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African American Communities and Mental Health
Mental Health America works nationally and locally to raise awareness about mental health. We believe that everyone at risk for mental illnesses and related disorders should receive early and effective interventions. Historically, communities of color experience unique and considerable challenges in accessing mental health services.
13.2% of the U.S. population, or roughly 42 million people, identify themselves as African American, according to 2013 US Census Bureau numbers. (1) Another 1 percent identified as multiracial. This represents an increase from 12 percent of the U.S. population, or roughly 34 million people, who identified themselves as African American in the 2000 Census. (2) In 2007, roughly 3 million of all blacks in the U.S. were foreign born. (3)
As of 2010, Fifty-five percent of all blacks lived in the South, 18 percent lived in the Midwest, 17 percent in the Northeast, and 10 percent in the West. (4)
Historical adversity, which includes slavery, sharecropping and race-based exclusion from health, educational, social and economic resources, translates into socioeconomic disparities experienced by African Americans today. Socioeconomic status, in turn, is linked to mental health: People who are impoverished, homeless, incarcerated or have substance abuse problems are at higher risk for poor mental health.
Notwithstanding the 2008 election of our first African American President, racism continues to have an impact on the mental health of African Americans. Negative stereotypes and attitudes of rejection have decreased, but continue to occur with measurable, adverse consequences. Historical and contemporary instances of negative treatment have led to a mistrust of authorities, many of whom are not seen as having the best interests of African Americans in mind.
According to the US HHS Office of Minority Health: (5)
- Adult blacks are 20 percent more likely to report serious psychological distress than adult whites.
- Adult blacks living below poverty are two to three times more likely to report serious psychological distress than those living above poverty.
- Adult blacks are more likely to have feelings of sadness, hopelessness, and worthlessness than are adult whites.
- And while blacks are less likely than whites to die from suicide as teenagers, black teenagers are more likely to attempt suicide than are white teenagers (8.2 percent v. 6.3 percent)
African Americans of all ages are more likely to be victims of serious violent crime than are non-Hispanic whites, making them more likely to meet the diagnostic criteria for post-traumatic stress disorder (PTSD).
Historically, attitudinal barriers have led to roadblocks to accessing services and treatment. In 1996, MHA commissioned a national survey on clinical depression. The survey explored the barriers preventing Americans seeking treatment and gauged overall knowledge of and attitudes toward depression. This survey revealed that:
- 63 percent of African Americans believe that depression is a personal weakness, this is significantly higher than the overall survey average of 54 percent.
- Only 31 percent of African Americans believed that depression was a “health problem.”
- African Americans were more likely to believe that depression was “normal” than the overall survey average.
- 56 percent believed that depression was a normal part of aging
- 45 percent believed it was normal for a mother to feel depressed for at least two weeks after giving birth
- 40 percent believed it was normal for a husband or wife to feel depressed for more than a year after the death of a spouse.
- Barriers to the treatment of depression cited by African Americans included:
- Denial (40 percent)
- Embarrassment/shame (38 percent)
- Don’t want/refuse help (31 percent)
- Lack money/insurance (29 percent)
- Fear (17 percent)
- Lack knowledge of treatment/problem (17 percent)
- Hopeless (12 percent)
- African Americans were less likely to take an antidepressant for treatment of depression; only 34 percent would take one if it were prescribed by a doctor.
Many of these problems persist to this day. As Doctor William Lawson of Howard University (and MHA’s District of Columbia affiliate) pointed out in an NPR interview in 2012, “Many African-Americans have a lot of negative feelings about, or not even aware of mental health services. They may not be aware of the symptoms of many mental disorders, or they may believe that to be mentally ill is a sign of weakness or a sign of a character fault.” (6)
The following statistics were taken from the “Mental Health: Culture, Race and Ethnicity Supplement” to the 1999 U.S. Surgeon General’s Report on Mental Health.
- African-American physicians are five times more likely than white physicians to treat African-American patients. African-American patients who see African-American physicians rate their physicians’ styles of interaction as more participatory. African Americans seeking help for a mental health problem would have trouble finding African American mental health professionals: In 1998, only 2 percent of psychiatrists, 2 percent of psychologists and 4 percent of social workers said they were African Americans.
- The public mental health safety net of hospitals, community health centers, and local health departments are vital to many African Americans, especially to those in high-need populations.
- African Americans of all ages are underrepresented in outpatient treatment but over-represented in inpatient treatment. Few African-American children receive treatment in privately funded psychiatric hospitals, but many receive treatment in publicly funded residential treatment centers for emotionally disturbed youth.
But African Americans today are overrepresented in our jails and prisons. People of color account for 60 percent of the prison population. Blacks also account for 14 percent of regular drug users, but for 37 percent of drug arrests. (Illicit drug use is frequently associated with self-medication among people with mental illnesses.) (7)
Disparities in access to care and treatment for mental illnesses have also persisted over time.
As noted by the Office of Minority Health:
- Only 8.7 percent of adult blacks, versus 16 percent of adult whites, received treatment for mental health concerns in 2007-2008.
- Only 6.2 percent of adult blacks, versus 13.9 percent of adult whites, received medications for mental health concerns during 2008.
- And while 68.7 percent of adult whites with a major depressive episode in 2009 received treatment, only 53.2 percent of adult blacks did.
And while implementation of the Affordable Care Act will close this gap somewhat by 2016, in 2011 20.8 percent of blacks were uninsured, versus 11.7 percent of whites. (8)
MHA has developed unique materials for African Americans.
- Depression and African Americans: Not Just the Blues
- What is Bipolar Disorder? A Guide to Hope and Recovery for African Americans
Partnerships and Resources
The following organizations are among those that offer additional information on this subject, focusing on outreach to African American communities:
- Capstone Institute/Center for Research on the Education of Students Placed at Risk, Howard University: http://www.capstoneinstitute.org/
- National Black Nurses Association: http://www.nbna.org/
- National Medical Association: http://www.nmanet.org/
- Lee Thompson Young Foundation: http://www.leethompsonyoungfoundation.org/
(2) “Mental Health: Culture, Race and Ethnicity Supplement” to the 1999 U.S. Surgeon General’s Report on Mental Health.