The Lack of Adequate Mental Health Care in Black Communities

Mental health conditions don’t discriminate, so why are Black people and people of color at higher risk of experiencing one? Why are they more likely to have a condition go undetected or not receive adequate mental health treatment once a diagnosis is made? The truth is, much of it stems from things like racial trauma, racial disparities, the stigma of mental health in Black and minority communities, and the deep-rooted systemic racism woven throughout the fabric of American history. 

Unfortunately, these unmet needs and other barriers often result in members of the Black and African American community experiencing significantly more severe forms of mental health conditions. In fact, studies show they’re actually 10% more likely to experience serious psychological distress, largely due to socioeconomic and racial disparities. Also, perhaps not surprisingly, given what we know thus far, the outcomes tend to be considerably worse than those who have access to mental health resources to seek mental health support.

Nearly 1 in 5 adults in the U.S. live with a mental health condition, so we should be asking, why aren’t there more mental health resources allocated to combat this continuously growing issue? We must address the question more pointedly, especially when looking at Black, Indigenous, and people of color (BIPOC) in minority communities. How does mental health in the Black community compare? 

By identifying and addressing the barriers to mental health care in Black communities, we can begin to overcome them. 

Barriers to Mental Health Care in Black Communities

There’s no denying that we have substantial racial and ethnic disparities in the mental health care system. Let’s examine in greater detail the reasons for these disparities specific to the Black and African American community.

“The sum of low cultural competency + limited self-awareness = provider bias and the potential for discrimination.”

Talkspace therapist Ashley Ertel, LCSW, BCD, C-DBT

Socioeconomic disparities

Housing, employment, education levels, and access to quality healthcare are all interrelated regarding the barriers that prevent Black people from receiving quality and necessary mental health care.

There’s no denying the presence of structural racism in the US housing system. For example, redlining, the discriminatory practice of denying care, credit, or development in minority neighborhoods, has led to incredible racial disparities that have prevented building wealth and financial stability in Black communities for decades. 

The playing field remains uneven by preventing Black people from owning property, accessing affordable rental housing, and establishing financial independence and wealth. The result is blatant socioeconomic disparities — Black communities have been neglected and under-resourced regarding the quality of and access to education, employment, transportation, food and housing sources, and healthcare.

A distrust of the healthcare system

For years, the Black American community has been experimented on in the name of “advancing” medicine, without concern for its short-term or long-term impact.

The well-known Tuskegee Study of Untreated Syphilis in the Negro Male is a prime example of why people in the Black community have difficulty trusting the healthcare system. Fast forward a few decades, and the distrust understandably continues. 

It doesn’t end there, either. Research shows that Black people are often misdiagnosed at a disproportionate rate for schizophrenia, for example. Other studies have found additional disparities and disturbing facts when it comes to caring for mental health in the Black community, including things like: 

• A Black person’s pain isn’t taken as seriously by doctors
• The Black community often has longer wait times when seeking medical attention
• Physicians spend less time with their Black patients

Then there’s the staggering fact that, although the U.S. is the world’s most developed country, non-Hispanic Black women are 3.2 times more likely to die from a pregnancy-related death than their white peers. 

“There is a long and disturbing history of Black communities being targeted by healthcare systems and supposed medical research. Because of this, it’s understandable that many within the Black community find it difficult to trust those placed in healthcare roles.”

Talkspace therapist Ashley Ertel, LCSW, BCD, C-DBT

Lack of culturally competent therapists 

For those in the Black community who are able to navigate and overcome the massive barriers to mental health care, once they finally do get into a therapist’s room, it’s not uncommon for them to be faced with culturally incompetent therapists. 

It’s essential for anyone in therapy to feel connected to their therapist. This is the only way they’ll be able to build trust and get the best mental health treatment possible to improve their well-being. 

Cultural bias, whether it’s intentional or unconscious, can be devastating when it comes to getting the care that can make a difference. 

Yet whether conscious or unconscious, the bias and potential discrimination of mental health care providers are known to cause misdiagnosis and overall poorer quality of care for the Black population, according to NAMI.

Finding therapy for people of color can be daunting given that these communities have been widely underserved. Start by looking for a culturally competent provider by asking a provider if they have experience treating the BIPOC community. You also might want to ask if they’ve received training in mental health, behavioral health, and cultural competence.

