Mental health matters
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Physician's Corner
African Americans are no different when its comes to prevalence of mental health conditions when compared to the rest of the population. However, your concerns or experiences and how you understand and cope with these conditions may be different.
This page focuses on how mental health affects the African American community so that you know how to find help.
Why Does Mental Health Matter?
Without mental health, we cannot be healthy. Any part of the body—including the brain—can get sick. We all experience emotional ups and downs from time to time caused by events in our lives. Mental health conditions go beyond these emotional reactions to specific situations. They are medical conditions that cause changes in how we think and feel and in our mood. These changes can alter your life because they make it hard to relate to others and function the way you used to. Without proper treatment, mental health conditions can worsen and make day-to-day life hard.
If you feel you or a loved one might be experiencing a mental health condition, remember that these are biological brain disorders. Anyone can develop a mental health problem. It isn’t your fault or your family’s fault. Seeking treatment can help you live a fulfilled life and can strengthen you and your family for the future.
How Do Mental Health Conditions Affect The African American Community?
Although anyone can develop a mental health problem, African Americans sometimes experience more severe forms of mental health conditions due to unmet needs and other barriers. According to the Health and Human Services Office of Minority Health, African Americans are 20% more likely to experience serious mental health problems than the general population. Common mental health disorders among African Americans include:
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Suicide, among young African American men
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Posttraumatic stress disorder (PTSD), because African Americans are more likely to be victims of violent crime
African Americans are also more likely to experience certain factors that increase the risk for developing a mental health condition:
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Homelessness. People experiencing homelessness are at a greater risk of developing a mental health condition. African Americans make up 40% of the homeless population.
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Exposure to violence increases the risk of developing a mental health condition such as depression, anxiety and post-traumatic stress disorder. African American children are more likely to be exposed to violence than other children.
Issues To Consider
Different reasons prevent African Americans from seeking treatment and receiving quality care.
Lack Of Information And Misunderstanding About Mental Health
In the African American community, many people misunderstand what a mental health condition is and don’t talk about this topic. This lack of knowledge leads many to believe that a mental health condition is a personal weakness or some sort of punishment from God. African Americans may be reluctant to discuss mental health issues and seek treatment because of the shame and stigma associated with such conditions.
Many African Americans also have trouble recognizing the signs and symptoms of mental health conditions, leading to underestimating the effects and impact of mental health conditions. Some may think of depression as “the blues” or something to snap out of.
Because of the lack of information about mental health issues, it’s not always clear where to find help when you may need it. Fortunately, you came to the right place to learn about what mental health conditions are and how to access treatments and supports.
Don’t let fear of what others may think prevent you or a loved one from getting better. One in 5 people is affected by mental illness. This means that, even if we don’t talk about it, most likely we have one of these illnesses or know someone who does.
Faith, Spirituality And Community
In the African American community, family, community and spiritual beliefs tend to be great sources of strength and support. However, research has found that many African Americans rely on faith, family and social communities for emotional support rather than turning to health care professionals, even though medical or therapeutic treatment may be necessary.
Faith and spirituality can help in the recovery process but should not be the only option you pursue. If spirituality is an important part of your life, your spiritual practices can be a strong part of your treatment plan. Your spiritual leaders and faith community can provide support and reduce isolation. Be aware that sometimes faith communities can be a source of distress and stigma if they are misinformed about mental health or do not know how to support families dealing with these conditions.
Do rely on your family, community and faith for support, but you might also need to seek professional help.
Reluctance And Inability To Access Mental Health Services
Only about one-quarter of African Americans seek mental health care, compared to 40% of whites. Here are some reasons why:
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Distrust and misdiagnosis. Historically, African Americans have been and continue to be negatively affected by prejudice and discrimination in the health care system. Misdiagnoses, inadequate treatment and lack of cultural competence by health professionals cause distrust and prevent many African Americans from seeking or staying in treatment.
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Socio-economic factors play a part too and can make treatment options less available. According to the U.S. Census Bureau, as of 2012, 19% of African Americans had no form of health insurance. The Affordable Care Act is making it easier and more affordable to get insured.
