Health With a Capital H
African Americans and Mental Illness: "It's not just the blues"
May 3, 2011
By Heather Edmonds, Senior Exhibit Outreach Specialist
Mental illness in the African American community is often times misunderstood, ignored, or stigmatized. The rates of mental illness in the African American community are similar to those of the general population. However, according to the National Institute of Mental Health, the African American community is underserved by the nation’s mental Health system. One out of three African Americans who need care for a mental illness receives it. Often times, mental illness in the African American community can be seen as “just the blues” and cause individuals not to seek professional treatment.
The Numbers Don't Lie
In 2008, 6.0 percent of African Americans age 18 to 25 had a serious mental illness in the past year. Overall, only 58.7 percent of Americans with serious mental illness received care within the past 12 months, and the percentage of African Americans receiving services is only 44.8 percent. Some populations within the African American community are more susceptible to mental illness and are more likely not to have access to specialty care. These individuals are more at risk for mental illness due to overrepresentation in homeless populations, individuals who are incarcerated, children in foster care and child welfare systems, and victims of serious violent crimes. These social determinants of Health—where we live, learn, work, and grow—have a significant impact on a person’s Health and Health disparities. According to a report from the Commission to Build a Healthier America, supported by the Robert Wood Johnson Foundation, education and income have a vast impact on one’s Health. A national survey found that 67 percent of registered voters believed a higher educational level can have a positive influence on a person’s Health, and 68 percent believed lower income can have a negative influence on a person’s Health. Poor education and low income are linked to low-income jobs, living in unsafe neighborhoods with low-quality housing, and limited access to quality Health services, which in turn can lead to homelessness, incarceration, and becoming a victim of a violent crime.
Many factors contribute to African Americans not pursuing treatment for a mental illness, including distrust in Health system and cultural competence, lack of insurance, access to care, and communities of faith.
- Distrust in Health system and lack of culturally competent services. There has been a history of mistrust among African Americans toward the Health system. A cross-sectional survey of parents who accompanied children to a primary care clinic found that 67 percent of African Americans distrusted the medical establishment, compared with 50 percent of white parents. Cultural bias against mental Health professionals in general prevents many African Americans from accessing care due to prior experiences with historical misdiagnoses, inadequate treatment, and a lack of understanding. For consumers of color, access to mental Health services and the quality of the services they receive are negatively affected by the lack of culturally competent services. Only 2 percent of psychiatrists, 2 percent of psychologists, and 4 percent of social workers in the United States are African American; there needs to be a focus on culturally competent services to better serve minority populations. Additional funding to African American psychologists and other mental Health providers will help provide these services and possibly increase the number of African Americans in treatment. When mental Health professionals are able to work effectively and sensitively with people of various cultures, more positive outcomes are likely with treatment.
- Lack of insurance. The uninsured are less likely to receive recommended preventive and primary care services, face significant barriers to care, and ultimately face worse Health outcomes. Forty percent of African Americans reported being uninsured for some portion of 2007–2008, compared to one in four whites. Income was not a factor in the report of being uninsured; nearly a quarter of African Americans making more than $84,000 a year lacked coverage at some point, compared to 16 percent of whites in the same income bracket. Due to the lack of insurance, African Americans are more likely to use emergency care services. However, these Health professionals do not have the expertise to diagnose and treat mental and behavioral Health problems. For those with insurance, coverage for mental Health services and substance use disorders is still substantially lower than coverage for other medical illnesses, such as hypertension and diabetes.
- Access to care. As stated earlier, income was not a factor in the reporting of being uninsured; however, socioeconomic status is linked to accessibility to quality care and mental Health. The Listening Project, a dialogue between the National Alliance on Mental Illness (NAMI) and African American psychiatrists, found that, in most Black communities, there are few accessible mental Health service providers and even fewer services that are run by and delivered by African-Americans. This is especially prevalent in impoverished communities, whether in urban or rural areas. For rural communities in the south, evidence indicates that mental Health professionals are less likely to be found in rural counties than in urban areas. A significant number of African Americans use Medicaid, a major public Health insurance program subsidizing treatment for the poor. Medicaid covers nearly 21 percent of African Americans. However, if mental Health professionals in urban or rural areas do not accept Medicaid, this adds to the frustration of accessing quality care.
