Overcoming Barriers: Addressing Mental Health Disparities for Black Women

Written by: Dr. Edith Langford

Author, Ethnographic Researcher & Clinician, Licensed Professional Counselor (LPC, LMHC), and Addiction Specialist (CASAC, ADC) with four decades of experience. After a lifetime of experiencing ongoing medical mistreatment, she is working on a memoir about medical racism in our healthcare system

In majority white-owned and operated clinics, numerous workshops have been conducted to address the low attendance of Black individuals in therapy. Staff often attribute this to offensive stereotypes such as apathy. For instance, the assumption that Black mothers do not attend family therapy with their children, who are experiencing school-related issues, is based on the belief that they lack sufficient concern.

However, if stigma is not the primary obstacle, what barriers prevent Black women from seeking necessary mental health interventions? It is vital for psychiatrists to recognize these barriers, as acknowledging them can significantly enhance the physician-patient relationship when treating Black women. One notable barrier is the limited access to healthcare providers. The American Psychiatric Association has reported that Black clinicians make up only about 2% of practicing psychiatrists and 4% of psychologists (American Psychiatric Association, 2017).

 These issues are further magnified when considering the experiences of young mothers in impoverished communities. These women often have their children at a young age, and their children usually attend the same elementary schools they did. Unfortunately, these mothers had negative experiences as students and may face the same principals, counselors, and teachers they did, which can be intimidating. It's not a matter of apathy; sometimes, it's intimidation and fear that prevent these mothers from seeking assistance for their children's issues. These young women need advocates—individuals who can not only speak for them but also teach them how to communicate with professionals who may have been abrasive and intimidating in the past.

 Accessibility is another significant concern. In some communities, Black mothers work multiple jobs and do not have the flexibility of nine-to-five employment that allows for attending school meetings or mental health appointments. The lack of job security means they cannot afford to leave work for therapy sessions, making weekend appointment availability essential.

 Additionally, Black individuals are more likely to be diagnosed with conditions that have poorer long-term outcomes, such as schizophrenia, compared to their White counterparts, even when presenting with similar symptoms (Schwartz & Blankenship, 2014)(1). This can lead to a broad range of differential diagnoses, including unspecified psychotic disorder, schizophrenia, bipolar disorder, or schizoaffective disorder. The implications of these diagnoses can be severe, resulting in increased use of seclusion, restraints, and involuntary commitment.

 The distrust in the medical system among African American women is significantly high, regardless of their economic status. This distrust is even more pronounced in the mental health system. There are numerous instances where African American individuals have been hospitalized after seeking help for depression or expressing sadness. In some cases, when a Black woman has reported job loss or a death in the family, a quick succession of questions and answers during the psychiatric evaluation leads to family separation and hospitalization, exacerbating the reluctance to trust the healthcare system. In contrast, a White woman in a similar situation might be more likely to receive community support and assistance rather than hospitalization.

 Lastly, the shortage of culturally relevant providers is a pressing issue. Reflecting on the past, the few Black social workers who entered the field in the '60s and '70s were often physically and mentally exhausted from managing the most challenging cases in their agencies. This pattern has persisted, as I have observed from my own experiences in the '80s. For example, when a young Black boy is labeled as disruptive or aggressive, I have volunteered to take on these cases, knowing that I could help him reintegrate into school rather than seeing him sent to a detention center or group home. Unfortunately, when these cases are handled by those who may not understand their cultural context, the outcomes are often not as positive.

 In a research project sponsored by the Justice Department on homicide studies in Virginia during the '90s, I found that many young boys, eager to learn at the start of their schooling, lost interest around middle school, often after being placed in special education. This segregation from mainstream activities, such as sports teams, and social interactions had a profound impact on their engagement and aspirations (Department of Justice, 1997).

Clinicians should consider (and acknowledge) these barriers when addressing Black women's mental health and when establishing treatment plans:

  • Stigma
  • Time/accessibility
  • Lack of access to culturally competent care
  • Decreased availability of providers from similar backgrounds
  • Decreased trust in the medical community

 The pursuit of culturally sensitive care in mental health is a multifaceted endeavor, deeply enriched by the recognition and inclusion of diverse backgrounds and experiences. As we progress, the focus must shift towards creating a healthcare environment that embodies understanding and adaptability, ensuring that every individual receives support that resonates with their cultural identity and personal history. The transformation required hinges on continuous learning, empathetic engagement, and systemic reform, guided by the voices and needs of the communities served.

 

References:

1. Schwartz RC, Blankenship DM. Racial disparities in psychotic disorder diagnosis: A review of empirical literature. World J Psychiatry. 2014 Dec 22;4(4):133-40. doi: 10.5498/wjp.v4.i4.133. PMID: 25540728; PMCID: PMC4274585.

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