In-Depth: Barriers to Mental Health Care in Black Communities
March 19, 2021
As a Black woman, Aliyah Edwards, senior, said she is undervalued. As one of few the Black students in predominantly white classes, she combats daily limitations and stereotypes that negatively affect her mental health.
Edwards’ sense of disconnect in school stems from a sense that staff hold her academic capabilities in a lower regard than her non-Black peers and from limitations in participating in after school activities as a Voluntary Interdistrict Choice Corporation (VICC) student.
“The lack of diversity in school makes you want to distance yourself, and it makes you get depressed because you don’t have a lot of common interests,” Edwards said.
As vice president of Marquette Academic and Cultural Club (MACC), she said racial diversity and familiarity are both vital for Black students, who want to voice their concerns, especially if they are reluctant to seek mental and emotional support resources.
Edwards, like many others, grapples with feeling insecure, intimidated and has experienced barriers to mental health care and support in Black communities.
Black Americans are 20 percent more likely to experience serious mental health problems than the general population, but only one in three Black adults who need mental health care receive it, according to the APA.
Historical adversity, such as institutional racism in health, educational, social and economic systems, led to socioeconomic disparities in the Black community, which can negatively impact mental health, according to the American Psychiatric Association (APA).
Racial Disparities in Mental Health Care
Dr. Seanna Leath, assistant professor of community psychology at the University of Virginia, said as Black people experience racial discimination more often, it is important to qualify racial discrimination as a form of traumatic stress and racism as a stressor.
“One of the challenges with mental health services is not listening to Black people describing symptoms while recognizing, for instance, that it could be related to stress into anxiety or recognizing race-related trauma in relation to PTSD,” Dr. Leath said. “Racism physically, emotionally and mentally hurts individuals.”
The COVID-19 pandemic exacerbated racial disparities. Black and lower income communities, which tend to have higher populations of essential workers, suffered greater implications than other racial groups, she said. This includes higher infection, death and unemployment rates as well as a resurgence of protests over police brutality.
She said it is important to refocus the reasons for the Black mental health stigma away from a cultural phenomena to historical barriers to mental health care.
“Adequate health care, housing insecurity and employment are related to mental health as life stressors,” Dr. Leath said. “Black people are less likely to access mental health services overall, so now we’re seeing increased rates of anxiety, depression and suicidal ideation.”
Suicide attempts among Black children and teens increased by 73 percent from 1991 to 2017 although rates fell or had no significant trend in white, Hispanic, Asian/Pacific Islander, and American Indian/Alaska Native teens, according to research in the Journal of the Pediatrics.
Racism in healthcare settings ties to stigmatization, she said. Black people are more likely to be misdiagnosed at a higher rate with schizophrenia spectrum disorders than white people and less likely to receive and access quality, culturally competent care.
Another barrier to Black people seeking mental health services is an inclination to rely on religion and churches due to racial discrimination in health fields. Black Americans have been subjects of unethical experimentation and racist history in the fields of medicine, psychiatry and psychology, Dr. Leath said, which reinforces stigmas.
A long-held idea in Black communities, she said, is mental health counseling “is for white people” and the expectation to be resilient as depression is a sign of weakness or being “crazy.”
“That’s not a privilege that should be reserved for white people, or any particular group, and we need to have the adequate language to talk about our stressors,” Dr. Leath said.
Labelling and Stigmatization
Adria Martin, junior, has experienced depression and anxiety throughout her life. As a Black female, she said it can be appealing to hide one’s mental health issues because of the stigma.
Martin refrains from drawing attention to herself, often code-switching, or changing how she talks around students of different races to avoid being further judged or feared.
“You feel a lot of mental and emotional stress because you’re different from kids who don’t look like you, and you don’t know what they think about you,” Martin said.
She said she relies on support from other students of color rather than counseling staff and administration because of a lack of trust and a sense she will not be heard and understood.
In her sophomore year, Martin said she went to the bathroom to destress and began to cry. A teacher overheard her and the situation escalated: multiple counselors arrived and called for a student safety officer, an ambulance and for someone to message a guardian.
“I believe certain things were blown out of proportion because I am a person of color,” Martin said. “If it weren’t, they would have just comforted them. I needed a break, but they were about to send me to the hospital for psychiatric help because of my history with mental health.
As Martin has sought out professional therapy, she has faced being labelled “crazy” or “mental.” Even if it is said as a joke, to Martin, it seems offensive and can be used against her.
“Once the label is there, it is there forever,” Martin said.
Dr. Marva Robinson, clinical psychologist and member of the Association of Black Psychologists, said if one student of color has a negative interaction with a white counselor and feels ostracized or wronged, others may be influenced to not seek out those services.
“Students can struggle internally and that can be demonstrated in ways like lower-grade depression or isolation,” Dr. Robinson said. “Eventually, there’s a label applied that those students aren’t thriving, when what has failed them is not providing adequate support.”
Racial Trauma and Mental Wellbeing
Dr. Robinson said being engrossed in images of violence against Black people and police brutality can also exacerbate mental health conditions and cause people to become sicker.
“With an increase in these images, there’s also a louder voice and platform being given to mental health conditions saying, ‘it’s okay to seek out help and come in for therapy’,” Dr. Robinson said.
Sam Wakapa, sophomore, said Black youth seeing themselves portrayed, for instance, in negative racial remarks following anti-racism protests, can harm their mental health.
“Black students take an emotional toll from racism as the emotional struggle of being a Black person in America,” Wakapa said.
