We are living through challenging times.
Political, cultural and racial divides as well as a global pandemic have left many Americans feeling psychologically distressed. In the early days of the pandemic, depression among adults in the U.S. tripled, jumping from 8.5% before the pandemic to 27.8%, according to an October 2021 survey in the Lancet Regional Health Americas. By 2021, rates of depression had climbed to 32.8%, affecting one in every three American adults. Though Black Americans tend to experience mental health challenges at a similar rate as their white counterparts, Black people are 20% more likely to experience serious mental health problems such as major depressive disorder or generalized anxiety disorder, according to a report from Resources to Recover, a nonprofit which promotes positive outcomes for people living with mental illness. In recent years, the Black community has begun to open up to professional counseling and is more aware that counseling exists, but experts say there is still a long way to go. “African Americans experience the same or higher rates of mental health issues in terms of depression, anxiety or PTSD when we compare them to white Americans,” says Portia Allie-Turco, Ph.D., a professor and clinical mental health program coordinator at State University of New York-Plattsburgh. But, “care that is safe or accessible for our communities and that honors and respects our culture … is lacking.” “How do we counsel Black people using only Eurocentric models?” she said. “We have to use models that fit who we are and how we live as people.”Being Black in America is a singular experience. yet there are shared cultural factors that can play a role in shaping mental health. Some of those factors serve as sources of support such as family attachments, values, spirituality and music or reliance on community and religious networks. Other shared cultural factors can negatively impact the mental health of Black Americans such as racism, inequality, discrimination, trauma, poverty and barriers to mental health care. ‘Pain and brokenness’ “Whenever you talk about our mental health, you have to look at it through a trauma-informed lens,” Allie-Turco says. Gentrification, homelessness, job loss, shootings, police brutality, voter disenfranchisement and daily microaggressions can have very real impacts on the mental health of Black Americans. “It wakes up trauma and it should be talked about in the vein of mental health, but it is not unless it is heightened,” notes Joan Been, a mental health advocate whose Charlotte, North Carolina-based Living Waters, a nonprofit, coordinates an annual summit in the city at which mental health professionals share ideas and collaborate on practices that will bring healing to Black communities. This year, the focus of the summit, held Sept. 23, was bridging the health-equity gap to help children and families heal from grief and loss.
“If we keep issues of pain and brokenness in our hearts, it stops us from getting healthy,” Been says. “Not healing affects our jobs, education and more.”Health providers can’t adequately address the needs of Black people without talking about community trauma. Even the very idea that Black people are resistant to therapy has roots in historical trauma, says Allie-Turco. “Why don’t we believe in mental health? It is not stigma. It is that we have mistrust that has been generationally validated. We don’t want to talk to a therapist because we don’t trust them, but we don’t trust them for a good reason.” More than any other race, Black American clients prefer Black therapists, she says. They want someone who looks like them and who already understands the experience of being Black. “Research shows when we go into therapy sometimes in cross-racial matches, we feel like we still have to code switch in therapy,” Allie-Turco says. The lack of Black psychiatrists, psychologists and licensed professional counselors in the U.S. has been well documented. Bringing more Black practitioners into the profession is one way to achieve more culturally competent care, but counselors of all races must be able to meet the needs of Black clients, says Been. On-the-ground resources Another emerging avenue for developing cultural competence in mental health care is by involving the faith-based community, community organizations, sister circles and barbershops, where counseling is happening informally. Been says these are the kinds of organizations that are doing on-the-ground work in addressing the mental health needs of their communities and often have the most insight into what is needed. Black Americans are more likely than their white counterparts to rely on religious institutions to help with mental health issues. One study found that 90.4% of Black people indicate prayer is very important when coping with stress.
“The idea is how do we take something we have always done and make it our own in this health care system?” Allie-Turco asks. In many ways, that has been the goal of Living Waters for the past six years: to bring together different mental health representatives during its summit. “When we have our summits, we invite all groups and ethnicities,” says Been. Convening as a safe space for all to discuss Black mental health has resulted in others outside of the POC community feeling more comfortable to step up. The efforts ultimately resulted in state-level funding to bring more Black mental health practitioners into the field, Been notes. Taking steps toward culturally responsive care is imperative for treating Black clients in an ever-changing social environment, but doing so requires acceptance of basic truths about the lived experience of Black people. “Any work with people of African descent has to recognize our strength as a people … and validating that our hesitation makes sense,” says Allie-Turco. Once that response has been validated, mental health professionals must then affirm the cultural factors that have sustained generations of Black people. “We have figured out how to form community wherever we go. We are hopeful people with internalized trauma such as colorism. We like to share stories in a relational way… these things have major implications for counseling,” Allie-Turco says.
First published in Black Mental Health Today, Fall 2022 (Vol. 5).