- Communities of faith. African Americans tend to rely on family and religious and social networks for emotional support rather then seek out professional care. As an African American woman, I’ve seen firsthand how friends and family who have gone through bouts of depression look to the church or faith community for help instead of seeking professional help. Churches are an important social community for many African Americans. A sense of connection and safety surrounds the church, and people tend to trust the church more than a Health care system. Individuals in the church look to prayer for healing, but more church leaders are saying that prayer alone is not sufficient and that mental Health services are needed. This provides an opportunity for the medical community and faith-based organizations to collaborate to provide services to the African American community.
Organizations at the Forefront of Change
Raising awareness to these issues will give the African American community options to make the best decisions to seek treatment and receive effective mental Health services. Mental Health information geared at African Americans goes viral in an effort to bring awareness. The Substance Abuse and Mental Health Services Administration (SAMHSA), working in collaboration with the Ad Council and the Stay Strong Foundation, launched a national campaign to raise awareness of mental Health problems among young adults in the African American community. The campaign aims to encourage, educate, and inspire young adults to step up and talk openly about mental Health. The new PSAs found at www.storiesthatheal.samhsa.gov were unveiled at a Black History Month event at Howard University to coincide with the first annual HBCU National Mental Health Awareness Day.
SAMHSA isn’t the only organization working to address this disparity.
- The National Partnership for Action was established to address Health disparities by mobilizing a nationwide, comprehensive, and community-driven and -sustained approach to combat this issue and improve Health equity among racial and ethnic minority populations.
- NAMI also developed a great resource, the African American Outreach Resource Manual, for individuals within the African American community who want to learn about mental illness and helpful resources. More information can be found at the NAMI Multicultural Action Center.
- The Black Mental Health Alliance has been serving the African American community for 25 years. This organization links individuals to resources such as psychiatrists, clinical psychologists, pastoral counselors, marital and family therapists, and clinical social workers.
- The goal of the Association of Black Psychologists is to have a positive impact upon the mental Health of the national African American community by means of planning, programs, services, training, and advocacy. This organization can help individuals find a psychologist in their local area.
- There are also programs that are collaborating with the faith-based community to bring awareness to the African American community. The PEWS Program (Promoting Emotional Wellness and Spirituality) launched in spring 2005 by Laverne Williams, community outreach coordinator, Mental Health Association in New Jersey. The PEWS Program educates African American clergy, lay staff, and church communities to better recognize mental illness and to link parishioners to resources. It also assists church communities in starting PEWS Mental Health Ministries and works to address the stigma surrounding mental illness in the African American community and to promote emotional wellness.
African Americans and other minorities are significantly underserved when it comes to accessing mental Health services due to social determinants of Health and Health disparities. Raising awareness to these issues will give the African American community options to make the best decisions to seek treatment and receive effective mental Health services. Community leaders, policymakers, mental Health professionals, Health organizations, and public and private sector decision makers need to collaborate to reduce mental Health disparities not only by providing us with current research, but also by applying that research to improve access to care and provide culturally competent services that are tailored to the needs of African American other minority communities. Friends and family can help by getting involved in community organizations that are advocating for better quality mental Health services for underserved populations.
- Surgeon General’s Report: Mental Health, Cultural, Race, Ethnicity, 2001
- National Alliance for Mental Illness: http://www.nami.org
- American Association of Suicidology: http://www.suicidology.org/c/document_library/get_file?folderId=232&name=DLFE-241.pdf
- U.S. Department of Health and Human Services (HHS): http://minorityhealth.hhs.gov/templates/content.aspx?lvl=3&lvlID=9&ID=6474
- HHS Fact Sheet: Minority Health Disparities at a Glance, 2005
- American Psychiatric Association: http://healthyminds.org/More-Info-For/African-Americans.aspx
- National Institute of Mental Health: http://www.nimh.nih.gov/index.shtml
- American Psychiatric Association: http://www.psych.org/