Racial Disparities Lead to Poor Mental Health Care for Black Americans

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."

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.

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.

“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.

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.

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."

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