Last Among Equals: The Burden of Mental Health for Black Communities.
March marks the first anniversary of a pandemic estimated to continue to see many more of those. The sudden and virtually unexpected nature of this worldwide health crisis has eclipsed a plethora of other ongoing concerns within each country. However, it has also highlighted the inequities found within the United States’ social structure.
As discussed in The Ghost Wound, the COVID-19 pandemic has shed an uncomfortable light on top of the mental health crisis within Black communities and neighborhoods, as well as the lack of understanding of the actual differences between mental health as a discipline and the realities of mental health for Black individuals.
With the rise of awareness regarding mental health, it is imperative to understand the nuances and differences in the mental health approach regarding race and the intersectionality between both spheres.
Furthermore, most importantly, it is time to acknowledge and understand that when it comes to mental illness, Black individuals are the last among equals—and that is the most dubious of honors.
Understanding the burden of mental illness.
It is well-known and understood within the field of psychology that mental illness does not distinguish between race or ethnicity—the prevalence of mental illnesses remains similar across racial groups, therefore disproving any potential relation between race and mental health.
However, across the world and particularly within the United States, there is an evident incongruity regarding exposure, triggers, treatment, and prejudices in mental health for Black individuals compared to other groups.
In the words of Cook et al., the burden of mental illness is significantly heavier for minority groups, despite equal biological propensities.
The reasoning behind this statement is nearly too evident—all unserved and underserved communities face a plethora of obstacles derived from structural and systematic racism, which in turn makes them more vulnerable to potential triggers against mental health and less likely to benefit from the healthcare system.
In short, Black communities play life on the “hard” level in comparison to other individuals, which renders them vulnerable to further mental health triggers.
This truth carries layered consequences in the understanding of mental health and how to treat it. It is, then, not enough to merely provide diagnosis and medication as one would to white individuals—it is quintessential to understand the nuances of racism and derived disadvantages.
The mental burden for Black and African-American communities is, then, a multi-level monster that must be deconstructed.
Socioeconomic Disparities.
Socioeconomic variables such as discrimination, structural poverty, and exclusion remain deeply intertwined with racism, and they are key factors that can make mental health a steep journey for Black people.
The correlation between mental health and socioeconomic status is one of the most well-known and explored aspects within academia. Regarding this, the American Psychological Association (APA) clarifies that, in a study that analyzed 34,000 patients within a database in Massachusetts between 1994 and 2000, factors such as poverty, unemployment, and the inability to afford housing arrangements were directly related to mental health risks, with economic stress being the most significant factor, but not the only aspect to consider.
The APA includes in the category of socioeconomic status a plethora of factors, including but not limited to income, financial security, educational possibilities and achievements, and perceptions of social status and class—all of which are potential triggers for mental health difficulties if unfavorable.
Perhaps unsurprisingly, all categories display poor results for Black people.
According to the Economic Policy Institute, in 2019, the median Black family earned 61 cents per dollar of income in a median white household—increasing from 2018 data but without reducing the gap between races. Likewise, the National School Boards Association reports that 32% of Black students live in poverty compared to 10% of their white peers, had a higher dropout rate, and lower graduation rates.
It is not a coincidence, either; systemic racism is designed to prevent Black people from reducing the gap between races and reach true equality. An article by Harvard Business School highlights how only 10% of Black resumes submitted for a position were called back for an interview. That percentage increased to 25% if the resume was “whitened”—that is, if the individual erased any potential mention of their race.
None of these numbers are new. Nevertheless, when put right next to the APA study, it highlights the dangerous and precarious circumstances of Black and African-American’s mental health within the United States and their exposition to more triggers.
Migration Trauma.
An often neglected aspect of Black mental health and wellbeing within the United States is migration trauma and stress.
Although the immigrant and Black communities are often considered by many to be separate entities, there is considerable overlap between both. According to The Immigrant Learning Center, there are 4.2 million Black immigrants within the United States, making one in every ten Black individuals within America an immigrant.
Amidst the plethora of factors involved during the migration process, it is nearly impossible to determine whether a person will develop mental health complications or not. However, a study carried by Kirmayer et al. for the Canadian Collaboration for Immigrant and Refugee Health (CCIRH) affirms the migration trajectory involves multiple risks and exposures to mental health problems on each stage—premigration, migration, and postmigration, although it always depends on the specific nature of the migration experience. The authors describe potential stressors such as communication difficulties, acculturation, the difference in family structure, complications in acceptance within the receiving society, socioeconomic difficulties, and integration.
However, with Black immigrants, there is an additional layer of complexity to address. It is quite important to distinguish the uniqueness of the Black immigrant struggle in comparison to the local Black American and acknowledge the concerning overlap of migration and racism—two significant stressors.
