The Call to Transform Black Mental Health Services

Written by Mohamed Diagne

“Understand that systemic racism contributes to Black people’s vulnerability to psychological, emotional, and social distress. It makes them hesitant to seek mental health services, especially from those who don’t look like them.”

– Tytannie Harris, LCSWChicago, IL

One of the many weaknesses of America’s infrastructure that has been underscored by the pandemic  is the lack of access to appropriate mental health services for Black Americans. Despite not being more biologically susceptible to the virus, the effects of generational discrimination and systemic racism have solidified the existing inequitable social structures that have led to Black Americans facing the brunt of the pandemic with little support. Throughout the pandemic, Black Americans died from the coronavirus at nearly twice the rate of white Americans (Hill & Artiga).  This is a consequence of income inequality, which directly translates to the likelihood of one’s job requiring in-person contact, as well as a consequence of healthcare disparities and biases regarding the treatment of African American illnesses. As an immediate consequence of this disparity, grief and economic instability has flooded the Black community, leading to an exponential increase in mental illness amongst Black Americans (Gibbs et al.)

Although the number of Black Americans requiring mental health services has increased, the number of Black mental health professionals remains relatively low.  Data from the American Psychological Association (APA) indicates that approximately 4% of American psychologists are Black, while an overwhelming 83% of psychologists are white (APA) . One potential argument for this disparity is that mental illness has been so stigmatized within the Black community that most Black Americans simply do not seek jobs in mental health. Supporting this, there was a 2011 study where researchers sampled random white and Black Americans and quantitatively assessed the extent to which each participant carried internalized stigma towards mental health through a “Internalized Stigma of Mental Illness Scale” (Brown et. al). The scale prompts participants to answer a series of mental-health related statements using a scale of 1-4, with higher scores being correlated with greater internalized stigma (Brown et al.) Not only do quantitative analyses of elder Black Americans’ viewpoints on mental illness indicate that mental illness is often interpreted as a “weakness” amongst older Black generations, but these same Black Americans are reported to be significantly less likely to engage with mental health services as a result of their internalized stigma towards psychological intervention ( Brown et. al).

Several studies tackle the origins of this aversion to mental health services, with all providing a diverse range of answers. A promising hypothesis, supported by the philosophical arguments of American psychiatrist Metzl, is the complex history between African Americans and the American mental healthcare system, in which psychological diagnoses were weaponized to portray African Americans who were tired of their treatment in American society as  ‘hysterical’,  ‘aggressive’, and ‘psychotic’ (Metzl).  

The  result of this is a multigenerational trauma response in which Black Americans harbor distrust towards mental healthcare services due to the damage that it has done to the Black community and their representation in contemporary American society. In turn, this contributes to a low percentage of African Americans working in mental health services today, leading the discipline to become yet another predominantly white field.

“My therapist has really been trying to get me to ‘get angrier.’ And I told her I have to be extra careful with that as a Black woman,”

-Amanda, NYC

As a result of the racial uniformity of modern mental health services, it is becoming increasingly difficult for Black Americans that desire racially sensitive care to find it. The significance of needing a Black therapist in lieu of a white one lies in the differences in how the two races move through society and, consequently, navigate their mental health. These differences can manifest as economic disparities, societal stereotypes, & intersectional oppression, all of which differ between white and Black Americans and, as such, require nuanced treatment.

Economic Disparities of the Covid-19 Pandemic

Although all races and economic classes were harshly hit by Covid-19, the pandemic notably affected Black Americans by capitalizing on the pre-existing wealth gap between them and the general population. This played a significant impact in the mental health epidemic in the Black community early in the pandemic. Prior to 2020, “Black families’ median and mean net worth was less than 15 percent that of white families, at $17,600 and $138,200, respectively”, according to 2017 data from the Federal Reserve (Dettling et. al).  This economic inequality  is particularly apparent when investigating the incomes of Black women in comparison  to the rest of the United States. According to studies from the National Women’s Law Center , “Black women make up 10 percent of the low-wage workforce—jobs that typically pay less than $11 per hour, or about $22,880 annually— while they make up just 6.2 percent of the overall workforce” (NWLC).  Contrary to this, their representation in the high-wage workforce is less than half  of what it should be given the percentage of Black women in America (NWLC).

