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People of Color and Mental Health Care: The Double Bind

Mental health issues in people of color are often misunderstood.

Key points

  • Racism can result in a host of mental health problems
  • This racism is often invisible to White people and even some therapists
  • Communities of color have greater fears and stigma surrounding mental health, but competent anti-racist help is available.
N. Gardner/Create HerStock
Source: N. Gardner/Create HerStock

Mental health disparities are an issue often overlooked and misunderstood. Just as we see in other areas of medicine, people of color suffer mental health consequences to a greater degree than White Americans. Not only are people of color limited in their access to effective mental health care, but they are also subject to discrimination and social disadvantage that can be invisible to White individuals, making existing problems worse.

Racism Contributes to Mental Health Problems

American racial ideology and its interaction with psychological processes help us understand the mental health division between groups. Racial ideology is an unwritten system of ideas and beliefs that apply to racialized groups and dictate how people of color are perceived or treated by society. We operate by these rules without consciously thinking about or considering them. The prevalence of covert racism in the form of microaggressions, combined with the toll of everyday racism, can cause anxiety, psychological distress, depression, and even suicidal thoughts in people of color.

Racial biases cause some to express skepticism toward people of color in need of psychological help. For example, it is a common opinion that people of color are “overly sensitive” in regard to racialized issues, leading to dismissal and invalidation when they seek support for the emotional suffering that results from racism, such as workplace discrimination or racial profiling by law enforcement. Sometimes, when the toll of racism is too much to bear, people of color break down emotionally – they may express anger, abuse substances, or engage in reckless behavior. They may be perceived as criminals rather than an individual in need of mental health care. Compassion often takes a back seat when judging individuals of color; society does not use the same yardstick for every person.

Stigma Within Communities of Color

Concerns about the treatment process are also a critical factor in determining whether racialized groups will benefit from treatment. If White people cannot perceive the disparate treatment that people of color receive in their day-to-day lives, how can they have or develop any sympathy for it? As such, people of color may wonder if a therapist will understand them. As children, people of all races are able to see racial disparity; later in life, White people must be specially trained to see that which society has blinded them to. The National Alliance on Mental Illness determined that “misdiagnoses, inadequate treatment and lack of cultural competence by health professionals cause distrust and prevent many African Americans from seeking or staying in treatment.” For example, there is a common fear among African Americans that White clinicians will not be receptive toward their problems and will not understand their lived experience (Williams, 2019). Although this is true of many therapists, it is not difficult to find African American therapists and counselors. In addition, the accreditation bodies are increasingly requiring more culturally-informed training for therapists of all races to improve access and competence. Therefore, it is not always the case that outside resources will be unequipped to handle the unique cultural problems and experiences that people of color face.

There are other barriers to mental health care for people of color, including fear of stigma within communities of color. One psychologist reported that many of her African American clients avoided psychotherapy due to fear of judgment. A client said, “Getting this type of help has, and continues to be, like a sore thumb in the African American community.” In many communities of color, visiting a counselor implies that the family has failed to resolve problems internally, and disclosures may add fuel to existing negative stereotypes.

Barriers to Care

Some critics assert that people of color are not disadvantaged in mental health. After all, a deeper look reveals that although Native Americans suffer the highest suicide rates, White Americans experience the second-highest, and Hispanic and Black Americans are among the lowest. Further, Hispanic and Black Americans report less mental illness throughout their lifetime in comparison to White people. However, these results are easily misinterpreted without cultural context. If certain racialized groups carry stigma surrounding mental illness, they are less likely to report occurrences of mental illness among themselves or others in their community. And by the time racialized people do report mental illness, it is typically more severe and persistent in comparison to the mental illness of White people. It also seems that White Americans get well faster due to better mental health support and treatment. In fact, a 2016 study found that psychotherapists were significantly more likely to accept White-sounding clients than Black-sounding clients for an appointment during a phone-based experiment (Kugelmass, 2016).

All factors considered, the lack of access to quality mental health care for racialized groups is clear, and their mental health needs are largely unmet. Culturally-sensitive approaches within mental health systems are essential to decreasing the stigma associated with psychotherapy, but larger societal changes are required to diminish the racism that fuels many of these inequalities.

References

Williams, M. T. (2019). Misconceptions about therapy linger in some communities. In N. Nittle (Ed)., America's Mental Health Crisis: Current Controversies (pp. 64-69). Greenhaven Publishing. ISBN-13: 978-1534506145.

Blume, A. W., et al. (2012). The relationship of microaggressions with alcohol use and anxiety among ethnic minority college students in a historically White institution. Cultural Diversity and Ethnic Minority Psychology, 18(1), 45.

Chow, J. C, Kim Jaffee, K., & Snowden, L. (2003). Racial/ethnic disparities in the use of mental health services in poverty areas. American Journal of Public Health 93(5), 792-797.

Curton, S. C, & Hedegaard, H. (2019, June). Suicide Rates for Females and Males by Race and Ethnicity: United States, 1999 and 2017. National Center for Health Statistics, Division of Vital Statistics, Division of Analysis and Epidemiology. www.cdc.gov/nchs/data/hestat/suicide/rates_1999_2017.pdf.

Huynh, V. W. (2012). Ethnic microaggressions and the depressive and somatic symptoms of Latino and Asian American adolescents. Journal of Youth and Adolescence, 41(7), 831-846. doi: 10.1007/s10964-012-9756-9

Kugelmass, H. (2016). “Sorry, I’m Not Accepting New Patients”: An Audit Study of Access to Mental Health Care. Journal of Health and Social Behavior, 57(2), 168–183. doi: 10.1177/0022146516647098

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