Mental health in the Black community: Access, safety, and well-being

Physical and psychological safety are critical components of mental health. But in the Black community, safety isn't always a given. Many factors together, including systemic racism and social stigma, create a mental health crisis. It's important to consider how these factors impact the Black community's well-being and mental health.

Mental health in the Black community

• Black adults are 20% more likely to experience mental health disorders, such as depression and anxiety.

• According to the APA, over 25% of Black youth exposed to violence are vulnerable to Post Traumatic Stress Disorder (PTSD).
• According to a 2019 study from Minority Health, "Suicide was the second leading cause of death for blacks or African Americans, ages 15 to 24."

4 factors that affect mental health in Black communities

Slavery has ended, but that hasn't guaranteed safety for the Black community or people of color. Since the emancipation of slaves in the United States, each generation has had to fight for security, wealth, and opportunity. 

Internalized trauma

Moving forward has become the default setting for many people of color, who have been carrying the stress of racial trauma, socioeconomic disparity, and the pressure to hide any sign of weakness for generations. 

After learning to suppress the trauma for so long, it becomes safer to act as if it doesn't exist than to unpack it. 

These buried emotions – coupled with lack of access to mental health resources – leave African-Americans at high risk for severe psychological distress.

Because of this, the state of emotional well-being in the Black community is precarious at best. Several factors compound generations of unhealthy coping mechanisms born out of the need to adapt and survive at all costs.

Systematic racism

Clinical associate professor Ruth White at the University of Southern California notes that "In the African American community, mental health issues are often compounded by the psychological stress of systemic racism." Systemic race inequality threatens physical safety, psychological safety, and economic security. 

Within the judicial system

• Black people are 3.5 times more likely to be killed by the police, even when unarmed and compliant.
• The incarceration rate of Black Americans is roughly five times higher than white Americans. Black Americans are also more likely to receive harsher sentencing for similar crimes.
• Black people are just as likely to be profiled and killed by police regardless of their economic status. 

In the healthcare system

• Black mothers are three times more likely to die due to childbirth than white mothers. This disparity is primarily due to habitual dismissal from medical professionals.

When building capital

• Black households earn lower salaries and hold around a tenth of the wealth that white families have. 
• They are less likely to own homes or face discrimination in hiring practices. And Black Americans are more likely to be turned down for loans and access to credit. 

When Black families can buy homes, they often experience predatory lending practices and higher insurance rates than white homeowners.

Lack of community and connection to culture

One of the great tragedies of slavery in the United States was losing connection to African American culture. Many Black Americans cannot trace their lineage beyond slavery. 

That means that part of the experience of being Black in the United States is not knowing from where you came. 

The Black community's stressors make it difficult to bond over culture. The idea that to survive, one must distance themselves from their Blackness is ingrained in Black American society. 

Intersectionality

Blackness is but one facet of identity. Many Black people also belong to other communities and traditions. Some are Latinx, half-white, members of the LGBTQ+ community, female, immigrants, or any number of other identities. This can complicate the experience of being Black — particularly in the United States. 

Sometimes, belonging to multiple marginalized groups can compound the danger for an individual. For example, Black transgender people are twice as likely to be killed or victims of violent crimes as white cisgender people.

Intergenerational trauma

The growing field of epigenetics has indicated that the effects of trauma can be passed down through generations. The field still has more research and testing to do. But current findings suggest that generations of violence against Black people go beyond the individual. Instead, it is encoded in the genetics of the African-American experience.

Barriers to mental health care in the Black community

The Black community faces several issues around access to and quality of medical care. Black people are less likely to have health insurance coverage, for instance. And so the costs of medical and mental health care are untenable. 

A lack of cultural competence

Cultural competence is the ability to understand and communicate with individuals from different ethnicities and cultural backgrounds. When culturally competent, healthcare professionals can self-assess and adapt to provide the best level of care regardless of a patient's background.

Unfortunately, cultural compliance is also challenging to define and standardize. While the CDC publicizes policies and organizational requirements, monitoring practitioners and organizations is another story. This lack of oversight means there is little guidance to take on the self-lead learning required to be more culturally competent.

Provider bias

As the National Alliance on Mental Illness (NAMI) notes, "Provider bias, both conscious and unconscious, and a lack of cultural competency can result in misdiagnosis and inadequate treatment." This issue negatively impacts mental and behavioral health diagnoses. NAMI's studies show that Black men are more likely to be diagnosed with schizophrenia when reporting symptoms consistent with mood disorders or PTSD. 