Medications
Some studies indicate that African Americans metabolize many medications more slowly than the general population yet are more likely to receive higher dosages. This may result in a greater chance of negative side-effects and a decreased likelihood of sticking with treatment.
Provider Bias And Inequality Of Care
Conscious or unconscious bias from providers and lack of cultural competence result in misdiagnosis and poorer quality of care for African Americans.
African Americans, especially women, are more likely to experience and mention physical symptoms related to mental health problems. For example, you may describe bodily aches and pains when talking about depression. A health care provider who is not culturally competent might not recognize these as symptoms of a mental health condition. Additionally, men are more likely to receive a misdiagnosis of schizophrenia when expressing symptoms related to mood disorders or PTSD.
Given this bias and the negative impact they have on our care, it is easy to understand why so many African Americans mistrust health professionals in general and avoid accessing care. While you have a reason to doubt whether professionals will mistreat you or not, don’t let this fear prevent you from seeking care. The section below gives ideas on how to find the right provider for you
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Finding The Right Provider For You
Cultural Competence In Service Delivery
Culture—a person’s beliefs, norms, values and language—plays a key role in every aspect of our lives, including our mental health. Cultural competence is a doctor’s ability to recognize and understand the role culture (yours and the doctor's) plays in treatment and to adapt to this reality to meet your needs. Unfortunately, research has shown lack of cultural competence in mental health care. This results in misdiagnosis and inadequate treatment. African Americans and other multicultural communities tend to receive poorer quality of care.
However, you can improve your odds of getting culturally sensitive care.
While we recommend you go directly to a mental health professional because this is their area of expertise, if you do not feel comfortable right away, a primary care doctor is a great place to start. The primary care doctor might be able to start the assessment to determine if you have a mental health condition or help refer you to a mental health professional.
Unfortunately, while you may prefer finding an African American mental health professional, this is not often possible because there are a small percentage of African American providers. The good news is that professionals are increasingly required to learn how to effectively treat people from diverse backgrounds. However, as mentioned before, many providers still lack cultural competence and do not know how to effectively treat African Americans.
When meeting with your provider, ask questions to get a sense of their level of cultural sensitivity. Do not feel bad about asking questions. Providers expect and welcome questions from their patients since this helps them better understand you and what is important to you. Your questions give your doctor and health care team important information about you, such as your main health care concerns. Here are some questions you could ask:
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Have you treated other African Americans?
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Have you received training in cultural competence or on African American mental health?
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How do you see our cultural backgrounds influencing our communication and my treatment?
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How do you plan to integrate my beliefs and practices in my treatment?
Your mental health provider will play an important role in your treatment, so make sure you can work with this person and that you communicate well together. Mention your beliefs, values and cultural characteristics. Make sure that she understands them so that they can be considered in the course of your treatment. For example, mention whether you would like your family to be part of your treatment.
If finances are preventing you from finding help, contact a local health or mental health clinic or your local government to see what services you qualify for. You can find contact information online at findtreatment.samhsa.gov or by calling the National Treatment Referral Helpline at 800-662-HELP (4357).
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Minority Women Veterans Are Our Most Invisible Heroes
May 19, 2017 By National Veterans Foundation
Our brave minority women veterans are often forced to navigate a discouraging obstacle course when they transition back into civilian life. No matter what their demographic might be, all military veterans returning home after a long time in active service face a distinct set of difficult challenges. Many of these challenges involve the extraordinary difficulties veterans have reconnecting to their families, workplaces, and communities.
Minority women veterans are certainly no exception to this distressing norm. They face the standard array of challenges that all veterans encounter, as well as the added dimension of specific difficulties that women veterans in general face.
In some ways, minority women veterans are fighting three battles at once, especially after they return home from active duty.
Compromised Status and Access Problems
As a group, women in the military are not granted the same status that male soldiers are usually afforded. When you add to these hurdles the reality of belonging to a minority group, the path to safety, satisfaction, and so-called normalcy can seem strewn with insurmountable obstacles. This has to change. Some progress has been made, but it’s simply not enough.
