Racial Disparities Lead to Poor Mental Health Care for Black Americans

stressed Black business woman

 Getty Images

Key Takeaways

  • Many Black Americans do not seek mental health services due to cultural stigma surrounding mental illness. 
  • Wealth and income inequality often control who has access to quality mental health services and the best treatment options.
  • When Black Americans do seek services, they are less likely to receive adequate mental health treatment if they are uninsured, underinsured, or under the care of racially biased clinicians. 

The police killings of Breonna Taylor and George Floyd amplified the national dialogue on anti-Blackness and racial discrimination, but it's important to address the significant impact that systemic racism has had on the mental health of Black Americans.

Black Americans disproportionately face risk factors linked to mental illness, including poverty, homelessness, and violence, as well as significant challenges in their attempts to obtain adequate mental health care. According to the National Institute on Minority Health and Health Disparities (NIMHD), Black Americans experience serious mental health issues 20% more often than white Americans.

The NIMHD also reports that less than 50% of all Americans with a mental health disorder are actually able to get the treatment they need, and that the percentage of Black Americans who are able to obtain treatment is only half of that of whites.

As researchers continue to study the effects of systemic racism on Black mental health, there is a growing opportunity to acknowledge how racial injustice and inequality against Black people in America has caused intergenerational trauma.

Cultural Stigma Is a Treatment Deterrent

In 2018, 50% of Black and African Americans with a serious mental illness did not receive mental health treatment. The cultural stigma surrounding mental illness is partially responsible, according to a 2013 study published in Nursing Research.

“In our community, there is a longstanding belief that [seeking] therapy automatically means you are ‘crazy’,” says Vladimire Calixte, LMHC, the founder of Therapy for Black Men. “Those living with mental illness remain silent due to an overwhelming fear of being judged."

In 2013, a cross-sectional survey of African Americans aged 25 to 72 found that both men and women were not open to discussing their psychological issues and were concerned about the stigma surrounding mental illness.

The perception that mental illness is taboo leaves many Black Americans unable to view mental health care as necessary to their overall well-being. Calixte believes that more education on mental health within the Black community is imperative, although the pandemic is starting to help shift previous attitudes surrounding stigma.

Vladimire Calixte, LMHC

COVID-19 has given the Black community permission to seek therapy as the world tries to process this pandemic. There's a decrease in the stigma and an increase in Black clients reaching out. We are collectively grieving the loss of our loved ones, our jobs, our way of life, and dealing with feelings of uncertainty and isolation.

— Vladimire Calixte, LMHC

High Costs and Insurance Restrictions Limit Access

Roughly 23% of Black Americans live below the poverty level, compared to 10% of white Americans. Economic disparities for Black people due to systemic racism leave many without insurance and unable to afford treatment, explained Calixte.

The U.S. Census reported that nearly 11% of Black Americans were uninsured, compared with 6% of white Americans. In 2013, a 10-year analysis published in Health Affairs found that Americans without health insurance seeking specialized care for mental illness faced barriers such as an increase in cost for treatment.

Having health insurance does not ensure access to adequate care, because treatment options are restricted by coverage limitations. In 2017, 44% of Black Americans were enrolled in Medicaid or public health insurance, compared with 34% of white Americans.

“Someone with Medicaid coverage may not have access to well-trained and experienced clinicians,” said Justin F. Miles, LCPCS, the founder of the Miles Institute of Integral Living

What's more, data released by the Centers for Medicare & Medicaid Services (CMS) found that Black Medicare patients are nearly four times more likely to be hospitalized from coronavirus than White Americans, showing that BIPOC are being disproportionately affected by COVID-19.

Those that are Black and impoverished have less access to different treatment methods and providers that use a variety of theoretical approaches to serve a diverse client base, Miles says.

Daily Survival Takes Priority Over Treatment

Racial inequities in employment, education, and housing have led to environmental conditions that put a strain on the health of many Black Americans. If you are Black and impoverished, you are much more focused on your daily survival needs than your mental health, Miles explains.

Miles says that most of his clients with Medicaid were forced into treatment by the legal system and sought mental health services to fulfill certain legal requirements. Black Americans with mental health conditions are more likely to wind up in jail rather than be referred to community-based treatment programs.

"Redlining was not an accident, flooding Black communities with drugs was not an accident, the prison industrial complex was not an accident, and there is not enough money and resources being allocated to improve living conditions.," says Miles.

Justin F. Miles, LCPCS

Their environment is a clear result of this country’s history of racism and the intentional underfunding of Black communities and Black institutions. How can a limited amount of treatment offset a lifetime of living in a war zone?

— Justin F. Miles, LCPCS

A 2020 study published in Hypertension found that Black Americans who had stress due to lifelong discrimination were at a higher risk for developing hypertension.

“For Black people, racial trauma didn’t start with the murder of George Floyd,” says Calixte. “Because of institutionalized racism, we are born into a life of trauma. From [racial] microaggressions to police brutality, we are constantly bombarded.” 

Biased Practices and Culturally Incompetent Clinicians Harm Black Clients 

In 2015, about 86% of psychologists in the United States were white, and by 2018, only 7% of psychiatrists were Black. The lack of diversity in the mental health field presents a challenge for clients who prefer a provider they feel is culturally competent. It also presents a problem for those hoping to avoid the pitfalls of psychiatry’s alleged racist history, racially-biased treatment, and potential malpractice due to negligence. 

Black Americans are reportedly less likely than whites to receive treatment for depression, and those with depression and other mood disorders are more likely to be misdiagnosed with schizophrenia. Black Americans are also less likely to be offered treatment for their mental health issues.

