Say mental illness in the African American community, and most likely you will cause a pause in conversations as large as the white elephant in the room. Mental illness has a disturbing and persistently negative history in the Black community throughout the United States.
Fueled by mistrust of a system that often views Black people as nothing more than guinea pigs ripe for experimentation, accepting the label “mentally ill” comes with a huge stigma.
At the same time that people of African descent distrust and fear some of the services provided by the mental health community, medical staffs are often wary of the Black community and fearful of Black people in general and in particular young Black men. These circumstances are encouraged by prejudice, racism, misunderstanding, and false impression.
And this is not a recent phenomenon. In 1840, a scientific report deliberately falsified the Black insanity rates from the United States Census to show that the further north people of African descent lived, the higher their rates of mental illness. This was to illustrate and support the contention that freedom drove Blacks crazy, thus justifying slavery.
Mental illness is a complex problem and does not discriminate. It strikes people of all races and both genders, and cuts across all social and economic classes.
Researchers have found that Black Americans are less likely than Whites to have a major depressive disorder, and when they do it tends to be more chronic and severe. They are also much less likely to undergo treatment, according to a major National Institutes of Mental Health study.
In the largest study of the Black population of its time, a National Survey of American Life, based on interviews conducted from 2001-2003, found that 10.4 percent of African Americans, 12.9 percent of Caribbean Blacks and 17.9 percent of non-Hispanic Whites had manic depressive disorder at some point in life.
Among participants with depression, the rate of chronic depression was highest in Black groups–56.5 percent in African Americans and 56 percent in Caribbean Blacks, compared with 38.6 percent in Whites.
The National Survey of American Life pointed out a striking difference in treatment among people of African descent with manic depressive disorder–fewer than half of African Americans with the disorder (45 percent) obtain treatment and only about one-quarter (24.3 percent) of Caribbean people who emigrated to the U.S. received treatment.
According to the National Alliance on Mental Illness (NAMI), mental illnesses are medical conditions that disrupt a person’s thinking, feeling, mood, ability to relate to others and daily functioning. Just as diabetes is a disorder of the pancreas, mental illnesses are medical conditions that often result in a diminished capacity for coping with the ordinary demands of life.
Serious mental illnesses include major depression, schizophrenia, bipolar disorder, obsessive compulsive disorder, panic disorder, post-traumatic stress disorder and borderline personality disorder. The good news about mental illness is that recovery is possible.
NAMI goes on to note that mental illnesses are not the result of personal weakness, lack of character or poor upbringing. Mental illnesses are treatable. Most people diagnosed with a serious mental illness can experience relief from their symptoms by actively participating in an individual treatment plan.
In addition to medication treatment, psychosocial treatment such as cognitive behavioral therapy, interpersonal therapy, peer support groups and other community services can also be components of a treatment plan and that assists with recovery. The availability of transportation, diet, exercise, sleep, friends and meaningful paid or volunteer activities contribute to overall health and wellness, including mental illness recovery.
Depression, anxiety, bipolar disorder, and schizophrenia are three common disorders that are often misdiagnosed or even overlooked in people of African descent. Experts also say that schizophrenia is twice as common as HIV/AIDS in the Black community.
According to Dr. Annelle B. Primm, director, minority and national affairs for the American Psychiatric Association, gaps in treatment between Whites and African Americans has “increased substantially since the 1990s.” She presented her findings in an article posted this year by the Centers for Disease Control.
Psychiatrists and psychologists agree that social determinants such as poverty, lack of education, access to resources, institutionalization, stress, and physical health status are part of the complex equation of why people of African descent are less likely to obtain the proper diagnoses and treatment for mental illness. Additionally, many of the risk factors for the health disparities are already more commonplace in the poor and homeless.
Another factor in the lower levels of treatment for mental illness among Blacks is that studies have shown mental illness treatment can consume personal wealth, cut workplace productivity and require vast amounts of spending on healthcare.
As one of the most ethnically diverse counties in the nation, the county of Los Angeles Department of Mental Health serves more than 200,000 clients annually. Yet, with a budget of more than $1 billion, African Americans continue to go underserved.
Treatment in the Black community has suffered greatly because resources are often less than equal in quality and access. Among the many complaints in this regard is that the healthcare system is so fragmented that you can’t get what you need to recover from a serious medical illness.
Proper diagnosis is also a major concern noted Gabriel Crenshaw, Ph.D., associate professor of psychology at Los Angeles Southwest College, who says, “Blacks are typically overdiagnosed with schizophrenia and underdiagnosed with bipolar disorder.”
Cultural differences, conditions and traditions can also be serious factors as well. This includes “Cultural Paranoia,” which refers to a healthy suspicion that is based on real experiences of prejudice and racism. While markedly different from the mental disorder of paranoia, it’s quite common among African Americans, who have and always had a distrust for the medical establishment, especially psychiatrist.
“Once you walk into a room and are expected to bear your soul, there has to be a rapport,” says Sandra Lee, Ph.D., associate professor of psychology at Los Angeles Southwest College. “Often the mental health profession doesn’t look like the patient.”
She added that patients also feel uncomfortable, because they find themselves educating the psychiatrist about being Black.
Consistent with the reality that African Americans have been particularly hardest hit by the troubled economy, a study by the National Bureau of Economic Research (NBER) reveals an increase in medical visits for mental illness such as anxiety and suicide attempts because of foreclosures. The most often impacted were individuals 20 to 49 years old, especially African Americans.
But despite so much dismal news when it comes to mental health, there are reasons to be hopeful that the concerted efforts from within the Black community and from other leaders will successfully reverse the current trends.
Collaborative efforts to eliminate health disparities are beginning to be implemented as advocates for systemic change push their agenda.
Among the proposed public health approaches being advocated are proportionate representation in health professions, bias-free interventions, educational equality, and improved career opportunities for people of color.
But mental health experts agree that most important of all efforts is increasing knowledge about the illnesses and the treatments. This can begin to help remove some of the stigma associated with mental illness, which can, in turn, lead to more people getting treatment and healing.