A couple of years ago, Kanye West’s widely-covered nervous breakdown placed a brief spotlight on mental illness within the African American community. His recent comments regarding slavery notwithstanding, the Rand Corp. in Santa Monica released this month an unsettling report on access to mental health services for African Americans. It appears that Black Californians are more likely to experience mental health problems than other ethnic groups, but are far less likely to seek and receive the care they need to live a fulfilling life.

The study revealed a connection between untreated mental health problems and multiple absences from work, which can take an economic toll on persons and families in the form of lost pay or lost jobs. This dynamic, researchers found, disproportionately affects communities of color. The data also revealed that mental health problems were causing 12-percent of Black Californians to miss four or more work days per year, compared with 6.1 percent for Asians, 7.9 percent for Whites, and 9.4 percent for Latinos.

Blacks, reportedly, are three times as likely as Asians and nearly twice as prone as Whites to suffer from severe psychological distress; African Americans are also more susceptible to bouts of mental illness than Latinos, though only by a small margin.

Black women often forgo treatment

Black women tend to face an even more daunting struggle with mental illness than do Black men. The Rand study found that Black women are more likely than men to go without needed mental health services and, as as result, are more likely to miss multiple days of work, thereby putting them at more risk than any state population of losing their jobs.

The Rand report only touched on the effect mental illness can sometimes have on Black employment. There is so much more to this hidden illness that has traditionally brought shame to individuals and family members who must confront the various circumstances arising from the health malady each day. While African Americans are no different with it comes to the prevalence of adverse mental health conditions, sometimes concerns within the Black community about how to understand and cope with the topic can be drastically different than with other races and ethnic groups.

African Americans sometimes experience more severe forms of mental health conditions because of unmet needs and other cultural barriers. According to the Health and Human Services Office of Minority Health, African Americans are 20-percent more likely to experience serious mental health problems than the general population. Common mental health disorders among African Americans range from major depression, attention deficit hyperactivity disorder (ADHD particularly among school-age youth) suicide (among Black men 20 to 35 years old), and post-traumatic stress disorder (PTSD common among Black youth residing in gang territories where shooting deaths occur frequently and also related to African Americans more likely to be victims of violent crime).

African Americans—particularly those residing in America’s inner cities—are reportedly more likely to experience certain factors that increase the risk for developing a mental health condition. These factors include, but are not limited to, homelessness because these individuals are at a greater risk of developing a mental health condition. Black people comprise up to 40 percent of America’s homeless population.

The constant exposure to violence among inner-city residents is said to increase the risk of developing a mental health condition such as depression, anxiety and PTSD. Black children, for instance, are more likely than any other age group in America to be exposed to violence.

Black children and PTSD

It has become media cliché to compare neighborhoods plagued by gun violence to war zones. The combat metaphors range from children caught in the crossfire, to explosions of gang warfare that including SWAT-like police teams patrolling the streets. Behind the bleak imagery in places like South and East Los Angeles, Oakland, South Chicago and Detroit lies the hidden collateral damage of people’s tender psychological wounds only to be revealed in the hospitals, schools and living rooms of these beleaguered communities.

A 2016 investigation by ProPublica, an online news source, highlighted a study of hospital patients in inner-city communities in Atlanta that revealed rates of PTSD comparable to those seen in veterans of the Vietnam, Afghanistan and Iraq wars. At least one in three young Black adults ages 15 to 30 years reported that at some point in their lives they had experienced PTSD symptoms—an array of stress responses including flashbacks, persistent feelings of fear and shame, a sense of alienation and aggressive behavior.

The National Institutes of Health went to Chicago’s Cook County Hospital—which tends to thousands of gunshot victims each year—and found that four in 10 patients screened showed symptoms of PTSD, with an even higher rate among those wounded by guns. Mental health experts at local hospitals such as Martin Luther King Jr. Community Hospital in Watts, and those at County/USC Medical Center and White Memorial Hospital in East Los Angeles have reported similar findings among their youngest patients, specifically those who have victims or were witnesses to gun violence.

