A Brief Black History of Mental Health Care
Well, it’s that time of year again. If you identify as a black person in the United States, it can be a time of celebration and remembering our history. It may also be a time where it feels as those around you are performing for the sake of political correctness - a performance that will come to an abrupt and scheduled end on March 1st.
I can go in a thousand different directions - but for the first blog of #BlackHistoryMonth 2021, I wanted to take a *quick* look at the black history of mental health in the U.S. of A. I say quick, because there simply is not enough time to look at the entirety of this trauma. We will take a glimpse at a tiny piece of the tip of the iceberg.
On January 18th, 20201 the American Psychiatric Association issued an apology -> “APA’s Apology to Black, Indigenous and People of Color for Its Support of Structural Racism in Psychiatry”. Here is a partial statement:
Early psychiatric practices laid the groundwork for the inequities in clinical treatment that have historically limited quality access to psychiatric care for BIPOC. These actions sadly connect with larger social issues, such as race-based discrimination and racial injustice, that have furthered poverty along with other adverse outcomes. Since the APA's inception, practitioners have at times subjected persons of African descent and Indigenous people who suffered from mental illness to abusive treatment, experimentation, victimization in the name of "scientific evidence," along with racialized theories that attempted to confirm their deficit status. Similar race-based discrepancies in care also exist in medical practice today as evidenced by the variations in schizophrenia diagnosis between white and BIPOC patients, for instance. These appalling past actions, as well as their harmful effects, are ingrained in the structure of psychiatric practice and continue to harm BIPOC psychological well-being even today. Unfortunately, the APA has historically remained silent on these issues. As the leading American organization in psychiatric care, the APA recognizes that this inaction has contributed to perpetuation of structural racism that has adversely impacted not just its own BIPOC members, but also psychiatric patients across America.
They go on to add a historical addendum. For clarification, psychiatrists are medical mental health doctors - meaning they can both diagnose mental health diseases AND prescribe medication for those diagnosis. I am a licensed clinical social worker meaning I am able to diagnose mental health conditions, but not able to prescribe medications. Also for clarification, it took 2020 for people and organizations to start issuing apologies for racial traumas, and atrocities that began literal centuries ago. This may bring up the notion of “performative justice” when in reality, actualized justice is what is so desperately needed.
Then there was the viral TikTok from Dr. Jennifer Lincoln discussing the racism that exists today within the medical system. The extensive history of racism, and abusive practices towards people of color give countless reasons as to why there is a distrust among communities of color toward the medical & mental health field as a whole.
Combine this with the fact that there is a massive shortage of brown clinicians. A story by Minaa B by Today stated that “the psychology workforce is 85% white and only 2% black”. While there are a whole host of factors that contributed to this, let’s start with the lack of generational wealth which limits financial access to higher institutions of learning - therefore slowing the ability for BIPOC to access careers requiring higher degrees. The statistics are resounding - when you come from a family that went to college you are more likely to attend AND graduate with a degree. When you come from a family with generations of college graduates, imagine the statistics then. While there is a larger number of first generation college students now then decades ago, first generation college students are often tasked with paving the way for themselves and the generation before them. When you come from generations of college graduates, this often corresponds with wealth (no, I am not referencing the billionaires of the world) and the ability to pave the way for yourself and the generation after you. The added stress and financial burden of considering the generation before you while planning for the generation after you often contributes to an increase of emotional distress. This of course can lead to an increase of mental health issues.
In December 2019 the Congressional Black Caucus issued a report, Ring the Alarm: The Crisis of Black Youth Suicide in America, detailing the suicide crisis experienced by black teens today. This report was produced before teenagers and people around the world were confined to their homes by a global pandemic. One of the most staggering findings? Between 1991 and 2017 suicide attempts among black teenagers (of all genders) rose 73%. That’s seventy-three percent. A USA Today story, indicates that while caucasian youth still die by suicide at higher rates, African-American youth are attempting suicide at higher rates than any other racial or ethnic group in the United States today.
Imagine living in a country where your body, your human nature is not respected, validated, or heard. Oh, wait.
Now imagine also struggling with a lack of access to resources and generational wealth due to systematic oppression and discrimination. Oh, wait.
Now imagine seeing people that look like you, and/or those you love, being murdered while doing everyday things. Murdered at the hands of those thought to protect you. Oh, wait.
Now imagine attempting to access help, but not being able to identify or connect with anyone who you feel can empathize with your experience. As due to centuries of systematic oppression there are only a few clinicians that look like you. Oh, wait.
These are simply a handful of the challenges people are facing as they walk through their everyday lives. So what do we do?
First - we normalize mental health care. Normalize talking about your emotions with your kids, your friends, your partners, and your families. If we don’t talk about our feelings, our stress, and our victories with the people we are in community with, then talking about our stuff will remain a foreign concept.
Second - we recognize that while there IS a shortage of BIPOC clinicians, they do exist. I promise. I am one. Here are some tools for finding some.
Third - even if there is not a good fit BIPOC therapist in your area, there may still be someone you can work with. Just ask intentional questions.
What’s your experience working with someone with my cultural/ethnic/religious background?
What challenges/struggles have you faced when working with people who may share a part of my cultural experience?
What kind of cultural competency training have you had?
Do you address or acknowledge the cultural differences in the room?
Fourth - if you meet a therapist and you hate them; if you are working with a therapist and you don’t like them - YOU CAN FIRE THEM AND FIND ANOTHER ONE. (This is not the case in some inpatient hospital settings.) However, if you are an outpatient client you can ask for someone else, and/or go find someone else on your own. (Inpatient means that you are sleeping/living there for safety/medical/psychiatric reasons. Outpatient means that you schedule an appointment without being admitted to the hospital/facility.) Sometimes finding the right fit does mean doing a bit more work to find the best fit for you and/or your child.
Despite all of the traumatic history that blacks have experienced, specifically in the U.S., your health and wellbeing are what continue the history of you. Even in spite of the chaos and trauma black people have continued to prevail, create beauty, create community, open doors, and break glass ceilings. If the glass ceiling you want to break is experiencing your life the healthiest way possible - you deserve that.
You deserve the kind of care that you need from the kind of person that respects who you are and who you want to be.