Early last fall, Wakapa said he was not aware of MHS or RSD taking initiative to support students in regards to mental and emotional health or speak to racism and to racial inequity.
“That sense of belonging and inclusivity was not made with teachers because they were reluctant to have those conversations,” Wakapa said. “It is hard attending a school with no Black teachers. It limits who I would talk about mental health or racism in school.”
He said a racially diverse staff would be beneficial for students to have a different perspective than that of their parents and to support all students, for instance, Asian students facing hate crimes.
Another difficulty of attending MHS, Wakapa said, is the academic competition, which he said can be stressful and scary at times because he must work harder in the same situations socioeconomically privileged students may not.
Executive Director of Student Services Dr. Terry Harris heard similar sentiments growing up from his parents, and he said the weight of being a Black student can create a level of stress, anxiety and depression.
This is referred to as imposter syndrome, Dr. Harris said, such as not feeling worthy enough to be in certain spaces, especially if Black students are trying to protect themselves from news showing negative interactions between Black people and law enforcement.
He said Black students may be experiencing stereotype threat, or to believe one’s behavior may confirm negative stereotypes about, for instance, all Black people, upon returning to school last year. Therefore, students may fear they need to represent their entire race.
“Slowly these messages get into your skin,” Dr. Harris said. “For example, when you don’t have a diverse staff, you’re telling young people who and what you value.”
The greatest and most challenging healthcare crisis in K-12 schools, he said, is students not being seen, heard, valued or validated.
Breaking Silence for Black Women
Sharee Silerio, documentarian, was raised in Florissant, Mo., around her uncle, who had schizoaffective disorder and a grandfather who had schizophrenia. She became aware of stigma on mental health because of the lack of conversation about their behavior.
Silerio’s uncle passed away unexpectedly in 2016 after his mental health had begun to deteriorate, and she became depressed, anxious and dispassionate. She turned to a friend, who told Silerio she was ungrateful for being depressed.
This incident gave way to a desire to make a safe space for Black women to cultivate empathy and compassion around mental health. She filmed a short documentary, “Black Girl, Bleu,” featuring interviews with Black women who share their experiences with mental health crises as well as conversations with therapists and resources for healing and self love.
“It’s a space for us to learn tools to manage our mental wellness, to deconstruct the ‘strong black woman’ stereotype that she is not allowed to be vulnerable or hurt,” Silerio said.
Facing racial microaggression in grade school, she said she felt less than human, and in St. Louis, racism runs deep. She hopes “Black Girl, Bleu” will allow viewers to see Black women as a human first and that blackness is not to be controlled or disenfranchised.
“To have the film described as powerful, beautiful and made women feel they are not alone in their struggles was amazing,” Silerio said. “I want Black women to know they matter, their pain matters, and their healing matters and they are not alone.”
Creating Safe Spaces for Black Men
Jermar Perry is a Philadelphia native and St. Louis resident since 2016. While attending Saint Louis University’s (SLU) Master of Social Work program, he rarely saw Black men or spaces for them in the city or his classes.
Perry created a space for Black men, the Village Healing and Writing Circle for Men of Color (HAWC) as well as The Village HAWC for All Black Humans, which are inclusive to the LGBTQIA+ community in August 2018. The self-help groups aim to support Black mens’ healing and reduce the stigma by providing culturally affirming mental health services.
In meetings, members volunteer to share their “joys” and “pains” and participate in a prompt-based discussion, he said. Afterward, the group members share their writing, such as a poetry excerpt, artwork or quotes, and then concludes with a prayer focused on mindfulness.
The objective is not for the group to share and lend advice but to learn to listen.
“Most people know how to actively listen, but how do you actively listen to someone?,” Perry said. “How do you listen with a clear mind, open heart and open ears?”
Bryant Antoine, Perry’s friend, fellow SLU graduate and social worker, is the co-founder of the The Village Programs to Access Therapy and Healing (PATH) organization since August 2019 after moving from Massachusetts to St. Louis in 2016.
“The feeling of service and purpose is amazing, and the amount of support we get for what we do is liberating,” Antoine said. “I don’t want to simplify how big Black healing is, but we just get a big outpouring of support, and I find therapy as well.”
Antoine said the Village HAWC provides a creative outlet, allowing everyone to interpret each other’s experiences through different mediums and as a community of people of color.
“We want you to walk away feeling like you were safe in the space,” Antoine said. “You are a part of a community, a space designed for you, no strings attached.”
Prioritizing Black Students’ Mental Health
Dr. Harris said it is important to teach students about emotional literacy at young ages because a part of the trauma is not understanding or processing one’s emotions.
Intergenerational transmission of trauma, he said, can cause Black families to cyclically avoid addressing mental health and potentially take up negative coping mechanisms.
“It doesn’t surprise me Black kids do not talk to therapists,” Dr. Harris said. “Black students will not access our resources until we do a better job of trying to heal and repair the hurt, the race-relations issues America caused and build trusted relationships.”
As educators, dealing with implicit bias is essential, he said, regarding how it impacts their interactions with and their value of students of color.
Dr. Harris said RSD partnered with Alive and Well, a trauma-based organization in St. Louis, to ensure teachers had information and webinars available about trauma to help students experiencing the trauma of racial injustice last year.
Top priorities, Dr. Harris said, are reassessing goals to increase the diversity of teachers, hiring staff, curriculum and student achievement in all courses, being strategic in sharing mental health resources and hearing more student input.
“We cannot shy away from the issue of race because it is important to young people,” Dr. Harris said. “We have to talk about Black health, and it is okay to say we need to be meeting the needs of Black students, not all students.