Why don’t more African Americans seek mental health services? Access to these consultations has always been difficult, particularly for low-income persons and the fact that federal, state and county budgetary constraints can make it difficult to provide necessary services. Distrust and misdiagnosis find African Americans negatively affected by prejudice and discrimination in the health care system. Inadequate treatment and a lack of cultural competence by health professionals often result in distrust and, therefore, may prevent many African Americans from seeking or staying in treatment.

“Social and cultural factors within the African American community play a significant role in the treatment of mental illness,” said Stephen Odom, Ph.D, with New Vista Behavioral Health. He said that because African Americans traditionally live a life centered around the church, they tend to seek guidance from a pastor, deacon or a member of the congregation instead of receiving a diagnosis from a qualified person.

Lack of services in inner city

“It would be wonderful if the clergy could have more training in detecting a mental illness and then refer the person to qualified treatment,” Odom said. “Because there remains high unemployment within the Black community, many people have no health insurance and Medicaid offers limited assistance in relation to mental health services. Assessing and treating mental health issues among African Americans continues to be difficult because of the lack of funding for badly needed services.”

Socio-economic factors also play a part. Treatment options for low-income Blacks are less available. In 2012, the U.S. Census Bureau reported that 20 percent of African Americans had no form of health insurance, despite the implementation of the Affordable Care Act.

Provider bias and an inequality of care also have a role. A health care provider who is not culturally competent might not recognize bodily aches and pains (particularly in Black women patients) when discussing depression and may not include such complaints when making a mental health diagnosis. Black men are more likely to receive a misdiagnosis of schizophrenia when expression symptoms are related to mood disorders or PTSD.

A common assumption of mental illness among homeless African Americans tends to focus on drug and alcohol use. Not long ago, the Substance Abuse and Mental Health Services Administration (SAMHSA) looked at the overall health and wellbeing of homeless and drug-addicted African Americans and whether they were receiving the necessary outreach and treatment needed to improve their lives. Their research found that 9.1 percent of African Americans (or 2.6 million persons) required treatment for illicit drug use and alcoholism. And although Blacks were reportedly less likely to need the same level of treatment for alcohol use than other racial and ethnic groups, they were considerably more likely to need treatment for illicit drug use.

The SAMHSA research also revealed that an estimated 2.2 million African Americans need but did not receive specialty substance use treatment in any given year, compared with 18.4 million persons from other racial and ethnic groups. Among Blacks who needed but did not receive substance abuse treatment, 92 percent reportedly did not feel the need for treatment, 5.2 percent said they felt the need for treatment (but made no effort to receive it), while only 2.8 percent said they needed treatment and would make an effort to obtain it.

‘Self medicating’ among homeless

Unfortunately, African Americans who do not receive treatment for a mental illness often join the legions of homeless persons who ultimately choose to “self medicate” to ease the pain of daily living. Alcoholism and illicit drug use are the main culprits of the epidemic of mentally ill homeless persons seen wandering through the streets of Los Angeles and other large metropolitan areas nationwide.

Los Angeles County Sheriff Jim McDonnell has stated that up to one-third of inmates at the Twin Towers jail facility in Downtown Los Angeles suffer from some form of mental illness. This has resulted in a plan to expand the jail to specifically house and treat mentally ill inmates. The number of jail inmates in California who are administered psychotropic drugs has jumped about 25 percent in the past five years, and they now account for about one-fifth of the statewide jail population.

Researchers from California Health Policy Strategies suggest that the increase in numbers may stem from better identification of people in need of treatment, but caution that jails have effectively become repositories for people in the throes of acute mental health crises. Across California, far more people with mental illness are housed in jails and prisons rather than in psychiatric hospitals. This scenario highlights the problem of insufficient staff training and patient treatment which, in the end, has contributed to an increase in inmate suicides, self-mutilation, violence and other problems.

“This is a long-term problem as we find that mental health treatment goes ‘up and down’ depending on who is in [political] office,” Odom said. “It is not a good idea to increasingly rely on the legal system to provide mental health treatment. It is good that people in jail are receiving the necessary treatment, but there must be a regimen of follow up sessions by qualified practitioners to achieve the best outcome for these persons suffering with a mental disorder.”