kid gets a disciplinary record, so this kid looks like they’re just horrible,” she said. “But if you sit them down and you ask them what’s going on, all behavior is communication — and they’re just trying to communicate.”
Davis noted that in some communities and households, mental health issues are often dismissed as a child being defiant or a troublemaker.
“Deep down, they don’t know how to express it other than the way they’ve expressed it in the behavior, so the behavior gets labeled and the true cause of it doesn’t ever get diagnosed,” Davis said.
Davis said that in her journey to find mental health treatment, she usually is not denied treatment outright. However, she always questions if her race plays a role in the treatment she gets or the ease at which she gets it. The risk of stigmatization, especially in regards to her race, factors in when it comes to identifying who is safe to share her condition with.
Recently, she said, she’s had a difficult time getting her antipsychotic medication from her pharmacy due to issues with insurance and difficulty getting an appointment with a provider. This has left her without the medicine she needs for days.
“Of course, they won’t say ‘you’re Black, you cannot get your medicine,’ but you best believe, somewhere in my mind, I’ll feel that ‘am I being discriminated against?’” she said.
A NEED FOR REPRESENTATION
Despite having grown up with her mental health condition, it wasn’t until she was diagnosed as an adult that she truly began to understand what mental illness was and what it meant for her.
“Growing up, I didn’t even know I had an issue,” Davis said. “But once I was diagnosed I was able to look back at some times in my life that obviously I still remember, that my behaviors were a little different.”
Although her family took the lead to get her help as a child, Davis said she wishes she’d seen more people who looked like her talking about mental illness. Today, she is a life coach at the Excel Center in Clarksville, where she teaches socioemotional learning. Her students often tell her they wish they would’ve had the class earlier. Davis agrees.
“I find it very rewarding that I can take a need I had and be able to share with others what I have learned,” she said.
In addition to external barriers like medical racism that make it harder for people of color to access treatment, a major reason Black people struggling with mental illness may face difficulties receiving adequate treatment is due to a lack of representation and education about mental healthcare, said Williams-Hampton. Studies show only 25% of Black Americans seek mental health care, compared to 40% of their white counterparts.
While Gen Z-ers and Millennials have normalized therapy on a wider scale than Gen X-ers and Boomers, who still have a way to go, Williams-Hampton said. And misconceptions about therapy — such as the stereotypical lying-on-a-couch image — still abound.
“We still have a lot of work to do in kind of helping people overcome those fears and those concerns so they create the experiences that help them realize they’re going to be okay, instead of therapy being something traumatizing,” she said.
Within the Black community specifically, Williams-Hampton said, more people are turning toward therapy today as an effort to find community. While places like church, community centers and neighbors have historically served as support systems, mass incarceration, gentrification, economic plight and natural losses like moving away or death has made Black communities more fragmented than in the past — and, she said, people are realizing they need professional support, too.
But when it comes to actually getting that help, Black people may have a harder time finding a therapist they connect with. Just 2% of psychiatrists in the U.S. are Black, according to 2021 data from the American Psychiatric Association, and just 4% of psychologists are Black.
The shortage of therapists of color can make people hesitant to go to therapy until they’re in crisis mode. When they reach that point, Johnson said, traditional forms of therapy are going to be less effective and their mental health harder to manage.
Waiting until someone is in a crisis to seek help can also lead to a person being misdiagnosed because they may exhibit more severe symptoms than they typically would, she said. Black people are more often diagnosed with schizophrenia and less often diagnosed with mood disorders compared to white people with the same symptoms, according to Mental Health America.
Therapy is a unique experience created by the client and the provider, Williams-Hampton said. While a white therapist can be competent and compassionate, people of color seeking therapy often want another therapist of color who can understand specific cultural references and validate their experiences without needing to justify or explain themselves.
“When you walk into a space with somebody that looks like you, there’s almost like a breath that you take,” she said. “It’s difficult for some people to be vulnerable with someone when they have an idea that, ‘I don’t know if this person hears or sees me.’”
For Davis, finding a good therapist has felt, in some ways, like dating. While she’s been going to therapy off and on for 20 years, she’s had to go through some therapists she didn’t connect with to find one she works successfully with now. Having a Black woman therapist who relates to her experiences is essential to getting the most out of therapy she can.
“I am telling you every single thing about me, and if you don’t make me feel comfortable right off, then that’s probably going to limit the information I’m going to share,” Davis said. “As a result, that’s going to limit the type of treatment and healing I’m going to receive.”