Distrust of the medical community

Even when insurance coverage isn't an issue, Black people are wary of receiving medical treatment. 

Distrust of medical professionals in the Black community has gotten attention over the years, and the pandemic recently pushed it to light in the push for the COVID-19 vaccination. Many people who delayed getting vaccinated cited a history of brutal treatment from the medical community. 

With mental health treatment in the Black community, there is a fear that reaching out for treatment will lead to mistreatment. Or ostracization and further reduced opportunities from the larger community.

The representation issue in the medical community

A poll taken after the death of George Floyd indicated that 41% of Black people experienced symptoms of anxiety and depression. Yet, only 2% percent of psychiatrists and 4% of psychologists are Black. So Black people often have to see a non-Black therapist for their mental health needs.

Should this matter? 

Well, in a perfect world, no. But therapeutic settings must be as safe as possible. Just as we offer people the choice of a male or female doctor, we should acknowledge that choice when it comes to race. 

Overwhelmingly, Black people find themselves spending a significant amount of time in therapy justifying and explaining racial, political, and social trauma to their mental health providers.

This experience underscores the need for culturally competent care. That is, training within the mental health community on how to relate to people who have different identities from their providers.

What is the mental health stigma in Black communities?

The stigma around mental health in the Black community, as with other stigmas, was not built overnight. Instead, mental health stigmas are developed and fostered over time. Some common beliefs related to mental health stigmas in Black communities include:

• Equating mental health issues to weakness or a lack of character 
• Mental health issues conflict with the necessary "survivalist" mentality that systematic racism developed
• Favoring and trusting prayer over mental health support to help those struggling with mental health issues
• Distrust of the justice system to provide care to Black individuals dealing with mental health issues, over criminalizing them

How the idea of strength reinforces mental health stigmas

Strength has become a prerequisite for surviving in a hostile world. Therefore, the Black community has become skilled at minimizing and disguising weaknesses. This coping mechanism, though, can quickly become toxic.

Strength as a necessity

To be successful, to be seen as "good enough," or to simply get into the room, Black people have had to be exceptional. For example, Black candidates are less likely to be hired for roles than white candidates despite their accomplishments and qualifications. That leaves no room for personal weakness or flaws that might cause them to lose the opportunity. 

Strength as a virtue 

Black people are taught to hide or suppress difficult feelings, making them a source of shame when they do arise. If you can't keep it together, it's because you weren't strong enough.

This characterization of strength as a virtue is a double-edged sword for people of color. On the one hand, it helps them deal with microaggressions, chronic threats, and a playing field littered with jagged inequities. On the other, it makes Black people less likely to ask for help — and less trusting of it when it is available.

Groups challenging the mental health stigma in the Black community

One of the best ways to change misconceptions about mental health is to amplify organizations dedicated to serving the Black community. Here's a list of some of these groups:

• Black Men Heal. They Provide limited and selective free mental health service opportunities for Black men.
• Black Mental Health Alliance. They offer information and resources, along with a "Find a Therapist" locator. This tool helps connect you with a culturally competent mental health professional.
• Black Women's Health Imperative. This organization advances health equity and social justice for Black women. They do so via policy, research, and advocacy.
• Inclusive Therapists. This organization provides identity-affirming, culturally responsive care to all people.
• LGBTQ Psychotherapists of Color Directory and the National Queer and Trans Therapists of Color Network. Both of these networks provide representative support for members of the Black and LGBTQ+ communities.
• NAMI Sharing Hope. This is a one-hour program to increase mental health awareness in Black communities via open conversation. NAMI also offers a more extensive list of resources on the Identity and Cultural Dimensions page.

The American Psychological Association. This organization offers resources for working with Black clients and racial trauma. Here are the APA Best Practices, a list of APA Mental Health Facts for Black Americans (2017), and the APA Stress & Trauma Toolkit.

Breaking down the stigma

Working with Black people in a therapeutic or mental health setting requires awareness and education. For many Black people, reaching out for help is done despite and amidst social, emotional, and cultural pressure telling them to do otherwise. 

Breaking down the stigma around mental health in the Black community can’t be done overnight. It happens in one-on-one conversations, every day, with the commitment to show up bravely, be seen, and to learn. And those conversations are a stepping stone to caring for the mental health and well-being of the Black community. 

If you’re looking for a safe space to openly discuss these challenges or if you want to become a better ally, try this demo to see if BetterUp coaching could be a good fit for you.