These feelings are justified because, historically, the mental health system hasn’t really given us a reason to trust them or consider therapy an option. Part of this mistrust comes from the fact that there are not many therapists of color available in the field. The American Psychological Association has only 1.5 percent African-American members. With microaggressions and subtle forms of racism so present today, it’s understandable that we might want to discuss very personal details of our lives and feelings with someone who understands our struggle.
In order to explore some of the reasons why more black people don’t practice therapy, and, by extension, why more black people aren’t receiving therapy. I had the privilege of speaking with licensed psychologists Dr. Sandra Levy and Dr. Robert Samuels about their insights into this topic, and with additional research, we found that exposure to the field, affordability and quality of therapeutic services contribute to holding our community back from receiving help. As you read, you’ll see how these factors seem to be out of our hands, making it all the more important for us to support each other.
Exposure to the Field
Recognizing you’re feeling unusually upset is the first step toward seeking help. Symptoms for diagnosis are not common knowledge amongst the general population though, and for African Americans who carry stigma against mental illness, there’s even less understanding. This combination makes it so that it can be difficult to even know when or where to look.
This also extends to choosing psychology as a field of work. Some of us might not have ever heard about psychology in our communities (or we have family who criticize it) so it’s not even an option. Regarding the two psychologists I spoke with, Dr. Sandra Levy, who is white, was supported in her career because she’d attended therapy for family issues as a child. Dr. Robert Samuels, a black therapist, was supported in a similar way, but there seemed to be less of an openness about family issues – he mentioned that he didn’t find out his mom attended therapy until he was in college and it came as a surprise. There also weren’t a lot of figures for him to look up to in this career. There weren’t any black public figures speaking openly about therapy and when he was attending Princeton, there was only one black psychologist on staff.
On a better note, African Americans might not be visible in psychology because we’re more present in social work, as seen at the very top and bottom of this chart from the Federal Bureau of Labor Statistics:Photo: Federal Bureau of Labor Statistics
In 2004, we made up only 4 percent of social workers. This field can be more appealing because it’s more community focused, which meshes well with the values of the black community, as well as being a more cost-effective program. While this increase is surely a positive, we still need black therapists who can give more personal attention and care to the individuals who are the backbone of the community.
Like most things, mental health services cost money. On the higher end of the spectrum, some people have the luxury of being able to pay co-pays out of pocket. Some rely on health insurance to help cover part or all of the cost, and the amount insurance covers for mental health is lower than for traditionally physical problems. Some don’t have health insurance at all, but can afford the other necessities of life. And still, some are living in poverty, even homeless. Forty percent of those homeless are African Americans, so it’s not surprising that our community isn’t able to access therapy because of the cost. Due to the stressors of living this way, these people are also three times more likely to suffer from mental distress. Those who need it most are getting help the least.
Community mental health centers can be a more affordable alternative in situations like these, but only if they’re accessible. In a huge metropolitan city like Chicago, we only had 12 mental health clinics for low-income people. As of 2012, that number was cut in half by our mayor. One of these clinics was most likely the closest resource for mental health help for someone in that neighborhood. Without it, they might have to sacrifice more time and money for public transit in order to get to the next closest one. But what probably happens more often is that they just stop going altogether because that extra bus fare could contribute to a meal or other more pressing necessity.
For those who can get the money together, the quality of care is sadly not the same. According to Dr. Levy, the practitioners at these places are put under a lot of pressure and can’t meet with clients as often as private practices – sometimes bi-weekly or even just when there's a crisis. “They don’t get the same therapy. It’s not the same thing … I could only conjecture that it leads to an unfortunate feedback loop to the community that this is bullshit,” she said. I imagine that it can feel like this person you’re talking to doesn’t really care, and that progress can seem slow when you’re only getting treatment every so often. Why keep going if nothing seems to be changing?
Lack of Cultural Competency
When African Americans manage to get through these initial barriers and have a therapeutic experience, further issues arise before true help can be received. Think about a black person going to see a white therapist. Even without meaning to, they might not be able to understand or delve into the relationship between race and mental health. Because they may not understand the values, beliefs and traditions exclusive to the black community, they can unintentionally say something to make the client uncomfortable.
Misdiagnosis is also a huge problem in the general population, and is especially detrimental for blacks because we can express symptoms in different ways than the white standard that diagnoses originate from. We might talk more about physical symptoms, a therapist who isn’t watching for this might not recognize that something like depression can manifest physically. Some studies have shown that black people metabolize medications slower than the rest of the population but are still given higher doses. Not having the right dose can cause negative side effects to be even worse, to the point where the patient doesn’t want to take them or continue therapy anymore. Instances like these can reinforce the stigma, making the person feel like they should have "kept it to themselves" or their community.
There are measures being taken to increase cultural competency, such as the American Psychological Association requiring programs to cover this issue for accreditation, but that's not enough. Learning a concept is easy, but practicing it is something else entirely. If the majority of your clients, colleagues and supervisors are white, you won’t get experience with people of color. And since this was the environment of white students of psychology in the 1980s, it means we have a whole older generation of psychologists who didn’t get to effectively practice this cultural competency. Once again, it’s up to millennials to be the informed and more open-minded generation.
A Hopeful Situation
That might seem like a lot of pressure for us as young people trying to achieve our own personal goals on top of uplifting our community. What can we do in the short term to change the macroeconomics of our country that contribute to how expensive therapy is? How can we make interactions between white therapists and black people less uncomfortable at a personal level? It doesn’t really seem like it’s up to us. But Dr. Levy and Dr. Samuels are excellent examples of therapists who truly try to understand clients. The former, as a white therapist, takes note when she sees someone of a different race, from a different country or economic background and makes sure to ask questions about that to see if it’s relevant to her client. She acknowledged, for example, the difference in growing up black in America vs. Ghana. “You can’t be afraid of addressing, ‘you’re black, I’m white,'" she said. I think if more therapists did this it could put their POC clients at ease, at least for a little while. Dr. Samuels takes proactive measures as well, making it a point to make himself seen on campus at the University of Rhode Island so that black students know he is available. His POC colleagues do this as well. While not representative of all therapists, it’s still encouraging to know that there are some who are open-minded and aware.
A cool thing about psychology is that the base of it is listening. A person doesn’t have to be a licensed psychologist to listen to and support their friends or loved ones who express mental distress. It can be lonely experiencing internal problems, so sometimes having someone listen is surprising and enough for the time being. It’s also crucial to not stigmatize the person when you’re listening — watch your facial expressions and don’t say things that blame them for their problems or make them feel like they’re overreacting. If they can’t be open with someone who cares about them without being judged, they’re probably not going to jump at the chance of a stranger doing the same. React in the way you’d want someone to if you were trusting them with your vulnerability.
To learn more about mental health, the therapists shared a few sites that have a wealth of information accessible to anyone.
- http://nami.org/ — the National Alliance of Mental Illness, which has a link for diverse communities
- http://www.abpsi.org/ — the Association of Black Psychologists, which pushes the idea of the uniqueness of psychological development in black people
- http://diorvargas.com/poc-mental-illness/ — If you’re reading this and need support, see for yourself that you're not alone
Keep your ears open and look out for our next installment, in which we discuss things that need to happen to break the stigma of mental health in the black community.