The month of February is reserved for Black History Month, as we remember and celebrate the many contributions and achievements of African Americans throughout our nation’s history. In our efforts of rejoicing, honoring, and thanking those who have fought to give us hope, we must embody the strength and wisdom of the past, as we look to the future to take action, empower and heal African American communities, as many are significantly affected by mental health conditions.
It’s no surprise that mental health is a significant concern in the United States, as millions of people are affected by mental health conditions every year; though, only about half are receiving treatment. The National Alliance on Mental Illness (NAMI) suggests that approximately 1 in 5 adults in the U.S., which is equivalent to 43.8 million, or 18.5 percent, experiences mental illness in a given year.
As race intersects with mental illness, the statistical findings become alarming. Research indicates that African Americans are disproportionately affected by mental illness compared to their White counterparts, due to social barriers such as: mental health stigma; distrust in health care systems; underinsurance; and inadequate social support. Stigma in mental health is the leading cause that deters individuals from seeking therapy, who would benefit from mental health services or participating in treatment. The public creates stigma by creating negative attitudes or beliefs towards individuals with mental health issues, which can harm social opportunities to those publicly labeled as mentally ill (i.e., obtaining jobs, finding housing, or sustaining relationships), because the public perceives them as dangerous, unsound, dysfunctional, criminals et cetera. More importantly, stigma emits false information and stereotypes about people or groups of people. Misinformed information and stereotypes in mental health further create discriminatory acts against those diagnosed or those who display “signs” of mental illness (i.e., one’s idea of how a mentally ill person may look or behave). African Americans who already experience prejudice and discrimination suffer from double stigma when faced with the burdens of mental illness.
There is a lack of interpersonal trust between African Americans and health care professionals, which contributes to many African Americans’ unwillingness to seek psychotherapy. Interpersonal trust between health care professionals and clients has shown to be an important aspect of care. The Tuskegee syphilis study is an excellent example of why African Americans have good reasons not to trust health care providers; however, mental health professionals have veered away from traditional perspectives of mental illness. Traditionally, mental illness is understood from a medical perspective. The medical model of mental illness treats psychological disorders in the same manner that a physician would treat cancer or a broken arm. The medical model argues that mental illness is related to the physical structure and functioning of the brain. However, more health professionals opt for a humanistic approach. The humanistic approach strives to restore human dignity within mainstream psychology by understanding the individual’s experiences as they experience it, advocating for clients’ agency, freedom, encouraging self-actualization, self-motivation et cetera. Understanding psychopathology from a humanistic perspective may help combat mental health stigma because the approach does not reduce human begins to psychological diagnosis. This relatively new wave of exploring mental illness may entice others to seek and possibly trust health care providers.
Between 2005 and 2013, the percentage of racial/ethnic minority groups within the psychology workforce grew from 8.9 to 16.4 percent, compared to 39.6 percent for the overall workforce and 25.8 percent for the general doctoral/professional workforce. I hope that the above findings, regarding the alternative approach to psychotherapy and increase in racial/ethnic minorities in the field of psychology, may relieve some distress for African Americans, as many are reluctant to seek therapy. However, I am not implying that only African American psychologists can help African Americans, as any psychologist who illustrates unconditional positive regard, empathic understanding, congruency, cultural competency, and centers therapy around the therapeutic relationship, between client and therapist, is useful for all who seek psychotherapy. The above statistical findings merely acknowledge the concerns of many African Americans, as cultural representation is essential, as it is only natural for human beings to immerse themselves around people who they find relatable and comfortable. It also illustrates the changes within the health care profession and encourages African Americans to seek therapy, as there are psychologists with great intentions and effective therapeutic outcome.
African Americans are 20 percent more likely to experience severe psychological distress than non-Hispanic Whites. Common mental health diagnosis amongst African Americans include: major depression; attention-deficit/hyperactivity disorder (ADHD); suicide (mostly amongst African American men); and post-traumatic stress disorder (PTSD). According to the Diagnostic and Statistical Manual of Mental Disorder fifth edition, PTSD includes but is not limited to: exposure to actual or threatened death; serious injury or sexual violence; directly experiencing of the traumatic event(s); witnessing; and learning that the traumatic event(s) occurred to a close family member or friend. African Americans have higher rates of severe mental health problems because they are more prone to be victims of violent crimes. The disproportionate rates amongst African Americans historically are embedded in the institutional dimension of racism and mental health; thus, creating a double stigma.
