Much of the stigma around mental health stems from crisis situations. We fear people who seem out of control, especially when we don’t know how to support them. For Black, Indigenous, and People of Color (BIPOC), social disparities can compound that fear.
Rakel Beall-Wilkins, MD, MPH
During my career, I’ve worked in addiction medicine, served people with psychiatric problems caused by HIV/AIDS, and served in a psychiatric emergency department (ED). I’ve seen plenty of people become aggressive or combative during mental health crises. But I still remember one day in the ED when a mother came to me crying.
She was so thankful that I, another Black woman, was caring for her son during his acute episode. She explained that her family was terrified by her son’s behavior – but they were even more afraid to call 911 or the police. They feared he would be criminalized because of his aggression. Or worse, killed.
Research supports the family’s apprehension. One study, for example, indicates that unarmed Black men showing signs of mental illness are at higher risk of being killed by police than unarmed White men with similar signs (Thomas et al., 2021). However, community advocacy can go a long way toward removing stigmas and easing the fears that too often lead to crisis escalation rather than treatment.
Here in Houston, for instance, community advocates recently pushed to create a crisis intervention team. Now, when someone suffers an acute mental health crisis, social workers and other people specifically trained to deal with such situations can respond. Through similar programs, we can better address the mental health needs of BIPOC communities.
By the Numbers
Mental health affects us all. More than 20% of adults and 16% of children in the U.S. have a mental health disorder, but less than half receive treatment (MHA, 2023).
According to the National Alliance on Mental Illness (NAMI), almost half of White Americans with mental illnesses receive therapy or counseling. Only 33% of the Hispanic and Latinx community, 31% of the Black community, and 25% of the Asian American and Pacific Islander communities receive needed therapy. Research (Perzichilli, 2020) also indicates that BIPOC are:
- Less likely to have access to mental health services
- Less likely to seek treatment
- More likely to receive low-quality care
- More likely to stop treatment early
To support mental wellness, especially in BIPOC communities, we must recognize and overcome barriers to care, including social stigmas and disparities, financial challenges, and accessibility.
Overcome Social Stigmas and Disparities
Unique stressors like racism and discrimination increase mental health vulnerability for BIPOC individuals. Within some Black communities, for example, a longstanding emphasis on physical, mental, and spiritual strength stems from generations of slavery and struggle. Therefore, having depression, anxiety, or other mental health concerns is sometimes viewed as weakness.
Our cultural beliefs and attitudes also influence how we express anxiety, sadness, and other emotions. Some people learn to focus on “physical” problems, such as pain or trouble sleeping, rather than underlying mental distress. Moreover, implicit bias may affect how expressions of need are perceived and treated.
During my residency, I presented about how BIPOC individuals with severe depression were more likely to be misdiagnosed with schizophrenia. Interestingly, the studies I showed indicated that implicit bias exists not just in White providers but in BIPOC providers, too. Research on this topic continues to show similar findings (Londono Tobon et al., 2021).
Thus, opportunities to reduce social disparities and stigmas can be found in both the civic and provider communities.
Community Opportunities
Communities have done a good job promoting the 988 Suicide & Crisis Lifeline. Why not apply a similar strategy to any acute mental health crisis? Community leaders should be encouraged to:
- develop crisis intervention teams, and
- create public education campaigns about the best resources to help those in a mental health crisis.
Mental health advocates should educate BIPOC communities about non-acute mental health conditions. Conducting outreach in places where people traditionally relax and feel comfortable might help normalize the conversation. Social media could also be used to promote accurate mental health information.
However, it’s essential that we also engage social media companies to include “trigger warnings” – as well as links to mental health resources – on potentially traumatizing content. We know that repeated exposure to brutality through social media, such as the recent videos of Tyre Nichols, can negatively impact mental health.
Healthcare Provider Opportunities
Another way to lower barriers to care is to reduce bias and stigma within provider communities. To start, all providers should be offered implicit bias training to strengthen mental health diagnosis and treatment in BIPOC communities.
In addition, we should encourage more holistic training in medical school; stop separating the brain from the body. As psychiatrists, we’re taught how medical problems throughout the body can ultimately impact the brain and behavior. That kind of holistic thinking should be an element of all patient care.