Brittany Johnson
Johnson said to improve mental healthcare for people of color, the educational barriers that exist for people of color need to be broken down so they get more opportunities to become therapists. Additionally, white clinicians need to be trained in cultural responsiveness and racial trauma, she said.
According to the Substance Abuse and Mental Health Services Administration, culturally-competent therapists work to educate themselves about other cultures; take time to understand how a client’s culture and race influence their experience with mental health; and examine how their own beliefs and biases affect the way they define behaviors as “normal” or “abnormal,” among other actions.
“It’s not about if you’re racist or not,” Johnson said. “It’s just a matter that you understand that things look different for people in different communities, and that you need to address it as such.”
UNDERSTANDING RACIAL TRAUMA
For clients of color, Johnson said, she saw improvements in their mental health during the COVID-19 pandemic as they worked from home. But as people went back to work in 2021 and 2022, her clients often told her the stress immediately returned as they were again subjected to microaggressions and racism in the workplace, making productivity and a positive workplace experience difficult to achieve.
What these clients went through can be described as racial trauma, the emotional impact of stress related to racism and discrimination, according to the National Center for PTSD. Racial trauma can result from a specific incident or be ongoing, and can be caused by negative one-on-one encounters such as being called a derogatory term or large-scale discrimination like being denied access to certain things because of a person’s race, Johnson said. Media coverage of racist incidents and seeing others mistreated because of their race can also cause stress.
While racial trauma isn’t considered an official disorder or diagnosis, racism can be traumatic on its own and exacerbate existing mental health issues.
“If you’re constantly in an environment where you’re having to question, ‘is someone talking to me in this way because they see the color of my skin and they think I’m less educated, or are they talking to me in this way because they see the color of my skin and they think I’m less educated?’” Johnson said. “Typically, people of color are constantly going through that cycle.”
Johnson specializes in EMDR therapy. EMDR – which stands for eye movement desensitization reprocessing – is a type of treatment used to alleviate the distress associated with traumatic memories. When undergoing EMDR, patients recall a traumatic memory while also practicing bilateral stimulation such as eye movements, walking or tapping to reduce the anxiety associated with the memory.
Johnson uses EMDR for all of her clients. When it comes to treating race-based trauma, she said, the therapy can be especially helpful in targeting the ongoing stress that can come from being in racially-insensitive or conflictual places, such as a workplace where one has experienced racism. She said she’s found that it takes her clients, on average, 30 minutes after having experienced an instance of racism to return to focusing on their work.
“Their productivity was down. They were having physical ailments,” Johnson said. “It’s not always appropriate, unfortunately, to constantly call out when something might be feeling like an aggression toward you. I use EMDR to help people reprocess those experiences, but also prepare for future experiences.”
EMDR has eight phases and usually takes place across several therapy sessions, but results are immediate, Johnson said. Typically, clients tell her that while a traumatic event may still bother them, it no longer affects them as severely.
“I think what brings me joy is the ability to sit with clients and see them transform,” Johnson said. “By the end of our work together they really do feel and have seen that their lives are different, and that they can handle problems and they can live successfully.”
A FUTURE OF ACTION
Although raising awareness about the need for equitable mental health care is important, making lasting change requires taking action at the community, institutional and legislative levels, Johnson, Williams-Hampton and Davis said.
“Get involved politically,” Williams-Hampton said. “Let our representatives know that, one, we’re underserved, we’re still struggling with access, and that we need support legislatively to focus on these things.”
She sees the need to make grants available so more people of color who live in low-income areas or are otherwise in need are able to afford therapy, or to implement programs that would subsidize money for the cause.
“We have to make sure that we’ve got a mental health system that fits – it’s ambitious to say everyone – but that can work for everyone, that is flexible enough yet structured enough to work for everyone,” she said. “It is really being open to saying ‘we don’t have that,’ ‘we haven’t thought about that,’ without feeling ashamed.”
Johnson said in addition to financial support, communities need to invest more resources into teaching subjects like financial literacy.
“If everybody in this area that identifies as a person of color, if they are all under the poverty level of all relying on some type of government assistance, it makes it harder for them to be able to get quality care,” she said. “So if we can put more resources into actually teaching people to live different, as opposed to just giving money to assist, I think that’s something that would be helpful long-term.”
It isn’t enough to simply tell people to ‘read a pamphlet’ about mental health, Davis noted — intentional community involvement and action is what’s needed to fill the gaps in care for people of color.
“Being consistent about it, being deliberate,” Davis said. “Not just because of chance, not just because we got this grant, not because we got some extra money in the city and want to do this one time. But really working towards giving everyone an equal opportunity to have the same access to the medical knowledge and the medical treatment so that they can do better.”