Although much of the racial wealth gap stems from income inequality, statistical analyses have concluded that the wealth gap is statistically too large to be solely attributed to income inequality alone (Federal Reserve Bank of Cleveland ). Factors such as implicit bias in the workforce, geography, home equity, and the probability of growing up in a nuclear family all contribute towards the racial wealth gap. 

“Even as Black or African-American men climb the corporate ladder, they still make less than equally qualified white men. They are the only racial/ethnic group that does not achieve pay parity with white men at some level.”

– Jackson Gruver, Payscale Data Analyst

This wealth gap  has led to Black Americans having a wildly different experience during the 2020 pandemic than their white counterparts. The economic insecurity of Black Americans translated to less of them being able to telework than the general population, with 19.7% of Black Americans being able to telework as of November 2021 contrary to 29.9% of White Americans, according to a Bureau of Labor Statistics Time Survey (Inequality). Additionally, during the spontaneous peak of American unemployment rates in May 2020, Black and Latinx Americans experienced the greatest spike in unemployment, with unemployment rates of 16.7% and 18.9% respectively,  despite the fact that the unemployment rate for all racial demographics is 14.7% (Inequality). Such statistics result in a higher risk of hospitalization for Black Americans, as well as a greater risk of economic burnout. 

This economic inequality  translates into mental health problems that are unique and entirely distinct from white Americans. While both Black and white Americans struggle with economic insecurity amidst the pandemic, Black Americans face the additional burden that, even if they make the same effort as their white counterparts to maintain their economic status, the structure and orientation of the American workforce will always be acting against said effort. This is a conversation that not many white therapists are well-equipped to counsel, as the lived experience of being Black in America will always provide the best emotional insight on coping with racial inequality, more-so than any form of higher education.

Healthcare Inequity

In addition to the economic disparities of Covid-19, Black Americans also had to endure direct discrimination from the healthcare system during one of the most infamous pandemics the world has seen. Studies conducted by The Kaiser Family Foundation, indicate that Black Americans suffer a 2.5x higher chance of being hospitalized in comparison to White Americans, with a 1.7x greater chance of being killed by the virus (Hill & Artiga). Given that Black Americans have an equal infection rate as white Americans, this suggests a racial barrier between Black Americans and quality healthcare support. This is supported by pre-pandemic data as well, given that, on average, being Black in America came with a 3.6 year deduction in your life expectancy in comparison to White Americans (Marabito). 

Naturally, the high death rates experienced in the Black community during the pandemic exasperated the mental health epidemic and heightened the necessity of mental healthcare workers. Specifically, it created a need for mental healthcare workers that had the unique experiences to understand the dual pain of losing a loved one and knowing that the outcome may have been different if they had been born with a different skin color. 

This is where the role of racial identity comes into play again. Although any psychiatrist or psychologist has the education to treat symptoms of bereavement or anxiety, there’s a massive difference between providing emotional support based on textbook knowledge versus providing emotional support based on a mutual understanding of the Black struggle in America.

A New Era

Although it may take many years to fine-tune the healthcare system to the unique needs of minorities, the racial diversity present in the newest generation of mental healthcare workers indicates that there will soon be a change in America’s mental healthcare system. Although only 4% of current mental healthcare workers are Black, 11% of psychologists below the age of 36 are Black – suggesting a three fold  increase in the number of Black psychologists in the most recent generation (APA). This is estimated to continue growing as the social sciences become more racially inclusive and culturally sensitive, which can’t be said for most scientific disciplines. With this diversification of mental healthcare services, there is hope for a near future in which Black Americans can enter mental health spaces without the fear of receiving abhorrent treatment because of the racial insensitivity of their provider.

Edited by: Ava Bagherian

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