The pandemic, economic anxiety, and reignited fights on racist structures have created a “mental health tsunami” in the Black community.
By Doha Madani
As a child, Reginald Howard struggled with destructive visions, moments where he imagined destroying the shelves at the corner store or pushing another child down, but when he tried to identify what was happening, his mother attributed it to his “Howard blood.”
“At that point, I probably should have been in therapy but because there’s such a stigma behind therapy in the Black community, and around the world but I’ll start within my community, I really didn’t get the help that I needed,” Howard said.
His father also struggled with mental illness, a situation that led Howard’s grandmother to refer to him and his sister as “demon children.”
Howard’s mental health went unaddressed as a child and he continued to struggle with mental illness into adulthood, which led to a crisis point in 2011.
Out of work at 20 years old, he learned his now-fiancé was pregnant. The anxiety of impending fatherhood triggered a depression in Howard, whose own father was in and out of his life.
“That really started making me spiral out of control, which led me to text few close family members and friends to say, ‘Take care of my son, I don’t want to be here anymore,’” Howard said.
Friends and family were able intervene during two separate suicide attempts by Howard, but he didn’t get into therapy for the first time until 2018, he said. His crisis points led Howard to do research and seek help, which allowed him to finally manage his own mental health problems.
It was his own journey to healing that inspired Howard to become more vocal about the benefits of therapy, inspiring him to become a mental health advocate and to create the “Black Mental Health Podcast” to let others know they’re not alone.
“I think the Black community has a language and the mental health community has a language,” Howard said. “And my purpose is to combine those languages together. I think this is two different languages but they speak the same truth.”
The mental health of Black Americans is under strain as 2020 unravels, bringing to light racial disparities across the country. Notable Black celebrities, such as Michelle Obama and Gabrielle Union, opened up in recent weeks about how racial strife in America has affected their own wellbeing.
Union, who has been vocal on social issues and her own experiences, said in an interview with Women’s Health that she was suffering from post-traumatic stress.
“The combination of a pandemic and this racial reckoning, alongside being inundated with (images of) the brutalization of Black bodies, has sent my PTSD into overdrive,” she said. “There’s just terror in my body.”
A global pandemic and a series of Black American deaths at the hands of police have placed the spotlight once again on the ways racism can pervade institutions unnoticed. The deaths of George Floyd and Breonna Taylor have become recent rallying points for protests against racist structures over this past year.
And it’s not just police departments.
Black communities have been disproportionately affected by the coronavirus, according to an April study from the Centers for Disease Control and Prevention. The pre-existing conditions that put most people at higher risk of dying from the virus, such as high blood pressure or diabetes, are more prevalent in communities of color, in part due to health disparities stemming from racial and socio-economic status.
A Washington Post poll conducted in June found that one in three Black Americans personally knew someone who died from Covid-19, the disease caused by the coronavirus.
As these disparities were being revealed and discussed, America was also reconciling what the American Psychological Association has dubbed a “racism pandemic.”
These compounding issues — ones that come with uncertainty and old traumas — have psychologists looking at a “mental health tsunami” in the Black community, the APA’s chief of psychology in the public interest and acting chief of diversity Brian Smedley told NBC News.
“The combination of physical distancing, economic anxiety, and for people of color, the very real stress from the racism pandemic means that we will have a lot of unmet mental health needs unless we can dramatically shore up the mental health infrastructure and address workforce shortages,” Smedley said.
These shortages are especially dire for communities of color, which a fragmented mental health system already has trouble reaching. A number of factors have contributed to the limited access to basic mental health care for people of color, including language barriers, stigma and underfunded public health programs, Smedley said.
But the disparity in mental health care can be particularly dangerous for Black communities, where generations of racial trauma have contributed to more general physical disorders, experts say.
“We know that racism is associated with a host of psychological consequences, including depression, anxiety and other sometimes debilitating conditions,” Smedley said. “Post-traumatic stress disorder and the stress caused by racism can contribute to the development of cardiovascular disease and other physical diseases.”