The causes of these difficulties are numerous and exceedingly complex. Many of these causes are intrinsic to the structure of the military itself, as most facilities, equipment, and health care options are geared more toward men than women. It is also apparent that sexism and sexual violence against women plays a large role in these outcomes.
The women veterans community tend to experience greater challenges than their male counterparts do when they leave military service and they are more likely to need more support in order to be successful after this transition.
Source: NVF’s Women Veterans Community page.
The Disabled American Veterans study cited above also concludes that access to VA facilities and treatment is much more difficult for women than men. It also found tremendous gaps in all of the services offered to female veterans. Caused largely by a traditionally male-dominated military structure, these gaps resulted in problems for women veterans in areas such as employment, housing, social issues, and several other key life areas.
Problems in Perception
The minority women that have served in our various military branches are brave, heroic, and committed to the protection of our country. In fact, there is no military area in which they have not made enormous contributions. They begin their military service with goals and dreams that are identical to every American soldier’s aspirations. They want to build better lives for themselves, their families, and their country.
In other words, these women veterans are identical to their non-minority colleagues, at least in their capacities as soldiers. And yet there is often a huge gulf in the public perception of minority women in the military, one that fails to confer the same dignity, esteem, and respect that most veterans receive as a matter of course.
These brave and dedicated women suffer from misguided and shallow stereotypes. They are perceived as “other” at two distinct levels. They are women and minorities first in public perception, not as the soldiers that their actions have truly made them.
Sometimes, minority women do not even receive the simple acknowledgment that they served our country. This acknowledgment would not suffice to give women minority veterans the tools and support they deserve, but it would be a way that our society can begin to transform itself.
A Revealing Pattern
It’s well documented that our military veterans are often ignored or treated poorly, especially compared to the services they render to our country. Almost all of our veterans have difficulties transitioning back to the civilian world after a lengthy period of services.
As we shall see, minority women veterans are not immune to these transition problems. In fact, they might actually experience the difficulties in transition more acutely than their non-minority counterparts. At the very least, it seems reasonable to say that minority women veterans experience the transition back to civilian life differently from the majority of other soldiers.
The Homelessness Epidemic
As a group, our military veterans suffer a disproportionately high amount of personal, social, and economic difficulties. On any given night, almost 40,000 veterans are homeless, about 9 percent of which are women. Approximately 45 percent of these homeless veterans are Hispanic or African-American, and a majority of all homeless veterans suffer from substance abuse or other mental health disorders.
Further examination of these statistics reveals an alarming pattern for these women. One study suggests that well over 60 percent of homeless female veterans are members of a racial or ethnic minority, with black women comprising a staggering 90 percent of these numbers.
This study suggests an intimate connection between the experience of minority women while in active duty and their startling rate of homelessness. A large percentage of these minority homeless are afflicted with PTSD, Depression, and devastating consequences of being sexually assaulted while in active duty.
An Illustrative Case Study
An exhaustive survey of these struggles is far beyond the scope of this post. Therefore, a complete catalog or statistical analysis isn’t our exact goal here. Rather, our goal is to draw attention to the general and particular struggles of minority women as they are reintegrated into society.
So far, we have spoken in largely general terms about what minority women in our military experience. This approach is a good start, but it can only scratch the surface of what is an undoubtedly pervasive problem in both our military structure itself and the network of support we offer our veterans after their service.
In the following section, we will examine some of the struggles that female veterans in sexual minorities face. Although every minority group of women experiences life after active duty differently, it isn’t difficult to imagine that the plight of many of them is similar to what lesbian and bisexual soldiers experience.
Sexual Minority Women Veterans
For our purposes, the demographic of sexual minority women will include veterans who **identify their sexual preference as homosexual or bisexual in nature. One of the most important things to understand is that the challenges that these women veterans face seem to represent an intensified microcosm of what civilian sexual minority encounter in the non-military world.
