During Mental Health Awareness Month we’re diving into “The State of Our Mental Health” by exploring the common challenges many of us are experiencing amidst the pandemic. Check back each week in May as we continue the conversation and share your own videos @talkspace using #TheStateofMyMentalHealth.

Obari Cartman’s work begins with stories. “I start with an individual and I say, ‘Tell me how you got here,’” said Dr. Cartman, a trauma-focused clinician and restorative justice coach who primarily works with young Black men in Chicago. “A lot of my work straddles that fence between individual therapy, and community advocacy and organizing.”

When we speak, Cartman has just returned from distributing 500 portions of fresh produce and masks to community members in Chicago with Real Men Charities, a grassroots group he helps lead. The group has long advocated for food justice in a community that regularly experiences high levels of hunger. Now, the pandemic has caused these long-simmering inequalities to erupt.

“It’s just a perfect storm of new problems on top of old problems,” said Cartman. To help community members deal with some of the mental health fallout of the crisis, Cartman has also moved his Black-men-centered healing circle online. He uses music and a casual, jargon-free atmosphere to invite men to open up about vulnerabilities they may find difficult to share: grief, economic insecurity, and the ongoing trauma of a pandemic that has reinforced America’s foundational racial and class injustices.

While some may dub the coronavirus pandemic a great equalizer — after all, viruses don’t discriminate based on income or race — the opposite, in fact, is true. The pandemic has exacerbated the vast racial, class, and gender inequalities that characterize the United States’ healthcare and economic systems. The crisis has demonstrated that mental health, like all health, isn’t merely a question of individual illness or wellness. It is instead fundamentally tied to communities’ collective social and economic health.

The Great Unequalizer

The toll of the coronavirus pandemic on low-income communities of color has been nothing short of cataclysmic.

Black Americans are 3.5 times more likely to die of COVID-19 than white Americans. Latino people are twice as likely to perish from the illness as non-Latino white people. Native American communities have also been particularly hard-hit, with the Navajo nation experiencing more cases per capita than any state in the country, including the U.S. epicenter of New York.

Meanwhile, people living in New York City’s poorest zip codes — the majority of them people of color — are more than twice as likely as those living in the city’s wealthy zip codes to die from the virus. Homeless Americans are also at dramatically increased risk, even though COVID-19 cases among unhoused people are vastly undercounted.

These health inequalities go much deeper than the current moment. People of color are more likely than white people to suffer from chronic medical conditions like heart disease and diabetes, which increases vulnerability to COVID-19. This is due to lack of access to healthcare, and lack of access to basic rights like nourishing food, and environmental safety. But it’s also due to racism itself, as the stress of experiencing repeated discrimination increases individuals’ vulnerability to high blood pressure, diabetes, and other chronic illness.

With almost 15% of U.S. workers unemployed as of April 2020, the racial wealth gap — itself a driver of health disparities — is also poised to grow starker. “There’s never been a moment when these inequalities in access to assets have been more striking and alarming,” said Rebecca Loya, a Senior Research Associate in Assets and Social Policy at Brandeis University.

We’ve already seen this relationship between health, wealth, and race play out in the COVID-era workplace. Essential workers in lower-paid industries like home healthcare, grocery, warehouse, and childcare are disproportionately people of color, especially women of color, who are forced to risk sickness for meager compensation. At the same time, service industries like retail, which have been particularly hard-hit by social distancing-related shutdowns, are also largely staffed by people of color. These jobs typically lack benefits and pay wages that leave many workers unable to afford rent, let alone amass savings.

Race, Wealth, and Mental Health

Inequality doesn’t just help determine our physical health. It also affects our mental wellbeing, and particularly the ways we experience and heal from trauma.

Americans with mental illness are disproportionately likely to live in poverty; poverty, racial discrimination, and gendered violence are in turn serious contributers to mental illness. Black Americans are 20% more likely than white Americans to experience mental health problems than their white counterparts, and this difference persists across class. This is partly due to minority stress, or the increased daily stress of existing as a marginalized person.

For Cartman, it’s vital to understand racial mental health disparities — not just in a clinical, individualistic sense — but as the result of violent, structural racism, whose origins lie in slavery and whose effects pervade our legal and economic systems.

