The American healthcare system is one of the best in the world. People from around the globe, especially those with the financial resources, are able to seek treatment for complex and rare medical disorders here.
Unfortunately, not all Americans have been served well in the healthcare arena. For at least the past forty years, medical research and health statistics have consistently reported that Black Americans and minority groups are less healthy compared to white Americans.
The health status of the Black community is greatly influenced by poverty, violence, mass incarceration, racial discrimination, toxic environmental exposures, and lack of access to general medical care. Additional causes of health inequalities also include poor housing, inadequate schools, limited access to healthy foods, and little to no access to comprehensive mental health services.
The Black community, like many communities of Color and communities with lower income levels, experiences struggles with anxiety and depression: the most common mental health disorders, and the focus of this article. These disorders, especially when combined with alcoholism and substance abuse, interfere with living a full and successful life.
According to the Office of Minority Health, a division of the Department of Health and Human Services, Black adults are more likely than white adults to express greater feelings of sadness, despair, and a sense of hopelessness. The American Psychiatric Association reports only one in three Black adults receives treatment for mental illness.
For many Black Americans living in a society beset with structural racism, discrimination, and microaggressions, not feeling safe while engaging in normal activities causes or even exacerbates feelings of depression and anxiety. Black people are living in a time when certain white people and law enforcement feel the need to ‘police’ Black people. There are periodic reports of Black people being questioned for “Driving expensive cars while Black,” “Birdwatching while Black,” “Sitting in first class while Black,” or being followed by salespeople for “Shopping in high-end stores while Black.” These microaggressions or being perceived as ‘unworthy’ or ‘not staying in your place’ can be psychologically stressful and even traumatizing. The presence of armed law enforcement officers in these examples only brings about heightened levels of stress and could result in being arrested, incurring bodily harm, or even death.
It is not unusual for some Americans to be hesitant to seek counseling or treatment for mental health disorders. Some people believe family and friends will consider them ‘weak’ or ‘crazy’ and avoid treatment out of embarrassment. This attitude is particularly strong in the Black community. Some Black adults have expressed that counseling is “a white people thing” and will avoid seeking help when it is desperately needed. Others may avoid treatment for a diagnosable mental health problem, believing such information could be leaked and affect their employment status, especially if using work-related health insurance. For the uninsured, paying for care out-of-pocket could greatly affect their ability to pay for basic needs like housing, food, and other necessities. Seeking financial help from family members/friends to pay for counseling and medications, if needed, could be another source of shame.
Black people with strong religious beliefs may feel compelled to ‘talk to the Lord’ or speak privately to their pastor or religious leader rather than engage with the medical community. While prayer and pastoral counseling can be useful tools in a treatment plan, they are no substitute for professional psychological support.
In other instances, Black adults may be reluctant to discuss feelings of depression or anxiety even with their established health care provider. There could be a sense of shame or reluctance to share one’s innermost thoughts and negative feelings about life in general. Men may be more hesitant than women to talk about their mental health struggles for fear of being prescribed medications that could inhibit their libido.
Anyone struggling with mental health challenges should receive comprehensive and quality services as soon as symptoms are apparent. For individuals with an established medical home, the first place to start is with your private medical provider. It must be stressed that the patient must be comfortable enough to have an open and honest conversation with the provider. Based on this information, your provider may perform a psychological assessment while in the office and make the appropriate mental health referral. Each person’s situation is unique, with different levels of complexity requiring different levels of mental health care. Some individuals may need a referral to a psychiatrist, psychologist, psychiatric nurse practitioner, or licensed counselor.
Seeking mental health care for the uninsured and those individuals with financial limitations is often challenging. One good place to start is by contacting a local, federally funded community health center. These centers often employ social workers who may be licensed counselors. Payment for services is based on a sliding scale depending on income. Another source of help would be to contact the local public health department or the nearest outpatient mental health clinic.
Some Black people may prefer to speak to a Black therapist. This can be difficult depending on your geographic location and the availability of Black mental health professionals. The key to getting better is to establish a relationship with a mental health professional that shows compassion, is culturally sensitive, and treats you with respect.
Listed below are several mental health resources:
Substance Abuse and Mental Health Services Administration (SAMHSA)
National Hotline 1-800-662-4357
This is a free, confidential information service for individuals and family members struggling with mental health or substance abuse disorders. This service provides referrals to local treatment centers, community-based organizations, and support groups.
An online space dedicated to the mental health of Black girls and women, this site can assist in finding mental health professionals in local areas and facilitates online support groups.
Black Mental Health Alliance
The organization, headquartered in Baltimore, Maryland, assists the Black community in finding “culturally competent and patient-centered licensed mental health clinicians.”
988 Suicide and Crisis Lifeline
988 is a dedicated three-digit dialing code to the National Suicide Prevention Hotline. This 24/7 free service is for anyone needing emotional support, whether they are contemplating suicide or not.
Denise Dixon Algood, MD, MPH is board certified in occupational and preventive medicine. She strongly encourages anyone with mental health/substance abuse problems to seek care and hopes these resources are helpful.