Episode 118: Recognizing Mental Illness

Overall, mental health conditions occur in Black and African American (B/AA) people in America at about the same or less frequency than in White Americans. However, the historical Black and African American experience in America has and continues to be characterized by trauma and violence more often than for their White counterparts and impacts emotional and mental health of both youth and adults. (See prevalence statistics below).

Historical dehumanization, oppression, and violence against Black and African American people has evolved into present day racism – structural, institutional, and individual – and cultivates a uniquely mistrustful and less affluent community experience, characterized by a myriad of disparities including inadequate access to and delivery of care in the health system. Processing and dealing with layers of individual trauma on top of new mass traumas from COVID-19 (uncertainty, isolation, grief from financial or human losses), police brutality and its fetishization in news media, and divisive political rhetoric adds compounding layers of complexity for individuals to responsibly manage.

Help-seeking behavior is affected by mistrust of the medical system and often begins with faith-based outreach. However, MHA screening data shows that Black and African American people who screen positive for depression self-identify as planning to seek help at higher rates than the general population says they will seek help. Unfortunately, Black and African American providers, who are known to give more appropriate and effective care to Black and African American help-seekers, make up a very small portion of the behavioral health provider workforce (see treatment statistics below). Because of these factors and more, Black and African American people are more likely to experience chronic and persistent, rather than episodic, mental health conditions. Yet, hope for recovery should remain, as light is shed on these issues – and the general public holds accountable policymakers and health systems to evolve better systems which eliminate inequities in mental health services.

Demographics/Societal Issues

While Black Americans experience a wide range of attitudes toward mental health treatment, there’s a stigma surrounding mental illness that prevents some people from getting help.

It’s important to consider how the stigma—and the forces that create the stigma—may make it difficult for individuals to reach out to a mental health professional.  

Beliefs About Mental Illness

Some communities accept the idea that mental illnesses are health problems that require treatment. But in other communities, there’s a serious stigma that implies a mental health problem is a sign of weakness and should be kept hidden from others.

Beliefs about mental illness are formed through experience, cultural traditions, and formal education. Stories from friends and family also play a role.

If family members talk about a “crazy” uncle who had to get hospitalized, younger generations may grow to believe that having a mental illness means you can’t function in society.

Similarly, if someone who commits a crime is said to have a mental illness, it may perpetuate the belief that individuals with mental illness are violent. Anyone that commits a crime or displays some type of undesired “bad” behavior would be stigmatized as having a mental illness or along that spectrum, which isn’t necessarily true.

  • Identity: This addresses the symptoms of a mental illness. Does someone believe symptoms of depression are a normal part of life? Do they think symptoms surrounding anxiety are a sign of a physical health issue?
  • Cause: Do symptoms stem from a spiritual weakness, personal weakness, or character defect? Or, can anyone develop a mental illness the same way they might develop a physical health issue?  
  • Timeline: This refers to beliefs about whether an illness is acute, cyclic, or chronic. So someone might assume depression should resolve within a certain time period or they may believe anxiety lasts a lifetime in all cases.
  • Consequences: Do individuals think that untreated mental illness has consequences? Or do they think that mental illness serves a helpful purpose (like depression sparks creativity)?
  • Controllability: How much does an individual trust that an illness can be treated? Do they think it can be cured or do they believe that treatment won’t help?

There are many cultural factors, societal pressures, and stereotypes that may influence beliefs about mental health in the Black community.

Additionally, issues like systemic racism and the lack of culturally sensitive treatment by providers may also play a role in the way the Black community views mental illness and treatment. It is not normalized in the way that it should be. People often view it as a personal and/or moral defect. As a result, the mental health field is viewed along the same lines as the other systems that have caused substantial harm to Black people.

Ideas about mental illness that may reinforce the stigma include beliefs about:

Mental Health Treatment Disparities

Community Stigma

Only 1 in 3 Black Americans who could benefit from mental health treatment receive it. This may be in part due to the disparities in mental health treatment.3

Black individuals often lack access to culturally competent care. As a result, the treatment they receive is often poorer.

Black individuals are less frequently included in research, which means their experiences with symptoms or treatments are less likely to be taken into consideration.

They’re also more likely to go to the emergency room or talk to their primary care physician when they’re experiencing mental health issues, rather than seeing a mental health professional.4

Black individuals are also more likely to be misdiagnosed by treatment providers. This can fuel the distrust toward mental health professionals as a misdiagnosis can lead to poor treatment outcomes.5

Contributing to the disparities is the fact that Blacks are more likely to have involuntary treatment, whether it is forced inpatient or outpatient treatment. This contributes to the stigma, hostility, and lack of willingness to voluntarily seek care.6

Much of the research has found that the Black community has a high degree of stigma associated with mental illness. In the 1990s, a public opinion poll found that 63% of African Americans believed depression was a personal weakness and only 31% believed it was a health problem.7

Other studies have found that the Black community is more inclined to say that mental illness is associated with shame and embarrassment. Individuals and families in the Black community are also more likely to hide the illness.8

Individuals in the Black community may be more likely to believe that since they’ve survived so much adversity, they’re strong—and no one has a right to tell them that there is something wrong with them (since they may view a mental health issue as weakness).

Studies that specifically examine the beliefs of Black women are scarce. But, one study found that Black women were more likely to believe that individuals develop depression due to having a “weak mind, poor health, a troubled spirit, and lack of self-love.”1

But not all studies indicate a high degree of stigma among Black women. One study, conducted in 2009,1 found that most Black women didn’t have a stigma attached to mental illness. Researchers found that women understood the causes of mental illness, accurately identified many of the symptoms, were aware of the potential consequences, and believed that mental illness could be managed with treatment and personal motivation.

Factors That Affect Mental Health

The Health and Human Services Office of Minority Health reports that Black adults in the U.S. are more likely than white adults to report symptoms of emotional distress, such as sadness, hopelessness, and feelings that everything is an effort.2

Individuals in the Black community likely experience distressing events that affect their mental health. Racism, discrimination, and inequity affect a person’s psychological well-being. The stress may increase a person’s risk of mental illness. Some experiences may even be traumatizing.

Financial problems tend to increase the chances of an individual will experience serious psychological distress. Black adults who live below the poverty line are two times more likely to report serious psychological distress than those living above it.

It is also important to remember that these social determinants of health are all layered, with racism adding in another substantial layer.

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