Conventional psychological frameworks risk framing the effects of historical trauma as an individual disorder. This can, ironically, reinforce social norms that blame marginalized people for the effects of their own oppression, instilling in them the feeling that, “I know that the system’s broken, but the system keeps telling me that I’m broken,” Cartman said. In contrast, Cartman takes a historical and systems approach, working with young men to illuminate this systemic brokenness, in order to begin to heal.

Loya, too, relates health inequalities to policies that have historically excluded people of color from access to healthcare and wealth. “Policies aren’t neutral. They’re driving wealth inequality. They’re actually fostering it,” she said. She points to the recent round of federal coronavirus relief checks, which conspicuously left out undocumented people and their families, as well as informal sector workers, who tend to be women of color.

The deliberate oversight is part of a long history of exclusionary economic policies, like the ineligibility of farm workers for social security, that specifically target people of color. “It’s disturbing, it’s central, and it’s a pattern over the history of our country,” Loya said.

A Legacy of Distrust

Barriers for marginalized people to receive equitable mental health support have also been heightened during the pandemic. To begin with, marginalized communities, especially communities of color, often lack access to affordable care: as of 2018, 27.9 million Americans lacked health insurance of any kind, while one in four Americans was unable to access medical care because of the astronomical cost.

When marginalized people do interact with the healthcare system, they are likely to have negative experiences, either through systemic neglect or active harm. This is true for communities of color as well as queer communities, many of whom are especially vulnerable to COVID-19.

For many LGBTQ and HIV-positive Americans, the U.S. government’s slow response to the coronavirus pandemic evokes the CDC’s brutal neglect of queer people in the early days of the AIDS epidemic. This connection extends to the policy level, as the Trump administration has worked to remove previous rules protecting LGBTQ patients from medical discrimination.

“Accessing any care is much harder now because of the added risk and added required safety precautions…on top of the usual problems of navigating a healthcare system that is often cumbersome and fraught with transmisogyny and ableism,” a friend of mine, a chronically ill trans woman, told me. “I didn’t have particularly good health before the pandemic and struggled to get healthcare for both trans issues and other health issues. All that is much worse now.”

Cartman has heard similar distrust among the men he works with. “I do believe that a lot of the mental health stigma around the Black community has to do with the same historical relationship to American institutions of healthcare,” he said. This includes a history of brutal medical abuse, including the Tuskegee Study of Untreated Syphilis, in which scientists purposely denied potentially lifesaving treatment to African American men enrolled in a study without their informed consent.

Today, Cartman sees this distrust manifested in wariness around potential coronavirus treatments, as well as in the reluctance of the young men he works with to participate in conventional talk therapy.

Care From The Ground Up

Loya, the Brandeis University researcher, has spent her career discussing income inequality. But it’s taken the coronavirus pandemic for many in her field to pay closer attention to the lived realities of the workers — mostly low-income women of color — who sustain our daily lives.

“I’ve certainly noticed that both the work and the people doing the work have suddenly been discussed,” she said. She hopes that the pandemic’s heightened inequality will come with heightened awareness — and an increased push to create a real social safety net.

“If I could wave my magic wand, one of the first things I would do is make these employment benefits available through the public infrastructure,” she said. Those benefits would include many of the assurances that people with intergenerational wealth take for granted: paid time off, sick leave, parental leave, and retirement savings.

Cartman, meanwhile, continues to focus his efforts on direct community work. He welcomes men into healing spaces by giving up the conventional “patient-on-the-couch” model of therapy in favor of cultural practices that have been marginalized by white American society: African-inspired drumming, food, music, and dance. “The trauma is in your body,” he said. “Some of it you really have to sweat out.”

Structural race and class inequality will not heal when the economy reopens, and if these gaps do begin to close, it will be thanks to the tireless efforts of community advocates. But Cartman, for one, isn’t waiting around for the powers that be to make things better. He has faith, instead, in the “inherent genius” of the young men he works with. “Once you realize that nobody’s coming to save you,” he said, “Then you can activate.”

From the Desk of Dr. Rachel O’Neill, LPCC-S

Society-Related Journal Prompts

• In what ways has your privilege protected you from the worst of the coronavirus outbreak? In what ways has your lack of privilege left you vulnerable?
• What are some examples of inequality that you’ve seen exposed by the pandemic?
• What are a few things that would have made the pandemic less severe for the most vulnerable members of our society?
• What are some concrete, tangible ways that you might be able to help those in your community who are struggling right now because of systemic inequities?
• Are there any organizations in your community that are helping to affect change?