Discrimination affects the quality of life in impoverished African American communities. Often the residents of the community are either underinsured or have inadequate health care coverage. There is also a lack of resources to find quality mental health services, with a therapist of their choice. Also, African Americans are overly prescribed medication. The above variables can have an adverse effect on the psychological functioning of African Americans.
Traditionally, pejorative stereotypes about African Americans have translated into policies that restrict and limit African Americans’ access to health care services. According to the U.S. Census Bureau, as of 2012, 19 percent of African Americans had no form of health insurance; although the Affordable Care Act made it more accessible and affordable to get insured, there are limitations regarding mental health care services. For instance, there is difficulty finding therapists who accept Medicare; this is a poor reflection of the relationship between therapists, potential clients, and insurance companies. Also, often the use of insurance requires a diagnosis, which is subjective and targets specific individuals as many insurance companies will only approve therapy when diagnosed with a severe mental disorder (e.g., schizophrenia, bipolar, or obsessive-compulsive disorder), which further perpetuates mental health stigmas and restricts access to health care services to those who do not meet mental health insurance requirements.
Although health insurance companies’ policies are limiting, there are alternative options for access to mental health care providers, such as psychologytoday.com, which entails potential therapists’ profiles including payment options (i.e., sliding scale or standing price per session) and acceptance of insurance. Websites such as NAMI and Pittsburghblackdirectory.com have a directory that explicitly lists African American therapists by zip code.
Furthermore, African Americans are overly prescribed medication when seeking treatment. Some studies indicate that African Americans metabolize medications more slowly than the general population; yet, they are more likely to receive higher dosages, which may result in a greater chance of adverse side effects and decrease the likelihood of participating in treatment. A plausible solution to combat mental health stigma is reframing stigma in mental health as a social injustice rather than a public health concern. The idea of reframing stigma in mental health not only expands the understanding of the phenomena and broadens the approach to eradicating stigma—it also places the responsibility for the stigma on the public instead of on the individual. When viewed in terms of prejudice and discrimination experienced by those who are seen as “outsiders,” the concept of social injustice argues the loss of opportunities experienced by those diagnosed with mental illness and highlights the social determinates that causes stigma such as institutionalized racism, lack of access to health care services, lack of education and resources et cetera.
The notion of deconstructing social constructions or “reframing” is not new; in part, it stems from the socio-ecological theory. The socio-ecological approach is a theory of change in communities; it attempts to understand others and their differences in socio-political cultural contexts, in a manner that does not blame others for environmental factors but to critically examine the context of the issues at hand and its impact. An ecological perspective may suggest developing a collaborative relationship between the residents of the community and those of service to the community (i.e., community psychologists, socio-political advocators, community researchers et cetera). When community advocators and residents work together, they can define the problem(s), identify resources, and find practical solutions.
Dialogical skills offer those who are oppressed within a socio-political context liberation; thus, liberation heavily relies on our ability to create meaningful dialogues. Community dialogues not only provide a safe place in which the residents and “community experts” can commune with one another, but it allows their differences to come together, as they actively listen to one another with care. The concept of dialogue seems rather simply; though, it is significant to the resident’s well-being. Evidence-based interventions have illustrated that healing the wounds of oppression requires the development of dialogical skills; this process releases oppressed communities from objectification.
Furthermore, dialogical development and reframing stigma in mental health systems are crucial, as it may help eradicate stigma in mental health and break down some of the barriers within African American communities. The process of eradicating barriers in mental health within African American communities can take place by targeting systems that contribute to the oppression, such as: system norms (attitude values, beliefs); resources (human, social, economics, opportunities); regulations (policies and procedures); and operations (power and decision making).
When we can collaboratively work with those in oppressed communities who are significantly impacted by the effects of discrimination and stereotypes regarding mental illness, we can strive towards progressive change.
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