The Immigrant Learning Center addresses the long-standing separation problem between the Black American and Black Immigrant communities, explaining how racial inequity and xenophobia against immigrants have caused a schism where some Black Immigrants attempt to escape the prejudices against Black Americans by setting themselves apart. At the same time, some Black Americans blame immigrants for the community’s struggles. This separation between both causes a sense of alienation and distress, keeping communities divided instead of cooperating towards success, which can slow the adaptation process for Black Immigrants.
This sense of separation is also made more severe by the radical differences in experience. For example, according to Pew Research Center, Black Immigrants have a lower average income than the U.S. average and other immigrants, but higher than Black Americans. At the same time, 26% of Black Immigrants have a college degree, compared to 10% of Black Americans
Depending on their original country and the nature of the migration process, there could be different degrees of trauma to be addressed. However, it is worth mentioning that most Black Immigrants come from prominently Black countries—the Caribbean and Sub-Saharan Africa. As such, they often experience first-hand racism and discrimination for the first time and must go through an adjustment process to accept their ethnic minority status and the appalling sense of “othering” it may produce.
Violence and Crime.
According to a study performed by Rivara et al. for Health Affairs magazine, the effects of prolonged and continuous exposure to violence on health are unavoidable, both physically and mentally. Amongst the latter, the authors highlight depression, anxiety, post-traumatic stress disorder (PTSD), and suicide.
On a similar line, McDonald and Richmond write for the Journal of Psychiatric and Mental Health Nursing that “urban adolescents are exposed to a substantial amount of community violence which has the potential to influence psychological functioning,” which often involves the apparition of mental health symptoms such as post-traumatic stress and aggression.
Distressingly enough, Black neighborhoods and communities are disproportionately exposed to violence. According to the American Journal of Preventive Medicine, Black youth is at a higher risk for “most physically harmful forms of violence”—such as aggravated assaults, fights, and homicides—in comparison to their white peers.
To illustrate this worrisome trend, it is quintessential to highlight data from the Centers for Disease Control and Prevention. According to the institution, a record of homicide and legal intervention deaths in 2019 emphasized a rate of 3.51 per 100,000 inhabitants for white individuals, but an unnerving 21.57 per 100,000 for Black people. In other words, Black individuals are over six times more likely to have violent deaths, and the Black community is, consequentially, more exposed to witnessing violent deaths within their inner circle.
According to the National Medical Association, the “violence epidemic” within the Black community is a monster that has three (3) heads—different aspects that must be considered: gang violence, intimate partner violence, and police brutality. The first two land on the category of so-called “black on black” violence, which means acts of violence caused by Black individuals and inflicted upon Black neighborhoods, while the latter is a distinctive pattern of racist profiling performed by white police officers against Black people, rooted in discrimination and hatred.
When it comes to police brutality, it is imperative to discuss the intersection between racism and prejudice against mental illness. The deep-rooted racist structure of the police institutions within the United States and their inability and lack of training to handle mental health crises can often have devastating consequences.
On January 10TH, Patrick Lynn Warren Sr. was shot and killed by a police officer in Killeen, Texas, in response to a mental health call made by concerned family members. He was unarmed. Earlier on October 26, two police officers shot and killed Walter Wallace Jr., a young Black man suffering from multiple mental illnesses, including bipolar disorder. He had an episode and held a knife, and he was shot at 14 times.
It may be easy to attribute these tragedies solely to the ongoing case of police brutality against Black individuals and other minorities. However, the murders of Warren Sr. and Wallace Jr. also showcase a multi-layered conflict: institutions have failed to support and assist Black mental health and perpetuate the mistrust within the community.
Nevertheless, “black on black” violence and police brutality, despite their vast differences, have the same origin—structural racism. The inability for Black people to break the cycle of violence found within their neighborhoods stems from the lack of opportunities granted by a society that does not wish to reduce the gap between races, often with devastating consequences.
The Journal of Cultural Diversity published an analysis that determined that exposure to violence for Black American youth yielded two types of results according to gender—for Black American adolescent girls, it generates internalized symptoms of mental health distress, such as PTSD. In contrast, adolescent boys externalized mental distress and often repeated violent patterns and delinquency.
The role of racial trauma.
Socioeconomic disparities have their roots in structural racism, reducing Black individuals’ abilities to ensure their growth, break the cycle of poverty, and ensure generational wealth.
Migration trauma for Black individuals is exacerbated by the cultural shock of arriving in a country where other Black people are not only a minority but one that is heavily discriminated against. Likewise, high preparation and education levels are often dismissed or diminished by perceptions and stereotypes about race.
Black-on-Black violence, such as gang violence and intimate partner violence, results from a vicious circle perpetuated by structural and individual acts of racism.
In the end, the root of every burden on the mental health of Black people is the same—structural, systematic racism.
