Published by National Alliance on Mental Illness (NAMI)
What happens at the intersection of mental health and one’s experience as a member of the Black community? While the experience of being Black in America varies tremendously, there are shared cultural factors that play a role in helping define mental health and supporting well-being, resiliency and healing.
Part of this shared cultural experience — family connections, values, expression through spirituality or music, reliance on community and religious networks — are enriching and can be great sources of strength and support.
However, another part of this shared experience is facing racism, discrimination and inequity that can significantly affect a person’s mental health. Being treated or perceived as “less than” because of the color of your skin can be stressful and even traumatizing. Additionally, members of the Black community face structural challenges accessing the care and treatment they need.
According to the Health and Human Services Office of Minority Health, Black adults in the U.S. are more likely than white adults to report persistent symptoms of emotional distress, such as sadness, hopelessness and feeling like everything is an effort. Black adults living below the poverty line are more than twice as likely to report serious psychological distress than those with more financial security.
Despite the needs, only one in three Black adults who need mental health care receive it. According to the American Psychiatric Association’s Mental Health Facts for African Americans guide, they are also:
Less likely to receive guideline-consistent care
Less frequently included in research
More likely to use emergency rooms or primary care (rather than mental health specialists)
Barriers to Mental Health Care
Socioeconomic factors can make treatment options less available. In 2018, 11.5% of Black adults in the U.S. had no form of health insurance.The Black community, like other communities of color, are more likely to experience socioeconomic disparities such as exclusion from health, educational, social and economic resources. These disparities may contribute to worse mental health outcomes.
Negative attitudes and beliefs towards people who live with mental health conditions is pervasive within the U.S. and can be particularly strong within the Black community. One study showed that 63% of Black people believe that a mental health condition is a sign of personal weakness. As a result, people may experience shame about having a mental illness and worry that they may be discriminated against due to their condition.
For many in the Black community, it can be incredibly challenging to discuss the topic of mental health due to this concern about how they may be perceived by others. This fear could prevent people from seeking mental health care when they really need it.
Additionally, many people choose to seek support from their faith community rather than seeking a medical diagnosis. In many Black communities in the U.S., the church, mosque or other faith institution can play a central role as a meeting place and source of strength. Faith and spirituality can help in the recovery process and be an important part of a treatment plan. For example, spiritual leaders and faith communities can provide support and reduce isolation. However, they should not be the only option for people whose daily functioning is impaired by mental health symptoms.
Provider Bias and Inequality of Care
Black people have historically been negatively affected by prejudice and discrimination in the health care system in the US. And, unfortunately, many Black people still have these negative experiences when they attempt to seek treatment. Provider bias, both conscious and unconscious, and a lack of cultural competency can result in misdiagnosis and inadequate treatment. This ultimately can lead to mistrust of mental health professionals and create a barrier for many to engage in treatment.
Black people may also be more likely to identify and describe physical symptoms related to mental health problems. For example, they may describe bodily aches and pains when talking about depression. A health care provider who is not culturally competent might not recognize these as symptoms of a mental health condition. Additionally, Black men are more likely to receive a misdiagnosis of schizophrenia when expressing symptoms related to mood disorders or PTSD.
How to Seek Culturally Competent Care
When a person is experiencing challenges with their mental health, it is essential for them to receive quality care as soon as the symptoms are recognized. It is equally important that the care they receive is provided by culturally competent health care professionals.
While we recommend seeking help from a mental health professional, a primary care professional is also a great place to start. A primary care professional might be able to provide an initial mental health assessment and referral to a mental health professional if needed. Community and faith organizations may also have a list of available mental health providers in your area.
When meeting with a provider, it can be helpful to ask questions to get a sense of their level of cultural awareness. Providers expect and welcome questions from their patients or clients, since this helps them better understand what is important in their treatment. Here are some sample questions:
Have you treated other Black people or received training in cultural competence for Black mental health? If not, how do you plan to provide me with culturally sensitive, patient-centered care?
How do you see our cultural backgrounds influencing our communication and my treatment?
Do you use a different approach in your treatment when working with patients from different cultural backgrounds?
What is your current understanding of differences in health outcomes for Black patients?
Whether you seek help from a primary care professional or a mental health professional, you should finish your sessions with the health care professional feeling heard and respected. You may want to ask yourself:
Did my provider communicate effectively with me?
Is my provider willing to integrate my beliefs, practices, identity and cultural background into my treatment plan?
Did I feel like I was treated with respect and dignity?
Do I feel like my provider understands and relates well with me?
The relationship and communication between a person and their mental health provider is a key aspect of treatment. It’s very important for a person to feel that their identity is understood by their provider in order to receive the best possible support and care.
If finances are preventing you from finding help, contact a local health or mental health clinic or your local government to see what services you qualify for. You can find contact information online at findtreatment.samhsa.gov or by calling the National Treatment Referral Helpline at 800-662-HELP (4357).
NAMI’s Sharing Hope Program
Sharing Hope is a one-hour program to increase mental health awareness in Black communities by sharing the presenters’ journeys to recovery and exploring signs and symptoms of mental health conditions. The program also highlights to navigate the mental health system.
"Sharing Hope: An African American Guide to Mental Health" provides mental health information in a sensitive manner through personal stories. Recovery is possible, and this booklet tells you where to find more information, seek help and be supportive. You can buy hard copies through the NAMI Bookstore.