By Kyana Harris •
The only thing harder than making the difficult decision to seek therapy is following through, and then feeling worse than you did before.
Minority mental health advocate, T-Kea Blackman had that experience when she first took the steps toward healing by way of professional help. Her therapist was a caucasian male. “I remember walking out feeling worse than I did when I came in. It felt like he invalidated my experiences as a black woman. I’ve realized I just don’t feel comfortable sharing with people who don’t look like me.”
Like many African Americans, Blackman is reluctant to seek help for therapy because of a racial disparity among mental health professionals in the country. Many others find it hard to relate to mental health professionals who don’t share their background, adding another layer to an already complex situation.
According to the National Alliance on Mental Illness (NAMI), only 25 percent of African-Americans seek professional help for behavioral health issues.
The answer as to why blacks in the U.S. aren’t seeking professional help is a not a simple one.
Historically, the healthcare system, like most American systems, has not always protected or supported its black patients. The Center for Behavioral Health Statistics and Quality reported that only one in three African-Americans who need mental health care receive it.
According to the American Psychological Association, the racial/ethnic composition of active psychologists in the workforce was 84 percent white in 2016. This number isn’t reflective of the diverse U.S. population, where minorities make up about 42 percent, according to U.S. Census Bureau data.
While there are black professionals in the industry, most black behavioral health practitioners don’t have degrees on the doctoral level. Behavioral health practitioners with doctoral degrees are also able to own their own practice. So while there may be counselors and therapists of color, most do not have the privilege of ownership and authority in the spaces they work, such as being clinical psychologists.
Lack of representation may lead to cultural incompetence, which impacts effective care and the overall wellness of blacks in the U.S. The 2003 President’s New Freedom Commission on Mental Health suggested funding to train more African American psychologists in order to decrease stigma and incite others to seek behavioral healthcare.
Marline Francois, a licensed clinical social worker and owner of Hearts Empowerment Counseling Center in Montclair, New Jersey explained how the amount of schooling and time required to become a clinical psychologist is costly for the average African-American.
“You have to have a Ph.D. and a lot of schools only accept 8-20 students. Only 2 or 3 percent of all African-Americans get their Ph.D in any discipline. When you consider that percentage, it makes sense that so few have them in the psychology field.”
In addition to the doctoral programs being competitive, students also face race-related challenges once accepted.
“A friend of mine was pursuing her doctoral degree in biochem engineering and her own advisor didn’t support her. They tried to keep her from graduating on time and wouldn’t allow her to do the research she wanted, with a focus in the African-American community,” Francois said.
In addition to the lack of clinical psychologists of color in the industry, there is also the challenge of communities of color not being able to access care because of a dearth of knowledge.
The 2014 National Conference of State Legislatures reported, “Although the goal of many state-funded programs (e.g., mental health, substance abuse, outpatient, community rehabilitation) is to improve the quality of care for all individuals and counteract the presence of negatively publicized views of mental health, attempts to provide care to minorities are substandard.”
Also on the patient’s side, there is also a lack of trust and t a stigma against behavioral health professionals. Distrust shows up as self-concealment, a term that is defined by purposely withholding information about one’s self. Considering the intimate nature of behavioral health, this makes it that much more difficult for a patient to get the necessary help their mental illness warrants. Stigma is characterized as feeling of shame or disgrace associated with a particular situation or circumstance. Stigma could prevent black patients from even considering behavioral health services altogether.
According to The National Association of Mental Illness (NAMI) “African Americans typically do not participate in treatment for reasons that may include but are not limited to mistrust, stigma, misdiagnosis, little understanding about mental illness, and feeling culturally misunderstood.”
This cultural understanding is essential to closing the gap between mental health practitioners and African-Americans.
“It is important for counselors to consider the underlying historical, social, and cultural variables that shape a client's beliefs regarding illness etiology, diagnosis, and intervention,” said 21-year-old University of New Haven student, Khaaliq Crowder.
Crowder began seeing a therapist as an adolescent when he was diagnosed with a developmental disability- ADHD. At 12, he felt forced into therapy and rebelled in the form of remaining silent or not being very vocal during his sessions.
