Race and Mental Heath Disparity

Psychology Today, October 8, 2003
By Hara Marano

a sad fact of life that disparities in insurance coverage and stigma collaborate to keep access to mental health care lagging behind physical health care for everyone. Overall, only one third of Americans with a mental health problem get care. Still, the percentage of African Americans receiving needed care is half that of whites.

It is a sad fact of life that disparities in insurance coverage and stigma collaborate to keep access to mental health care lagging behind physical health care for everyone. Overall, only one third of Americans with a mental health problem get care. Still, the percentage of African Americans receiving needed care is half that of whites.

California psychologist Gloria Morrow contends that the distrust and stigma that blacks feel about mental-health treatment stem in part from difficulty in finding a therapist to whom they can comfortably relate. African Americans comprise less than 2% of licensed psychiatrists in California and less than 4% of mental-health providers nationally. Mental-health practitioners "don't 'get it' when they are working with people who don't look like them," she insists.

One effect is to shift sufferers into care settings not designed for recurring disorders such as depression. "We know that people are going to emergency rooms because of the stigma of going to a counselor," she explains.

They also experience difficulty in talking about their problems, especially to non-blacks. There is often a gulf of mistrust that is fed by both sides.

A lack of knowledge has had a particularly negative impact on diagnosis and treatment. Blacks are more likely to be diagnosed with schizophrenia than with depression, and this is especially the case if they have manic depression. In the past, blacks have been offered antidepressant medication far less frequently than whites. And despite evidence suggesting that blacks may metabolize psychiatric medications more slowly than whites, thus requiring lower dosages, they are often given higher dosages; as a result they experience more severe side effects than do whites, frequently prompting them to stop treatment altogether.

One fact that is both cause and consequence: blacks do not volunteer for studies, observes the University of Illinois' Carl C. Bell, M.D. "So it is difficult to document that they need half the dose of antidepressant medication that whites need."

It's bad enough that treatment disparities exist on their own. But the cultural mistrust that keeps blacks from treatment has been successfully fueled by the Church of Scientology. Bell is particularly distressed that Scientology has specifically targeted black communities with its anti-psychiatry message. "They are forever pumping into the black community scare tactics, that there's a genocidal plot to put black children on Ritalin, there's a genocidal plot to put black people on antidepressant medication."

But when all is said and done, it may be that blacks turn less to the mental health system because they have long had other sources of coping. "For us, the church has been our psychologist," says Morrow.

Unfortunately, she notes, "the church has not often sanctioned people getting help other than from the church. Religious beliefs are supposed to sustain you through everything. There's the belief that 'your faith will carry you.'"

But because African Americans "pay attention to their pastors" she has sought the help of the religious community to give parishioners permission to take advantage of available treatments.

She has taken matters in her own hands and developed a partnership between psychology and the black church that is especially sensitive to the needs of African Americans. It was easy enough to contemplate--her husband is a pastor. But the seed for Partners in Faith was planted when she was attending a funeral for a suicide victim and the pastor asked whether anyone in attendance had ever contemplated taking their own life. "All these black people who had never opened up about it before acknowledged it to a black pastor," she recalls.

She began a conversation about mental health in her own community and started with a needs assessment. She is currently putting together a comprehensive resource guide to culturally sensitive treatment. "This isn't just for blacks," she says. "We're checking out practitioners. We're interested in those professionally trained practitioners who won't automatically send someone not like them someplace else. We're aiming to develop a community model of care."

Maryland psychiatrist Marilyn Martin, M.D., sees room for a major educational campaign in the black community. "We need to educate people about the symptoms of depression. We need to educate about handling stress and we need to help people deal with conflicts. We need to tell people there are ways to help you be strong."

She believes that practices like yoga, meditation and walking--once regarded as "alternative" but now solidly in the mainstream of health prescriptions--have to come into the black community. "Blacks feel a loyalty to their community to do as those around them do--to manage stress by eating and drinking," she observes. "We have been highly focused on loyalty; to do otherwise is something 'white.' We need to honor our traditions but bring in new ways of coping with stress."

Bad Homes, Good People

Black American women who can't find, or don't have, [supportive] resources may come out of childhood fearing success. We believe that bad things happened to us as children because we were bad girls. Such negative thinking stifles initiative--we won't even try. Sometimes we anticipate fearfully that if we are successful we may have to stand alone. We may find it easier to be unsuccessful than to deal with rejection, because, when we were kids, no one was in our corner to tell us that rejection is a part of life.

Marilyn Martin, Saving Our Last Nerve

Living with Change

Our "identity," who we are, isn't set in stone, as we might imagine. It changes constantly as each day brings new experiences and challenges. We must always be ready to grow, and that isn't always easy. Even though life is about change, we are resistant to change, especially in relation to loss, disappointment or pain. We find it hard to let go of the comfortable old self. We find it hard to give up a relationship even when the relationship is obviously over. We don't want to give up our old ways of coping or the often fruitless dreams we invented to take the bite out of our suffering.

Before we can change, we must find meaning in our suffering. Only then can we let it go and learn to live with old wounds and, slowly, to let them heal.

Marilyn Martin, Saving Our Last Nerve

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