I met with a group of approximately 40 Black women and proposed this simple question to them: “What Is It?”
In my clinical experience, I frequently listen to comments from other mental health professionals and agency representatives about why the Black community often seems to fail to seek mental health diagnoses, treatment, and services. Two phrases commonly used to justify the perceived reasons by these professions about the Black community include:
- There is a stigma in the Black community concerning mental health services.
- Black people do not seek mental health care.
As this group of Black women answered my question, I realized one problem is that mental health professionals miss the opportunity to ask the Black community about their perceived resistance. Asking this group their thoughts opened up a wealth of knowledge to share with other mental health professionals. This post will attempt to dispel the myths generated in the mental health community about why the Black community can be resistant to mental health services and instead, explain the obstacles that cause this barrier. Four key topics were discussed with this group of women: stigma around mental health, barriers to accessing mental health care, lack of representation in the field, and historical mistrust of the health care system.
What Is It?
1. Stigma Around Mental Health
In persons with mental illness (PWMI), stigma acts as a barrier to engaging in help-seeking behavior. Black people are particularly vulnerable to the presence and effects of mental illness stigma. For PWMI, stigma manifests through three main mechanisms: experienced, anticipated, and internalized. These are the barriers that this group described as concerns when seeking mental health care in the Black community.
Internalized strength, resilience, and working through obstacles are highly valued in the Black community. Individuals facing mental health experiences are often seen as weak or failing, leading to anticipated fears about being stigmatized, judged, and even rejected. Negative stereotypes (i.e., “crazy”) are also concerns in the Black community. The thought of being labeled can carry negative consequences including teasing, social isolation, and damaging reputations. What compounds this trepidation is how mental health issues are portrayed in media and society, often showing negative consequences for Black people when seeking mental health treatment. There is an expectation to “pray it away” or to rely on faith and family support rather than seeking professional mental health care. This can be a method for addressing mental health issues, though it can prevent needed mental health treatment.
2. Barriers to Accessing Mental Health Care
Economic disparities also play a role, as Black individuals are more likely to face financial obstacles, such as lack of health insurance or limited access to affordable mental health care. Mental health services are often expensive and not fully covered by insurance, which can deter Black people from seeking help due to out-of-pocket costs. It disproportionately affects the Black community, causing fears about affordability and long-term mental health care. Given the financial barriers, placing the immediate needs of survival will deter mental health care.
Geographic barriers are another challenge for accessing mental health care for the Black community. Some may reside in communities with fewer mental health resources and a lack of nearby clinics or providers. Logistical obstacles also occur including transportation issues, long wait times, and traveling long distances to receive mental health care.
3. Lack of Representation in the Field
There is a shortage of Black psychologists which limits the availability of culturally competent care. As of recent data from the American Psychological Association, (APA), only about 4% of psychologists in the U.S. are Black, which is disproportionate to the population they serve. Black psychologists understand the cultural, social, and historical contexts that affect mental health in the Black community. They can offer culturally sensitive care, which is crucial for effective treatment. African Americans often feel more comfortable seeking help from professionals who understand their lived experiences and cultural nuances.
Black psychologists work within the community to challenge stereotypes, provide education, and reduce stigma around seeking mental health care that can reduce the mental health stigma. Black psychologists are also skilled at addressing racial trauma, a form of psychological distress that results from experiencing racism, discrimination, or systemic oppression. This kind of trauma is common in the Black community and requires Black therapists who are well-versed in its complexities.
4. Historical Mistrust in the Health Care System
The Black community has a long history of mistrust in the health care system whether it is knowledge of 20th-century horrors, such as the Tuskegee Syphilis Study or recent studies that have demonstrated inconsistent if not callous treatment from the healthcare system and mental health professions (i.e., not being listened to, higher pain tolerance, and lack of cultural sensitivity). Mistrust of academic and research institutions and investigators is the most significant attitudinal barrier to research participation reported by African Americans. Scharff & et. al (2015) reported that this etiology stems from historic events, but is also exacerbated by more current actions, including socioeconomic and health care system inequities. Consequently, this mistrust often extends to mental health services, making it more difficult for Black people to seek mental health care for fear that it may expose them to harm or discrimination.
Systemic racism within health care institutions was also cited by this group as a major problem within the Black community. They described the fear of being misunderstood, mistreated, or dismissed by mental health professionals who may not understand their cultural background or experiences. In response, I shared the feelings as being a “healthy paranoia.” A “healthy cultural paranoia or cultural mistrust is Black Americans’ distrust of white society as a defense against threats of racism and discrimination.” This cautious and skeptical attitude towards the health care system includes mental health services. Healthy paranoia in the Black community regarding mental health care is rooted in legitimate concerns about historical exploitation, (i.e., involuntary committed), systemic racism, (i.e., harsh treatment and over-diagnosis), and ongoing disparities in healthcare. Past abuses in the mental health system, (i.e., institutionalized and inhumane treatment) are real concerns. Although this wariness can be protective in the Black community to avoid harmful or dismissive care, it can also create a barrier to obtaining the necessary mental health support.
What I learned by asking the question “What is it?” to this group of Black women is that the mental healthcare community needs systemic change. It starts with understanding the reasons behind the seeming avoidance of mental health care services in the Black community. This is key to breaking down barriers and promoting mental wellness in the Black community.
It is imperative to increase the number of Black mental health professionals to raise awareness about mental health within the Black community. Their presence and advocacy help bridge the gap between mental health care and the Black community, providing culturally competent care and working to eliminate disparities in access and treatment. Multifaceted approaches should include cultural competence in mental health services to develop trust by using community-based mental health initiatives with the goal of greater mental wellness while maintaining vigilance against unjust or harmful practices in the Black community.