“When I went to college and I had my own independence, I felt like I hit a wall again and realized I need to get help no matter what people think.”As he continued seeking help at the university level, it became clear that there were cultural barriers. He described his experience as being uncomfortable.“I had one therapist who couldn’t understand my black culture references when describing people in my life. One time he mentioned Obama which was not relevant. Also as a black queer person, our plight is much different than a white queer person. I had pledged a D9 organization a year ago. He didn’t understand the trauma and the dynamics of black Greek life or even black college student life, which was ironic because he’s a college therapist.”
SUNY - Fredonia college student Monica Manney expressed similar sentiments. “Working with a non-POC counselor is hard because of the differences culturally. I felt like I had to explain what I was talking about before I could explain how I felt about it because of that.”
Considering the amount of race-related policing African-Americans have faced for several decades, it is likely to infer that the mental wellness of the population is not being considered. The US Dept. of Justice reported, “Black people with mental health conditions, particularly schizophrenia, bipolar disorders, and other psychoses are more likely to be incarcerated than people of other races.”
Studies have shown that people of color who experience feelings of being overlooked in daily activities have even more difficulty seeking help for more serious issues, such as mental health. These feelings of being overlooked and silenced negatively impact their mental health. “Comparative studies between African Americans and Whites suggest that although African Americans may demonstrate somewhat lower prevalence rates of depression and anxiety disorders over the life course, African Americans suffering from depression or anxiety disorders tend to experience greater mental illness severity and chronicity, and report greater functional impairment in comparison to their White counterparts (Himle, Baser et al)”
This rang true for Howard University senior film major, Azira Azizuddin-McCloud. She has given up on seeking help after several bad experiences with mental health practitioners.
Though she is a full-time student, she is expected to help financially support her family back home in Michigan. Her rocky relationships with both parents also put a strain on her development into adulthood. At one point, she resorted to drinking alcohol to cope. Once she realized how things were spiraling out of control, she sought professional help.
Her first attempt was through the HU Counseling Center. She was placed with a latino man whom she never got to meet.
“We set up a time for our sessions but when I went to the center, I was in the lobby waiting for two hours. He later texted me and said that he told admin to let me know he had an emergency with another client. When I asked to be switched to someone else, they never reassigned me to another counselor,” she recalled.
The second attempt was at an off-campus practice ran by blacks. Much to her surprise, she was placed with an asian woman. “It was still a woman of color, so I figured I’d give her a chance. Had it been a white woman, I probably wouldn’t have moved forward with it,” said Azizuddin-McCloud. Unfortunately, the woman could not relate to her. “She was overwhelmed by my problems. She told me I was bringing too many issues, and I needed to choose one because she wouldn’t be able to solve all my problems.”
Considering the fact that Azira is a high-achieving student awarded prestigious scholarships that fully cover her tuition, it was hard for the woman to understand her internal struggles. Despite this, she was paying out of pocket to get some semblance of support from a professional.
While on summer break, Azira used an app called Better Help. The telehealth resource pairs users with licensed professional counselors for a monthly rate ranging from $40 to $70. This alternative to traditional face-to-face therapy aims to make professional help more accessible. The film major was finally paired with a black woman but she too was ineffective.
“It was all I could get ahold of because I was in LA for the summer. I didn’t have access to the free services available because I didn’t have a car there. We would conduct sessions through phone calls. Better Help has financial aid too, so it was helpful in that sense.”
But when she tried to continue her sessions after the summer break, the asian therapist was hard to get ahold of on a consistent basis.
“I made so many attempts to get the help that I needed and no one was willing to help. I was spending all my money on these services that weren’t doing anything for me. And paying for transportation to get there. In that last attempt, I was skipping class in order to fit into her schedule. My mental health took a turn because I felt like she abandoned me,” she shared.
The relationship between behavioral health services and African-Americans will continue to be strained if professionals aren’t actively working to bridge the two groups together.
Negative help seeking attitudes may also be compounded by ill knowledge of the behavioral health resources available. NAMI suggested,“increasing the quality of training for service professionals is just one component toward overall multicultural competence and effective delivery of services to populations less familiar with mental health care.” State and nationally funded programs should identify ways of tailoring their approach to increase the black community’s likelihood of considering seeking help.