Mental Health Factors of Sexual Minority Women
As they do in most categories, lesbian or bisexual women veterans experience a disproportionate amount of mental health disorders during and after active duty. In fact, sexual minority women experience substantially poorer mental health outcomes than even their heterosexual women peers.
This means that women vets who identified as lesbian or bisexual experienced significantly greater amounts of mental distress, sleep problems, and overall dissatisfaction with life than their heterosexual women veteran counterparts. Additionally, sexual minority women veterans were much more likely to demonstrate health risk indicators than heterosexual women vets. These risks include smoking, obesity, and a failure to develop networks of emotional support.
Symptoms of a Larger Problem
There’s no way around it — the statistics surrounding sexual minority women are very distressing. They indicate (they assert actually) that there are systematic gaps of support for these women, both at the cultural and structural level. Whether we’re talking about physical or mental health outcomes, none these challenges emerge in a vacuum.
Similarly, the health risk behaviors of these women should be construed as intimately connected to the same systematic gaps that contribute to physical and mental health outcomes. The upshot of these statistics is profoundly troubling — an egregious lack of inclusion and support for sexual minority women vets exist at a multitude of levels.
In this way, and many others, the distressing experiences of sexual minority veterans reflect those of minority veterans in general. None of these important groups are afforded the status or levels of care that is required for a happy and productive life after their service.
A Triple Standard For Minority Women Veterans
In no way should this description of the particular struggles of minority women be construed as an attempt to diminish the difficulties that all veterans encounter. In fact, these descriptions should serve to emphasize these more general struggles and help give families and caregivers a set of analytic tools that will benefit the entire veteran population.
But women veterans experience added dimensions of difficulties, ones that are in some ways over and above those of male veterans. And, as we can glean from statistical and anecdotal evidence, the situations worsen even further with minority women. Perhaps the most distressing conjecture we can make about minority women in the military is this: they are sometimes ignored and mistreated in the exact same way that they are in the wider world.
Women Minority Veterans Need Sufficient Care, Not Special Treatment
These women experience incredible difficulties in transitioning back to civilian society. This holds true whether we’re talking about negative effects OR the lack of the “positive” consequences that veterans sometimes experience in the civilian world.
These “positive” consequences are elusive and difficult to quantify, but they seem to include things like dignity, appreciation, and respect from the civilian world. The sad truth is that minority women veterans typically do not receive the same social benefits that other military service veterans do. Simply put, minority women do not usually signify as military veterans in our society.
The minority women who serve our country are incredibly tough-minded people, just like all veterans are. They are not more fragile than their non-minority peers and they’re certainly no less adaptive. This might only be semantics, but our minority women veterans do not require special treatment. They just need support and care that is appropriate to their experience.
The change must occur at both the macro and micro levels. It must occur at the policy and the structural level, both within and outside the actual military. The VA has made some progress in this area, but more is required for our minority women veterans to optimize their chances at healthy reentry into society. More is required of all of us.
To Be Female, Anxious and Black
by Angela Neal-Barnett, PhD
Anxiety disorders are the most common mental health disorder in the United States. Data show that for Black women, anxiety is more chronic and the symptoms more intense than their White counterparts. This description, however, only tells half the story. What it does not tell us is how anxiety is perceived and experienced daily by Black women.
Images of Black Women
To fully understand anxiety and Black women, we must understand how Black women are viewed in this country. Research and history tell us that three basic images exist-the Strong Black Woman, the Angry Black Woman, and the Jezebel/Video Vixen. These images affect how other people see Black women and how they see themselves. They also play a role in the development and maintenance of anxiety.
Strong Black Women are legendary. Harriet Tubman, Sojourner Truth, and every Black grandmother is renowned for her persistence and perseverance. There are many positive aspects about being a Strong Black Woman, but there are negatives as well. A Strong Black Woman “keeps on keeping on “even when she knows she should stop, placing her mental and physical health at risk.
An Angry Black Woman will “cuss” you out before hearing you out. Tyler Perry’s Madea is a classic example of the Angry Black Woman. Our work with these women has found that many of them are anxious. The anger is an outward expression of their discomfort with negative affect associated with anxiety.