The U.S. Preventive Services Task Force is in the process of recommending that primary care providers (PCPs) screen adults for anxiety and depression, which could help bridge the divide between “physical” and “mental” care. As PCPs make mental health a routine part of care, their increasing comfort with mental health conversations should trickle down to their patients.
Overcome Financial Challenges
Economic well-being has historically been a struggle for BIPOC communities for many reasons, including institutionalized racism. Almost all BIPOC communities suffer from a generational wealth deficit.
Although there aren’t many ways to rectify this fact alone, people can recognize the unique financial disparities that exist within BIPOC communities and acknowledge there is progress to be made. Then, with greater awareness, they can support laws and policies that ease financial barriers to care. This could take the form of promoting increased funding for community mental health centers, for instance, or expanded insurance coverage for low-income individuals.
Increase Access to Care
Even when people overcome social and financial barriers to care, the nationwide shortage of mental health professionals makes it difficult to receive treatment. It’s even harder for BIPOC individuals who prefer to see providers who share their culture. Only about 2% of psychiatrists and 4% of therapists identify as Black, for example (O’Malley, 2021).
Still, there are resources designed to increase access to care, such as:
- Therapy for Black Girls, a website that helps Black girls and women find BIPOC therapists by location, virtual offering, clinical specialty, etc.
- Rapper Megan Thee Stallion’s website, which links to numerous mental health resources, including the StrongHearts Native Helpline, The Steve Fund, and the LGBTQ Psychotherapist of Color directory.
- The Psychology Today website, with listings for BIPOC and non-BIPOC mental health professionals – including psychiatrists, LCSWs, etc. It also helps people find online therapy and video counseling.
Empower Yourself, Empower BIPOC Communities
Mental health is no different than physical health; it impacts all people across cultures and communities. Consequently, everyone can play a role in reducing stigmas and overcoming barriers to mental wellness in BIPOC communities. It starts with educating yourself. Then, you can advocate for others.
If you notice someone struggling, take the time to talk with them without distractions. Tell them about your concern and ask how you can help. Be aware that their lived experience might differ from yours, but start the conversation. You don’t have to be a mental health expert, just someone willing and able to point them in the right direction.
Above all, everyone should know that help is available. Nobody should have to struggle, fearful and alone, like the mother I talked with in the ED. Professionals work hard every day to create safe spaces where everyone can take care of their mental health.
Dr. Rakel Beall-Wilkins, MD, MPH, serves as a Medical Director at Magellan Healthcare. You can contact her at beallwilkinsr@magellanhealth.com. Additional resources from Dr. Beall-Wilkins can be found at https://www.magellanhealthinsights.com/author/rbeall-wilkins/.
References
Thomas MD, Jewell NP, Allen AM. Black and unarmed: statistical interaction between age, perceived mental illness, and geographic region among males fatally shot by police using case-only design. Annals of Epidemiology, Volume 53, 2021, Pages 42-49.e3. https://doi.org/10.1016/j.annepidem.2020.08.014
Mental Health America. The State Of Mental Health In America. https://mhanational.org/issues/state-mental-health-america#:~:text=16.39%25%20of%20youth%20(age%2012,totaling%20over%2028%20million%20individuals.
National Alliance on Mental Illness. Mental Health Care Matters. https://www.nami.org/NAMI/media/NAMI-Media/Infographics/NAMI-Mental-Health-Care-Matters-FINAL.pdf
Perzichilli T. The historical roots of racial disparities in the mental health system. Counseling Today. 07 May 2020. https://ct.counseling.org/2020/05/the-historical-roots-of-racial-disparities-in-the-mental-health-system/
Londono Tobon, Amalia, et al. “Racial Implicit Associations in Psychiatric Diagnosis, Treatment, and Compliance Expectations.” Academic Psychiatry : the Journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry, U.S. National Library of Medicine, Feb. 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7933096/
O’Malley L. Addressing the Lack of Black Mental Health Professionals. Insight Into Diversity. 17 November 2021. https://www.insightintodiversity.com/addressing-the-lack-of-black-mental-health-professionals/#:~:text=Data%20from%20the%20American%20Psychiatric,percent%20of%20psychologists%20are%20Black
https://therapyforblackgirls.com/