Research has also found that Black teens are less likely to be asked about eating disorder symptoms than white teens, even though they are 50% more likely to show bulimia behaviors.

Racial bias is also apparent during medication therapy. Though the rate of opioid overdose is nearly twice as high for whites, Black patients are more likely to receive drug testing for illicit use and have their prescriptions discontinued. Black children are also more likely to be diagnosed as psychotic than white children, but less likely to be receive treatment for their illness.

Misdiagnosis due to a clinician’s racial bias can lead to improper treatment, including wrongly prescribed medications that cause dangerous side effects and worsening mental health conditions.

Impoverished Black people may be especially vulnerable to malpractice, Miles explains, because many community mental health centers hire who they can afford and not clinicians with better training and experience. Signs of mental illness in Black Americans are often interpreted by whites as aggressive or criminal behavior, which means that clashes with the law can be an introduction to mental health services.

“Court programs are grant-funded, so the focus is on keeping the money coming in—not referring people for quality mental health treatment,” Miles says. "The services at inner-city residential treatment centers are far less superior than programs offered at centers outside city limits."

What This Means for You

Calixte, Miles, and other experts believe more education around mental health is needed in the Black community, but the only way to create real change is to form policies addressing the harm that has already been done. This will require all Americans to take an honest look at white supremacy and implicit bias, and consider how systemic racism contributes to the racial inequities in health care.

Mental health will not improve for Black Americans until more resources are provided to improve living conditions within their communities. Greater diversity within the mental health field will grant Black clients access to culturally competent providers, and incentivize the completion of treatment.

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.

23 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. American Psychological Association. African Americans have limited access to mental and behavioral health care.

  2. U.S. Department of Health and Human Services Office of Minority Health. Mental health snapshot of African American men

  3. U.S. Department of Health and Human Services Office of Minority Health. Mental and behavioral health - African Americans

  4. Mental Health America. Black and African American communities and mental health.

  5. Ward EC, Wiltshire JC, Detry MA, Brown RL. African American men and women's attitude toward mental illness, perceptions of stigma, and preferred coping behaviors. Nurs Res. 2013;62 (3):185-194. doi:10.1097/NNR.0b013e31827bf533

  6. U.S. Department of Health and Human Services Office of Minority Health. Profile: Black/African Americans.

  7. Berchick ER, Hood E, Barnett JC. United States Census Bureau. Health insurance coverage in the United States: 2017.

  8. Rowan K, Mcalpine DD, Blewett LA. Access and cost barriers to mental health care, by insurance status, 1999-2010. Health Aff (Millwood). 2013;32(10):1723-30. doi:10.1377/hlthaff.2013.0133

  9. Centers for Medicare & Medicaid Services. Preliminary Medicare COVID-19 Data Snapshot.

  10. Cullors P, Johnson MA. Impact of disproportionate incarceration of and violence against black people with mental health conditions in the world’s largest jail system. 2014.

  11. Forde AT, Sims M, Muntner P, et al. Discrimination and hypertension risk among African Americans in the Jackson Heart Study. Hypertension. 2020;76(3):715-723. doi:10.1161/HYPERTENSIONAHA.119.14492

  12. Lin L, Stamm K, Christidis P. American Psychological Association. How diverse is the psychology workforce?. 2018;49(2).

  13. Green CR, Gaston-Hawkins LA, Biljani R. Racism, policing, and COVID-19: How do we justify racial disparities in 2020?.  Psychiatric Times. 

  14. Raz M. Psychiatry under the shadow of white supremacy. Nature. 2020;580:449-450. doi:10.1038/d41586-020-01126-w

  15. Dalencour M, Wong EC, Tang L, et al. The role of faith-based organizations in the depression care of African Americans and Hispanics in Los Angeles. Psychiatr Serv. 2017;68(4):368-374. doi:10.1176/

  16. Gara MA, Minsky S, Silverstein SM, Miskimen T, Strakowski SM. A naturalistic study of racial disparities in diagnoses at an outpatient behavioral health clinic. Psychiatr Serv. 2019;70(2):130-134. doi:10.1176/

  17. National Eating Disorders Association. People of Color and Eating Disorders.

  18. Swift SL, Glymour MM, Elfassy T, et al. Racial discrimination in medical care settings and opioid pain reliever misuse in a U.S. cohort: 1992 to 2015PLoS One. 2019. doi:10.1371/journal.pone.0226490

  19. Gaither JR, Gordon K, Crystal S, et al. Racial disparities in discontinuation of long-term opioid therapy following illicit drug use among black and white patients. Drug Alcohol Depend. 2018;192:371-376. doi:10.1016/j.drugalcdep.2018.05.033

  20. Schwartz RC, Blankenship DM. Racial disparities in psychotic disorder diagnosis: A review of empirical literature. World J Psychiatry. 2014;4(4):133-40. doi:10.5498/wjp.v4.i4.133

  21. Alegria M, Vallas M, Pumariega AJ. Racial and ethnic disparities in pediatric mental health. Child Adolesc Psychiatr Clin N Am. 2010;19(4):759-74. doi:10.1016/j.chc.2010.07.001

  22. Liang J, Matheson BE, Douglas JM. Mental health diagnostic considerations in Racial/ethnic minority youth. J Child Fam Stud. 2016;25(6):1926-1940. doi:10.1007/s10826-015-0351-z

  23. Smith KM. How bigotry created a black mental health crisis. The Washington Post.

By Shanon Lee
Shanon Lee is a health journalist whose work has been published in Forbes, the Washington Post, Women's Health, and more.