Racial trauma on the body
Racial trauma encompasses the physical and emotional reactions to the racism that causes stress, which could overwhelm a person, according to Ashley McGirt, a licensed therapist who specializes in racial trauma. Triggers range from the visceral to the tedious — anything from viewing a video of police brutality to an act of everyday racism often described as a microaggression.
“So racial trauma is watching George Floyd have a knee to his neck for eight minutes and forty-six seconds. Racial trauma is watching Ahmaud Aubrey be gunned down while jogging. That’s what racial trauma is,” McGirt said.
The experience of racial trauma, which can recur throughout a Black person’s lifetime, can cause a number of mental health issues such as anxiety, depression, hypervigilance and fear that have the potential to impact physical health.
An estimated 67 percent of Black adults cite discrimination as a significant source of stress in their lives, according to the APA’s Stress in America survey released in July. And 78 percent of Black adults surveyed agreed that being Black is difficult in today’s society.
Studies have shown over the years that stress is a significant factor in overall physical health. Unchecked stress can contribute to disorders such as high blood pressure, heart disease, obesity and diabetes, according to the Mayo Clinic.
Even going to the doctor can be a source of stress for Black adults, who fear discrimination in the medical system through misdiagnosis and a dismissal of their symptoms. Black women in particular, who have high maternal mortality rates in the U.S., have contended with racial bias from health practitioners.
As someone who saw her own family members suffer physically from their mental health disorders, McGirt wants to help other Black families heal and extend their own lives. Change also has to occur, however, in acknowledging how the racist history of the mental health field has contributed to stigma and lack of access to care for Black people, McGirt said.
“As mental health clinicians ourselves, we have to be doing our own work,” McGirt said. “As a Black therapist, I definitely have to work ten times harder because I’m having to find creative and unique ways to treat my clients because this system was not designed for us.”
The industry’s problem with race
The mental health field is currently struggling to bolster its availability of therapists, counselors, and psychiatrists of color to address the overwhelming need of culturally competent professionals. About 4 percent of psychologists are Black, 6 percent are Hispanic and 4 percent are Asian, according to 2018 data from the APA’s Center for Workforce Studies.
While therapy and mental health support is stigmatized in many communities, Black communities also contend with fear of misdiagnosis and institutionalization due to the field’s racist past, Dr. Jonathan Metzl, director of medicine, health and society at Vanderbilt University, said.
“I think the mistrust of the mental health community is well founded,” Metzl said. “And certainly it’s because there is a lot of history of the mental health framework being used to oppress black people.”
“The Protest Psychosis: How Schizophrenia Became a Black Disease,” written by Metzl in 2011, outlined how Black men were disproportionately diagnosed with schizophrenia in the 1960s and 1970s. The book outlined how Black men who were in the Black Panthers and the Nation of Islam were diagnosed and hospitalized in way that essentially mirrored imprisonment, Metzl said.
A 2001 study by the Department of Health and Human Services found that “feelings of mistrust and stigma or perceptions of racism” have largely kept African-Americans away from seeking care. African-Americans are also even less likely to receive mental health treatment than the general undertreated population of undertreated Americans, the study found.
The psychology and psychiatric fields have to go far beyond cultural competency to address the wider structures that contribute to mental illness, Metzl said.
“It’s not just ‘come to my therapy office’…really if you want to gain trust, address the structural drivers of mental illness and really take on racism, and poverty, and income inequality,” Metzl said.
Fragmented public health systems and community-based clinics that have been chronically underfunded for years contribute to leaving people of color on the fringe of mental health care, Smedley said.
“Our infrastructure with regard to health and mental health services in communities of color has been frayed,” Smedley said. “Community health centers do a fantastic job of providing high-quality care, often under difficult circumstances. And many provide excellent behavioral and mental health care. But they’re too few and far between and still chronically underfunded.”