“Unfortunately, many therapists do not receive quality education in the way of cultural competency. As we have seen play out in the news, the topics of race and systemic oppression become unnecessarily polarized, which leads to many educational institutions avoiding classroom conversations. This is unacceptable, it won’t get our therapists the training they need to fully meet many of their clients’ needs. Further, I have seen many therapists who didn’t realize their own need for ongoing professional consultation and development. I would encourage all therapists to find a consultation group where they can openly discuss topics such as race, culture, and disparity.”

Talkspace therapist Ashley Ertel, LCSW, BCD, C-DBT

The Importance of Empowering & Accessible Mental Health Care

Erasing the stigma that surrounds mental health in Black communities is a critical step. It will ultimately empower people to seek help more easily when needed. Whether it’s for a mental health condition, a diagnosis, or for a crisis, getting adequate, effective care is essential. Beyond reducing or eliminating the mental health stigma, how else can we accomplish this? 

Offer support and services

Marginalized communities also need structures in place that can offer support and mental health services. For example, wellness centers and community health centers can ease some of the various barriers (such as lack of access) that currently prohibit people from receiving appropriate and effective treatment. 

Mandate adequate training

Prerequisite training for those in medical professions — particularly in the mental and behavioral health fields — should also be mandatory. This will help ensure that people in Black communities: 

• Aren’t misdiagnosed or written off, as they often are now
• Level of care is adequate and comparable to other populations
• Are taken seriously when they do receive care 

Diversity in care providers

Finally, there needs to be greater representation and diversity of professionals in the mental health field. 

Having a mental health professional who understands a patient’s background and who can relate to them as an individual means people will be more comfortable opening up and sharing their experiences. It will allow for an efficient treatment plan to improve overall well-being and empower someone to thrive in every aspect of life.

We can’t deny that there’s a clear disparity when it comes to appropriate, meaningful care for mental health in the Black community. Acknowledging this fact is the only way we can change things moving forward—Black mental health matters. From there, we can get to a place where mental health care in Black communities and in all other minority communities can be appropriately addressed in an equitable, effective manner. 

Sources:

1. African Americans | NAMI: National Alliance on Mental Illness. Nami.org. https://www.nami.org/Your-Journey/Identity-and-Cultural-Dimensions/Black-African-American. Accessed July 19, 2022.

2. Mental Illness. National Institute of Mental Health (NIMH). https://www.nimh.nih.gov/health/statistics/mental-illness. Published 2022. Accessed July 19, 2022.

3. Badger E. How Redlining’s Racist Effects Lasted for Decades. Nytimes.com. https://www.nytimes.com/2017/08/24/upshot/how-redlinings-racist-effects-lasted-for-decades.html. Published 2017. Accessed July 19, 2022.

 4. The U.S. Public Health Service Syphilis Study at Tuskegee. Centers for Disease Control and Prevention. https://www.cdc.gov/tuskegee/timeline.htm. Published 2021. Accessed July 19, 2022.

5. Gara M, Minsky S, Silverstein S, Miskimen T, Strakowski S. A Naturalistic Study of Racial Disparities in Diagnoses at an Outpatient Behavioral Health Clinic. Psychiatric Services. 2019;70(2):130-134. doi:10.1176/appi.ps.201800223. https://ps.psychiatryonline.org/doi/10.1176/appi.ps.201800223. Accessed July 19, 2022.

6. Hoffman K, Trawalter S, Axt J, Oliver M. Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proceedings of the National Academy of Sciences. 2016;113(16):4296-4301. doi:10.1073/pnas.1516047113. https://www.pnas.org/content/113/16/4296. Accessed July 19, 2022.

7. Qiao W, Powell E, Witte M, Zelder M. Relationship between racial disparities in ED wait times and illness severity. Am J Emerg Med. 2016;34(1):10-15. doi:10.1016/j.ajem.2015.08.052. https://pubmed.ncbi.nlm.nih.gov/26454472/. Accessed July 19, 2022.

8. Sabin J, Nosek B, Anthony G. Greenwald A, Rivara F. Physicians’ Implicit and Explicit Attitudes About Race by MD Race, Ethnicity, and Gender. J Health Care Poor Underserved. 2009;20(3):896-913. doi:10.1353/hpu.0.0185. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3320738/. Accessed July 19, 2022.