This entry is focused on the mental health issues among Black males and the challenge of dealing with race and racism in mental health agencies. Because of the extensiveness of need, combined with stereotyping that is perhaps unique to this population, and notable gaps in culturally appropriate services, special consideration is given to Black males as an added special population of concern. Further, the mental health needs of Black males are a mirror reflection of those of the special populations discussed earlier.
The Scope of the Problem
Approximately 25% of American adults experience a mental health or substance use disorder in any given year. However, only a fraction of those affected will be properly diagnosed and receive care. For Black males and their families, the consequences of neglected mental health needs are devastating. Our prisons are bursting at the seams with mentally ill Black men. Failure to address mental health issues among Black men often leads to substance use or relapse, job loss, various social and family crises. Finding care that is affordable, respectful, and accessible is a major challenge for African Americans in general and for black males in particular.
Suicide rates are creeping up each year. For example, over the last twenty years, suicide rates among black males between ages 15 and 19 increased 114%. Suicide is currently the third leading cause of death among black males between fifteen and twenty-four years of age.
Despite the extensiveness of need, there are a dearth of agencies that are sensitive, familiar and capable of dealing with the needs of Black males suffering from mental illness and its accompanying problems. Nor do these agencies have sufficient therapist of color to effectively engage or retain Black males in therapy over extended periods. Further, mental health is still a taboo subject for Black men. They suffer in relative silence. Overall, there is very strong stigma and shame in the Black community associated with mental health problems generally. This stigma and shame is generated from culture, and for males exacerbated by cultural norms and expectations of masculinity, and the socio-political environment.
Black men are not exempt from perceived threats to their masculinity. Like other men in American society Black men have learned to place an emphasis on independence, competitiveness, emotional stoicism and self-control. In fact, there is hyper masculinity present in younger Black males to deal with societal emasculation. This hyper masculinity often mask’s problems in daily living. It’s called “fronting” among urban youth. These are but some of the factors contributing to low service utilization rates, racial, and gender disparities in mental health outcomes.
What’s Race Got to Do with It?
There is a fragile relationship between the Black community and the mental health services sector. On one hand there is mistrust, doubt, confusion, and on the other fear, misinterpretation, and racism. Research clearly shows that in medical and mental health, Black Americans have poorer access to care, quality of treatment, and outcomes than whites. For Black males, these inadequacies are even more pronounced.
The staffs in some mental health agencies are often wary of the black males, have limited insight into their lives, and lack the skill sets to deal with the volume and complexity of problems Black males face. The situation is fueled by prejudice, misunderstanding, misconceptions and sometimes overt racism. A major problem is that mental health agencies have limited Black clinicians and program managers.
Nationally the numbers of black male psychiatrists, psychologists, and social workers are dismal. New York State is no exception to this reality. Increasing the presence of Black males in clinical and managerial positions is a pressing need. Professional schools can contribute to this effort by developing outreach and marketing strategies that are appealing to the career interests of Black males, and also ensure that curriculum offerings are designed to support their retention and success in these programs once enrolled.
White led agencies have an important role to play in ensuring an appropriate representation of Black males in staffing patterns and to increasing the availability of culturally appropriate services. Unfortunately, however, too many of these agencies have not used their considerable platform and resources to raise awareness about how racism creates obstacles to both proper diagnosis and treatment for Black males with mental illness or to increase the number of males of color in key staff positions. Therefore, there must be a commitment amongst these agencies to on-going training that goes beyond cultural competence and include addressing the structural racism present in mental health agencies as in all other American institutions.
Dr. Alvin Poussaint, Harvard psychiatrist, says “one reason African-Americans may not seek out professional help is because only about 2.3% of all psychiatrists in the United States are African American.” Therefore, the perception is that the “therapist.” “Doctor” or “counselor” will not understand “me”. Even worst, some may think they don’t even care. In their thought provoking book, Lay My Burden Down: Suicide and the Mental Health Crisis Among African Americans, Dr. Poussaint and co-author Amy Alexander, hypothesize that high rates of the suicide and self-destructive behaviors among some African American males is a reflection of longstanding untreated mental health problems and inadequacy of existent mental health services.
There is a strong reluctance to discuss mental illness in the Black community and family systems. Black men are not open to sharing their struggles even with their intimate partners or, at times, even other men of color. Especially around symptoms that deal with emotional vulnerability. This unwillingness to disclose is magnified when it comes to white mental health professionals. These are but some of the multiplicity of issues that must be addressed for mental health providers and clinician to barriers and increase access to quality mental health services for Black males.
Policy Issues and Solutions
Recognizing that the issues associated with improving mental health outcomes for African American males are not only clinical but are also political. Black males therefore must move beyond being consumers and engage in political action with other strategic partners. Currently only a few agencies engage their clients in the policy making process in substantial ways. There is also a need to get community power brokers involved in creating a responsive and effective system of care for these men. We must always remember that policies and programs are developed as a result of advocacy and public pressures in this society. National Alliance on Mental Illness (NAMI) is an excellent case example of the power of organizing, advocacy, and public pressure.
Black men must make local, state and federal officials aware of their distinct mental health needs, and barriers to mental health services by testifying in and organizing public hearings. There must be a demand for services and service models that fit their specific needs. There must also be a strategic process to engage the media into reporting problems related to disparities in care.
The long-range goal is to promote policies that lead to social justice and brings about equity and positive treatment outcomes that address long standing failures in providing effective services for Black males. To do this, it is imperative for agencies and clinicians to understand that Black males are a diverse and complex group and design services accordingly. Agencies and clinicians must see beyond pathology and destruction and anchor services and programs in policies that acknowledge the significant strengths and resilience present in Black males.
Institutional and individual racism must be recognized and addressed. This writer is of the opinion that internalized racial inferiority and superiority must be understood and dealt with at all levels. In the absence of appropriate mental health services disparities and unnecessary suffering of Black males will continue to persist and worsen.