Bridging the gap to address Black mental health disparities
Camille Dixson
Master’s Student, Health Behavior and Health Education
Being a Black woman living in America with a history of my own mental health concerns, talking about mental health is already a big hurdle. This challenge has not only burdened me — I’ve heard an echo of similar sentiments across the Black community. The 2021 National Survey on Drug Use and Health (NSDUH) found that of the 21% of Black and African Americans who had a mental health concern, only 39% of these individuals received mental health services. This is shocking when we compare this against the percentage of non-Hispanic whites (52%). The suicide rates of people of color continue to rise with Black Americans facing a 58% increase in suicide rates between 2011 and 2021 with suicide being the third leading cause of death for Black or African Americans between the ages 15 to 24 in 2020.
This begs the question as to why this problem is so pervasive. Why did mental health become such a big issue within our community? And why does it seem like nothing is working?
Let’s scale it back and look through the problem from a historical lens. Black Americans have faced a great depth of mental health concerns from historical events such as the institution of slavery to more recent events, including high-profile incidents of police violence against Black individuals, including the murder of George Floyd in 2020, which sparked the Black Lives Matter protests. Research has shown that stress from seeing acts of police brutality through social media, intergenerational trauma, and attacks both physical and verbal may be attributed to the high rate of post-traumatic stress disorder (8.7%) within some areas of the Black community.
Research tells us that everyday life stressors can be a significant driver of mental health concerns in Black populations. Bearing the weight of racial trauma in addition to having to complete everyday tasks like going to work, feeding your family, or taking care of your health can take a toll on mental health.
Structural and systemic barriers have made addressing mental health concerns difficult for Black Americans. Obtaining health insurance has been dictated by various laws such as the National Labor Relations Acts of 1935, which provided health insurance and other benefits for individuals represented by unions. Because many Black and other racial and ethnic minority groups often work in service, agricultural, and domestic industries, employer-sponsored health insurance is frequently not offered; neither are other union rights that open the door for increased wages and benefits.
Additionally, the Supreme Court ruling of the National Federation of Independent Business v. Sebelius case decided that Medicaid expansion is up to each state. Opposition to Medicaid expansion, particularly in the many Southern states that oppose its implementations, has been pinpointed to reasons of potential gains racial and ethnic minorities or immigrants could benefit from once it is passed.
Furthermore, many Black Americans hold mistrust in the medical and healthcare system. History has given many of us plenty of reasons to be apprehensive. From the psychological distrust from the Tuskegee syphilis experiment resulting in a disastrous study of 600 Black men without their informed consent to the generally high rates of being misdiagnosed when seeking mental health care, there is a long history of the healthcare system doing harm to the Black body and mind.
Many attempts at solving the mental health disparities impacting Black people have been made, but it's vital to specifically examine the position of Black therapists in the problem. Currently, only 4% of psychologists in the United States are Black. This deficiency within the workforce may be attributed to barriers including affording college and weighing the financial decision of a psychology degree over other more lucrative careers in respect to potential student loan burden, job hiring discrimination, and bias with standardized testing required for becoming a licensed therapist or counselor such as the Examination for Professional Practice in Psychology (EPP). Dismantling these barriers may open the door to decreasing Black mental health challenges by offering more therapists who look like their patients and may hold similar experiences.
Currently, the mental health system and public health have taken on a black-and-white approach to addressing the disparities Black individuals in the United States face in mental health care. This way of attempting to fix the issue through surface-level techniques such as diversifying workforces or nearly four decades of banal cultural competency training is not making a big enough shift for a problem that is so urgently present in this population. A lack of consideration for the historical lens that created these systemic inequalities which have often come from oppressive roots such as intergenerational trauma and medical exploitation is failing to fix deeply ingrained challenges that cause the issue to persist. In the case of the present opposition to Medicaid expansion, it appears efforts to combat decision-making that may seemingly come from racial and ethnic discrimination should be created to ensure that policies like Medicaid expansion can assist minorities in obtaining and increasing health insurance coverage. This is what health equity strives for and if there are ways to better health equity and states are not engaging in those opportunities, then something needs to be done to address what appears to be a bigger issue than just expanding Medicaid. In an effort to bridge the gap of mental health disparities within the Black community, solutions such as improving healthcare access, replacing standardized testing with equitable alternatives, addressing racial trauma, and supporting future Black psychologists dedicated to Black mental health disparities are vital. To enact changes that will discourage the continuation of these disparities and attempt to repair the historical wrongdoings that impact the mental health of Black people today, we must take on holistic and interdisciplinary tactics that acknowledge the paths that led us here and look to explore how we can dismantle systems that previously have and continue to support disadvantages in vulnerable populations like that of mental health within the Black community.
About the Author
Camille Dixson is a second year Master of Public Health student in Health Behavior
and Health Education at the University of Michigan School of Public Health. She holds
an undergraduate degree in Sociology with a Public Health minor from Central Michigan
University. She is passionate about urban health, maternal health, healthy cities,
and Black health disparities.