Black History Month, observed every February, is an opportunity to raise awareness of the ongoing challenges black communities face, including those related to mental health. Particularly over the past few years, the physical and emotional effects of racial violence and the ongoing pandemic have taken an unprecedented toll on our friends of color - most strikingly after the death of George Floyd.
This has underscored the importance to recognize the need for mental health care that is inclusive and culturally responsive to the needs of this community that has been historically under-represented and impacted by health inequities.
Institutions must act and address the systemic barriers that have disproportionately affected Black people’s mental health and provide solutions to reduce disparities and improve clinical outcomes.
Barriers to Receiving Mental Health Treatment:
- In 2020, 52% of Whites with mental illness received mental health services, whereas only 37.1% of Black Americans and 35% of Hispanics received services.
- More than 80% of Black Americans are “very concerned” about the stigma associated with mental illness that discourages them from seeking treatment.
- Racial mental health disparities cost the United States around $278 billion between 2016 and 2020 - as a result of premature deaths that have been linked back to mental health, substance use disorder, and suicide.
- Black American adults are 20% more likely to experience serious mental health problems, such as major depressive disorder or generalized anxiety disorder.
- According to a 2019 study, Black Americans have the highest lifetime prevalence of PTSD (8.7%) compared to their White (7.4%), Latino (7%), and Asian (4%) counterparts.
- Black Americans and Latinx children were about 14% less likely than White youth to receive treatment for their depression.
- In 2018, a study found that the suicide rate of Black American children 5 to 12 was nearly twice that of White children of the same age.
- Pre-pandemic: 65.4% of Black Americans with major depression and 42% with serious mental illness did not receive mental healthcare. Respectively, these figures compare with 58.6% and 35.9% of Americans overall.
- Although overall rates of suicide seem to have decreased during the height of the pandemic, a Maryland study revealed an increase in suicide by 94% among Black American residents compared to a 45% decrease among White residents.
There are many contributing factors Black Americans may encounter with behavioral and mental health treatment. These barriers may prevent individuals from seeking much-needed behavioral health interventions and could result in negative downstream effects such as worsening psychological distress, functional difficulties, diminished quality of life, and even loss of life. These obstacles may include:
- Stigma: Often negative stigma exists surrounding mental health symptoms or seeking therapeutic services; this presents as a major obstacle to receiving professional help.
- Lack of Cultural Competency: Some healthcare professionals may not hold training to interact effectively with patients of different cultures.
- Representation: Lack of diversity of healthcare professionals due to systemic barriers in education.
- Financial Restrictions: May lack insurance coverage or difficulty accessing public benefits to pay or receive assistance for treatment due to healthcare disparities.
- Access: Individuals may have limited access to professional services, specifically in underserved or rural areas. Transportation to and from appointments may also pose a problem in accessing continued care.
- Historical Trauma: Past experiences of historical racial trauma (i.e., slavery, segregation, racism, deceitful medical experimentation such as the “Tuskeegee Syphilis Trial”) may hinder their desire to safely seek out mental health treatment without fear of discrimination or bias.
- Communication Barriers: Lack of in-house translators or translational services presents a major roadblock in receiving services in one’s first language.
- Mistrust of Treatment: Together with bias, stigma, and discrimination, people of color may feel their care could be compromised.
Strategies to Reduce Mental Health Disparities:
Behavioral health centers and hospitals can respond with strategies to reduce disparities in under-represented groups and address barriers to ensure everyone has access to the high-quality care they need, regardless of their race, ethnicity, socioeconomic status, or other factors.
Available Mental Health Treatments:
- Increasing Cultural Competency: Clinical providers can receive training on specific cultural experiences of marginalized groups and develop strategies for working with diverse populations.
- Diversifying Providers: By increasing the diversity amongst the workforce, individuals seeking care may feel more comfortable communicating their problems and building trust with providers who share their racial or ethnic backgrounds.
- Offering Affordable Options: Building and providing equitable healthcare resources, providing available resources such as financial assistance programs, helping to navigate through insurance systems to obtain health coverage, and offering increased access to public benefits are some ways to defray or eliminate the costs associated with mental health treatment.
- Elevating Public Education and Awareness: Culturally responsive public education of mental health services provided may reduce the stigma surrounding mental health symptoms and promote awareness of accessible treatments. Assessments such as the Adverse Childhood Experiences (ACE) are an important screening tool to use with trained clinicians to help understand the role of early life stress on adult physical and mental health conditions.
- Providing Language Services: To remove language barriers, mental health programs can offer services, assessments, documentation, and patient-facing resources in a patient’s fluent language.
- Addressing Fear of Discrimination and Systemic Barriers: Creating safe, non-judgmental, and inclusive environments for all individuals while being mindful and respectful of specific cultural sensitivities.
- Medication Management: Antidepressants, antipsychotics, and mood stabilizers are common medications used to treat mental health disorders such as depression, anxiety, bipolar disorder, and schizophrenia.
- Psychotherapy (group/individual): Commonly referred to as “talk therapy” and involves speaking with a training therapist to better understand and manage symptoms. There are many different approaches to therapy such as cognitive-behavioral therapy (CBT), dialectical behavior therapy (DBT), psychoanalysis, and integrative or holistic therapy, among others.
- Electroconvulsive Therapy (ECT): ECT uses brief, low-energy electrical pulses to stimulate nerve-cell activity in the area of the brain that affects mood. Stimulating this area helps to alleviate symptoms of depression. The electrical impulses are delivered through electrodes placed on the scalp. Patients are given anesthesia to relax and ensure the procedure is pain-free.
- Transcranial Magnetic Stimulation (TMS): TMS is an FDA-approved outpatient treatment that uses magnetic fields to non-invasively stimulate nerves in the brain. This innovative and safe technique requires no sedation or anesthesia and successfully treats individuals suffering from Major Depressive Disorder and Obsessive-Compulsive Disorder. Published reports from TMS treatment studies for depression show more than half of patients treated with TMS Therapy experienced significant improvements in symptoms and one-third of patients experience full remission of their depressive episodes.
Care New England’s Statement of Diversity:
Butler Hospital firmly believes in treating all people with dignity and respect, which is one of Care New England’s core values. Diversity refers to all differences among people. This includes, but is not limited to:
We have established an environment that puts diversity, equity, and inclusion at the center of our work, and informs how we both approach and treat all our patients and families. From a regular review of best practices and models of care to leveraging consistent feedback and input from our patients and staff, Butler Hospital and Care New England prioritizes the highest quality of care and with the utmost level of dignity and respect for all our patients - regardless of who they are, or where they live.
- Sexual orientation
- Gender identity
- Gender expression
- Religious beliefs or spirituality
- National origin
- Physical ability
- Cognitive ability
- Medical condition
- Reproductive and behavioral health
About The Author:
Eric Tirrell is the clinical manager of the Transcranial Magnetic Stimulation (TMS) program and the research operations manager for the Center of Biomedical Research Excellence (COBRE) in Neuromodulation at Butler Hospital. He also serves on Butler Hospital’s Diversity, Equity, and Inclusion committee with members of the group providing contributions to this post.
Disclaimer: The content in this blog is for informational and educational purposes only and should not serve as medical advice, consultation, or diagnosis. If you have a medical concern, please consult your healthcare provider, or seek immediate medical treatment.