The racial component increases exposure to mental health triggers and puts Black individuals at risk. It can cause what experts have called Racial Trauma or, according to Mental Health America, Race-Based Traumatic Stress (RBTS.)
Exposure to racism, discrimination, and violence causes mental and emotional injuries within minorities and other marginalized, unserved, and underserved groups. Symptoms and behavior occasioned by RBTS are virtually indistinguishable from PTSD and are widespread across Black neighborhoods within America.
According to ABC News, citing sources from the U.S. Census Bureau, following the widespread distribution of the video featuring George Floyd’s murder, there was a spike in anxiety and depression amongst Black and African-Americans by 26% and 22%, respectively.
To explain this issue, Mental Health America describes three (3) stressors for RBTS: direct traumatic stressors are micro and macro-aggressions experienced by the individual in the flesh, vicarious traumatic stressors involve acts of racism and discrimination experienced by other individuals of the same race or ethnicity that provide an indirect impact to the person, while generational traumatic stressors involve traumatic events that transcend generational gaps and are transmitted.
Naturally, RBTS and its three types of stressors are aggravators for the mental health of Black Americans that do not apply to white individuals and remain deeply interconnected with the other types of mental health triggers discussed previously.
Keeping this in mind, it is not a surprise that according to Dr. Thomas Vance of Columbia University, Black individuals are 20% more likely to experience serious mental health problems, and that 25% of young Black men and women exposed to violence are more prone to developing PTSD—which may also conflate individuals with developed RBTS.
Racism as a limitation for quality mental health assistance.
Black writer and blogger Asa Todd describes her struggles with mental health in a charged entry that succinctly summarizes the experiences of uncountable Black individuals seeking assistance for their symptoms.
“Professionals often assumed I had no education, despite my Bachelor’s degree.” Todd writes for Mental Health Today. “It was assumed my father wasn’t in my life, despite him waiting for me in the waiting room. After a suicide attempt when I purposely overdosed on my anti anxiety medication, I was labeled as a drug addict and pill seeker—not someone suffering from severe bipolar depression.”
However, what can be classified as the metaphorical “final nail in the coffin” for mental health management and treatment towards Black communities is the apparent racial bias, discrimination, and lack of understanding towards the heavier burden of mental illness for Black individuals and other unserved and underserved communities.
In these terms, according to Snowden, Ph.D., the assessment of racial and ethnic bias within mental health involves three particular stages: disparities in access, quality of diagnosis, and treatment. Naturally, these take place in every potential scale—from mental health institutions within the United States to a particular licensed professional’s practice.
A poignant aspect to consider within these three stages is provider bias, a form of implicit bias found within health providers. In fact, a study shows that at the very least, two-thirds of health providers display implicit and unconscious bias against certain marginalized groups, including racial and ethnic minorities.
The importance of this within the mental health field cannot be underestimated—in the psychology and psychiatry fields, proper diagnosis and treatment require the study of behavioral patterns and attitudes, making it particularly vulnerable to misdiagnoses based on implicit bias and racism.
A natural way to balance this concerning chain of events would be to encourage more Black medical professionals within the mental health field. Although psychologists and psychiatrists of every race and ethnicity must understand the implications of structural and systemic racism, the presence of Black professionals in the mental health field can guarantee a reduction in implicit bias and a deeper understanding of the nuances regarding the burden of mental health for Black and African-Americans.
However, the reality is discouraging. According to data from the American Psychological Association, in 2018, only 4% of the United States’ psychology workforce identified as Black, in comparison to the overwhelming 84% of white professionals in the field.
Recognizing the institutional limitations against Black individuals seeking mental health assistance, in January 2021, the American Psychiatric Association released an apology towards Black, Indigenous, and People of Color for its role in supporting structural racism. The document highlighted that “inequities in access to quality psychiatric care, research opportunities, education/training, and representation in leadership can no longer be tolerated.”
Although it is undoubtedly a step forward, a glass-half-empty outlook is nearly inevitable—if the official apology and compromise to undo the damage caused by structural racism was released a mere three months ago, how long will it take to see the gears set in motion?
Conclusion.
It is clear that, even without any biological predisposition towards mental illness, external factors prevalent within racist societies ensure Black individuals within the United States remain exposed to more triggers and mental health stressors than their white peers. Naturally, this increases their propensity towards certain types of mental afflictions.
Socioeconomic disparities, racial and migration trauma, and exposure to violence create a nurturing environment for mental health wounds and crises. A mental health system heavily biased against Black people guarantees they cannot receive the proper assistance to heal those wounds.
However, this is just the external layer of the conflict. Within Black communities and neighborhoods, there are further limitations to the access, understanding, and healing of mental illnesses—all internal obstacles that must be explored and analyzed to progress in the process of overcoming external issues.
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