The Jezebel/Video Vixen represents the sexualized Black woman. The term Jezebel comes from the Biblical Queen who turned her husband against God. Since slavery, Black women have been sexualized in derogatory ways, often represented in rap and hip-hop videos. Black women, particularly professional Black women work hard to dispel the Jezebel/Video Vixen image.
Social Anxiety
In workplaces, college and professional school settings around the country, Black women often find themselves the only one or the first one. In these situations, they have been taught that they have to be twice as good to go half as far, that they are representing the race and that they are being watched more closely than their white counterparts; beliefs that are not necessarily inaccurate. These beliefs coupled with the Strong Black Woman image increase risk for social anxiety.
Another social anxiety risk factor in the workplace and college/graduate/professional school setting is the acting white accusation. As the images attest, far too often we forget that there are more than three (3) ways to be a Black woman in this country. The acting White accusation, has nothing to do with wanting to be White and everything to do with what it means to be Black. In other words, it is an attack on one’s racial identity which in turn, can create anxiety.
PTSD
The rate of sexual assault among Black women is 3.5 times higher than that of any other group in this country. Black women are also less likely to report their assault. Many suffer in silence for years, never sharing with anyone what has happened to them. Thus, the trauma remains unnamed, unknown and untreated and the symptoms worsen.
Racism is a form of trauma that disproportionality affects Black women (and men). Trauma in the form of racism can be directly or indirectly experienced. Driving while Black, shopping while Black, and everyday racial micoraggressions are direct examples of racial trauma. The most common indirect examples are the viral videos of unarmed Black women and men being killed. Vicariously witnessing race-based trauma, can be as devastating as the direct form.
Help Seeking
Slowly, the stigma associated with seeking help for anxiety is disappearing. Women have begun to understand that an anxious Black woman is not crazy, she is simply anxious and with assistance can reclaim her life. Black women who seek help want a therapist who understands their issues. Imagine telling you someone you are tired of being a strong Black woman and they recommend you stop working out. It’s happened! Therefore, it is important that therapists enhance their cultural competence and be open to culturally adapting anxiety interventions. Cultural competence involves, but is not limited to, familiarity with stereotypical images of Black women, racism as trauma and the acting white accusation. Cultural adaptation can include assessment and discussion of racial trauma and the deconstruction of images of Black women.
Another form of cultural adaptation involves how an intervention is delivered. In our program, we use sister circles, an indigenous form of healing. Within the circles, we adapt CBT for a Black female populations. As example, rather than use cognitive restructuring to replace erroneous thoughts, we teach musical cognitive restructuring. Research has found both the method and content to be feasible and effective.
Mental Health and African Americans
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Poverty level affects mental health status. African Americans living below the poverty level, as compared to those over twice the poverty level, are 3 times more likely to report psychological distress.
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African Americans are 10% more likely to report having serious psychological distress than Non-Hispanic whites.
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The death rate from suicide for African American men was more than four times greater than for African American women, in 2014.
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However, the suicide rate for African Americans is 70% lower than that of the non-Hispanic white population.
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A report from the U.S. Surgeon General found that from 1980 - 1995, the suicide rate among African Americans ages 10 to 14 increased 233%, as compared to 120% of non-Hispanic whites.
1 U.S. Surgeon General, 2001. http://www.ncbi.nlm.nih.gov/books/NBK44251
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Tanya St. John / February 28, 2017
Mental illness does not discriminate. One in four Americans will experience a behavioral health disorder in any given year regardless of age, race, religion, gender or economic status. Anyone can develop a mental health disorder. However, there are factors that can increase the vulnerability to and severity of mental health disorders in the African American population and decrease their likelihood of seeking and receiving adequate treatment, including:
1. RACISM
Mental Health America points out that, “Despite progress made over the years, racism continues to have an impact on the mental health of Black/African Americans. Negative stereotypes and attitudes of rejection have decreased, but continue to occur with measurable, adverse consequences. Historical and contemporary instances of negative treatment have led to a mistrust of authorities, many of whom are not seen as having the best interests of Black/African Americans in mind.”
