Mental health conditions occur in Black people at about the same rate as they occur in White people, but historically, their access to treatment has not been equivalent. The experience of being Black in the United States is an individual one, but there are some themes that are frequently found. Experiences of racism, mistreatment, and trauma are all too common and these occurrences greatly inform how they interact with the world around them. These incidents can compound and may also have a profound impact on mental health and one’s ability to seek help.
How History Informs Views on Treatment
Discrimination against people with mental health conditions has been widely observed despite efforts to change perceptions and conversations about it. As poor as treatment surrounding mental health has been, Black people have experienced deeper levels of inequality, and these disparities are especially apparent in mental health treatment.
Unfortunately, problems of systemic discrimination continue today and have caused a great deal of apprehension regarding seeking help. Two of the most prevalent historical experiences found in mental health treatment for Black people are:
- Segregation was viewed as “medically necessary”: It was not so long ago that segregation was legal and facilities were allowed to discriminate on the basis of race. While legal action was taken to try and end segregation, many states pursued it, claiming they had a right to operate facilities as they saw fit because segregation was “medically necessary”.
- Psychiatry was used as a tool to mistreat people: “Medically necessary” segregation is an idea built on the foundation of racism. Historically, it was argued that Black people were biologically “inferior”, which is one of the beliefs that fueled slavery for so long. Slaves were viewed as child-like, unable to care for themselves, and mentally ill if they tried to escape. Treatment options for Black people were limited and those that did operate were ineffective or harmful in nature.
People often argue that this history is behind us, but discrimination is still prevalent, even if it is not as overtly obvious. There are significant disparities in how mental health conditions are diagnosed. For example, Black people are more likely to be diagnosed with schizophrenia as compared to White people, with no scientific basis. It is more common to find that Black people with mental health conditions are being pushed in the criminal justice system and into prisons rather than receiving the treatment they need.
Stigmas Surrounding Mental Health
Conversations around mental health are often informed by personal experience. Culture, identity, family, and education can all factor into how someone views mental health. It is not uncommon to find that people equate mental health conditions with weakness or see it as a sign that something is “wrong” with a person. Assumptions about mental health conditions can make people feel shame and as if it is something to be hidden from others. They may be afraid of how others will perceive them. No matter how right or wrong it is, stigmas still greatly influence people’s opinions on mental health and treatment options. Knowing what stigmas are prevalent and how to counteract them is important in helping people overcome barriers that prevent them from seeking help.
There are different kinds of stigmas that can be influenced by personal experience or representations in the media. The most common types of stigmas are:
- Personal: Internalized stigmas or negative attitudes towards mental illness that may be a result of personal experience or struggles with their own mental health.
- Public: Stigmas that are informed by others including friends, family, or acquaintances.
- Institutional: Stigmas that are related to systemic policies, however intentional or unintentional they are. An example of this would be the fact that there is often lower funding for mental health services compared to other areas of healthcare.
Stigmas not only impact how a person views themselves, but can also inform how loved ones interact with them. Negative representations in media and cultural beliefs can play a significant role in how a person views mental health. These factors can deter a person from seeking help due to feelings of shame, fear, or guilt.
Stigmas also can make symptoms of mental health worse. They can lead to:
- Reduced likelihood of seeking help
- Loss of hope
- Lowered self-esteem
- Increased severity of symptoms
- Difficulty maintaining relationships
- Reduced likelihood of staying in treatment
Barriers in Seeking Mental Health Treatment
Overcoming stigma is only one of the major barriers facing Black people seeking treatment for mental health. There are a number of barriers that can make it difficult to seek treatment or obtain quality care. Barriers may be institutionalized or be influenced by historical experiences. Some of these include:
- Compared to White people, Black people are more often misdiagnosed with conditions such as schizophrenia rather than other mood disorders, even if they are presenting the same symptoms as a White person. Additionally, they are less likely to be prescribed medications or therapy as compared to the rest of the population.
- Black people are more likely to be incarcerated compared to White people due to racial disparities. Those with mental health conditions, specifically in cases that involve psychosis, are more likely to be in prison or jail than people of other races.
- Black people make up less than two percent of the American Psychological Association. This lack of representation can make people worry that practitioners are not equipped with the tools or cultural competency to address specific issues.
- Mental health is highly stigmatized in Black communities. Fear of being labeled as “crazy” by loved ones can make it difficult to discuss issues of mental health or seek treatment when needed.
- Care may not be culturally competent. For example, Black people are more likely to describe physical symptoms when discussing mental health issues and providers may not connect the two together. This often results in misdiagnoses.
- Disparities in access to healthcare and treatment persist despite efforts to change this. Statistically, Black people are less likely to have access to treatment as compared to White people. This is largely due to socioeconomic disparities which may exclude them from access to specific resources.
- Religion and faith are prominent in Black communities. Although it can be a great source of comfort, it can also make it difficult to seek treatment. Many may choose to seek support through faith and spirituality rather than through medical institutions.
Providing Culturally Competent Care
It is imperative that people receive a correct diagnosis and quality care for mental health conditions as soon as they are recognized. In order to do this for members of the Black community, providing culturally competent treatment is vital. A provider should be open to discussing issues related to race and healthcare including their background, experiences, and any relevant trainings that make them equipped to handle their unique needs.
Although changes are being made, the reality is systemic racism and discrimination still impacts the lives of people of color in a variety of ways. Healthcare is no different and making sure providers are equipped with the knowledge and skill to counteract these disparities is critical in ensuring people of color are able to access the same level of care and resources.
In addition to making sure treatment is culturally competent, education surrounding mental health can help reduce stigmas and encourage people to seek help when needed. Having a mental health condition is not shameful and seeking treatment can greatly improve a person’s quality of life.
Breaking down barriers in mental health treatment requires both increased cultural competency and changes in how we view and discuss mental health. Addressing these aspects of treatment can help people achieve a happier, healthier life.
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