Evidence of the historic context that contributes to mistrust within the African American community can be seen in the pseudoscience of “diseases” such as Drapetomia and Dysaethesia Aethiopica, created to maintain the status quo of slavery in the South.
During slavery, an overt display of mental illness often resulted in more frequent beatings and abuse, which forced slaves to disguise or hide their mental health issues (Hastings, Jones, & Martin, 2015). The outcomes of these events have been long-lasting, perpetuating myths about mental illness. Sixty-three percent of African Americans believe that depression is a personal weakness. Family and community members often insist on prayer as a singular solution over seeking professional treatment:
“Why are you depressed? If our people could make it through slavery, we can make it through anything.” “When a black woman suffers from a mental disorder, the opinion is that she is weak. And weakness in black women is intolerable.” “You should take your troubles to Jesus, not some stranger/ psychiatrist.”
(Depression and African Americans, Mental Health America)
In more recent history, the CDC details the Tuskeegee Syphilis Experiment which did not inform its subjects, 600 black men, of the study’s true purpose, and did not provide proper treatment, among other failures. Further support for this barrier of mistrust is explained in Protest Psychosis: How Schizophrenia Became a Black Man’s Disease, (Beacon Press 2010), by author and Vanderbilt University Professor of Sociology and Psychiatry, Jonathan Metzl. Metzl researched Michigan’s Iona State Hospital records and uncovered a disproportionate diagnosis of schizophrenia in African American men during the 1960’s and 70’s, speculating that the much of the misplaced hysteria was attributable to involvement of African American males involvement in the civil rights movements of the time.
2. RELIGIOUS BELIEFS
Some African Americans even see mental illness as a punishment from God. Up to 85 percent of African Americans describe themselves as “fairly religious” or “religious” and they commonly use prayer as a way to handle stress, according to one study cited by the American Psychiatric Association. Spiritual beliefs, family, and community are a great source of emotional support, but can be a barrier to receiving needed professional medical or therapeutic treatment. Faith communities can become a source of distress if they are not educated about mental illness and ways to support individuals and families in their struggle for recovery.
3. POVERTY
While mental illness is not by any means restricted to individuals of lower economic status, the stressors that can accompany poverty – hunger, homelessness, lack of other basic needs or an inability to find jobs or afford treatment – can be contributing factors. U.S. Census Bureau data shows the 2014 poverty rate for African Americans was 26.2 percent. According to the McSilver Institute for Poverty Policy and Research, “it is well documented that mental illness is exacerbated by poverty. However, more recently, it has been recognized that poverty may contribute to the onset of mental illness.” In a continuing downward spiral, mental illness can increase health care costs, effect overall health, and lead to further impoverishment. African Americans make up 40 percent of today’s homeless population.
4. VIOLENCE
African Americans of all ages are more likely to witness or be victims of serious violent crimes. Exposure to violence increases the risk of developing a mental health condition such as post-traumatic stress disorder, depression, and anxiety. African American children are more likely than other children to be exposed to violence, which can have a profound, long-term effect on their mental health.
5. LACK OF PROVIDER CULTURAL COMPETENCY
A lack of cultural competency in the mental health care system can also pose barriers to seeking professional help. Only 3.7 percent of American Psychiatric Association members and 1.5 percent of American Psychological Association members are African American. According to Psychology Today, “studies have shown that African Americans view the typical psychologist as an ‘older, white male, who would be insensitive to the social and economic realities of their lives.'”
Without proper treatment, mental health conditions can worsen and make day-to-day life harder. Silence and stoicism – denying oneself help in order to appear strong – need to be overcome. True strength lies in recognizing the need for help and seeking it out. To make progress in this arena, there needs to be:
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An end to the stigma by increasing awareness of mental health needs in the African American community
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An increase in the number of African American mental health professionals and greater cultural competency in those currently in the field
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Increased education in the faith communities about the role of professional mental health treatments and how they can work together
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A greater focus on prevention, intervention, and maintenance