5 MINUTE READ
Supporting the Mental Health of Black Americans Takes an Honest Discussion of Racism
During the pandemic and after the killing of George Floyd, many Black Americans are feeling anxious, tired and distressed. Here’s how to find help.
By Nzinga Harrison, MD, Co-Founder and Chief Medical Officer, Eleanor Health
Racism kills. Sometimes suddenly, as with the murder of George Floyd. And sometimes slowly, over years and generations by unequally affecting the physical and mental health of Black Americans.
Research has shown that the pain and injustice experienced by Black people from both widespread, systemic racism and individual experiences of discrimination become sources of chronic stress on the mind and body. “Weathering” is the medical term used to describe the effect these stresses have over time which contributes to shorter average life spans. That’s because dealing with a lifetime of cumulative stress can lead to a range of poor health conditions, including heart disease, cardiovascular illness and mental health disorders like depression.
Black Americans don’t even need to experience police violence first-hand to be traumatized by it. A 2018 study found that Black people who merely lived in states in which unarmed Black men were killed by police reported worse mental health. White people who were exposed to the same killings did not show any effects.
Now today, when one of these killings is right on video for the world to witness – and the COVID-19 pandemic is taking a disproportionately high toll on Black families, with more than three times as many deaths in Black communities compared to others – many Black Americans are left feeling numb, tired, anxious and distressed. As a Black psychiatrist, I’ve experienced these emotions myself and seen these emotions in my patients and communities far too often.
It’s important to know that there are steps we can take to alleviate this anguish. From talking with friends and family to seeking spiritual guidance to even just staying away from social media, practicing self-care can be an effective coping strategy. But sometimes, when everything becomes too much to bear and starts to affect your health or to interfere with your life roles as a parent, worker, spouse, sister or friend, it’s time to seek professional help.
Barriers to treatment
Black Americans overall experience higher levels of psychological distress than other groups, but receive less mental health treatment. There are many reasons for these disparities, including stigma around getting help for mental health needs, cost and distrust of our country’s educational, legal and financial systems, all of which are affected by institutional racism.
In fact, health care itself is not immune from perpetuating discrimination. Many Black people justifiably distrust the health care system, after a history of horrific experiments – from Dr. James Marion Sims, hailed as the father of modern gynecology, who performed surgical experiments on enslaved Black women without anesthesia to the Tuskegee Study in which Black men were intentionally not treated to allow medical doctors and researchers to learn about the natural history of syphilis.
Unfortunately, discrimination in both physical and mental healthcare settings still persists today. Recent studies show that Black Americans report racial discrimination as the most commonly cited reason for receiving poor treatment by doctors or hospitals. Racial bias has been identified among nurses and physicians and is associated with doctors spending less time with Black patients, giving less eye contact during exams and sitting farther from Black patients during visits. Additionally, implicit bias among physicians has been shown to affect treatment decisions and is directly related to worse quality of care. These are behaviors Black patients notice, feel and carry with them. These experiences of racism and discrimination with health care providers are directly related to poorer health outcomes.
So what can we do differently?
Finding the right therapist
Because of experiences with racism and discrimination, many Black people needing mental health support feel more comfortable seeing a Black therapist. But it’s about a lot more than just comfort. Black therapists share much of the same lived experiences as their Black patients, and more importantly, they don’t shy away from bringing up the subject of racism. An open, transparent discussion of racism – which we know impacts mental health – builds trust, which is core to an effective therapeutic relationship.
Of course, it’s not always possible to see a Black therapist. Nationwide, there’s a shortage of qualified mental health professionals overall, and with Black clinicians underrepresented in this total, there are not enough Black therapists to go around.
So, what should you look for in a therapist, whether Black or not? It’s critical for therapists to be comfortable discussing racism and its impact on your health. This is often not naturally easy for non-Black therapists to do. For one, many haven’t been trained to do so, or they’ve been taught it’s not “polite” to bring up the subject of race for fear of offending their patients. Also, therapists are human too, and so are vulnerable to implicit bias which may interfere with forming a solid therapeutic relationship.
My advice then is two-fold. One, challenge yourself on any bias or fear you may have about seeing a mental health professional, and despite that bias or fear, take the plunge. If you go into your first session with a new therapist, and you don’t feel heard or respected, find another therapist. Seeing a therapist for the first time isn’t like getting married – it’s like going on a first date. You are trying out the relationship to see if it is a good fit. There’s nothing wrong with not returning if you don’t feel comfortable and heard and respected. And two, once you do feel safe with a new therapist, take the risk of talking about race and how it affects your health. It may feel difficult to bring it up, especially if your therapist is of a different race or ethnicity, but it is incredibly important. The medical evidence shows us that the burden and stress of racism worsens our mental and physical health, and a caring therapist wants to help with that.
Finally, during these times, don’t forget about the mental well-being of your children, especially teens. Black youth are also experiencing the stress of racism and discrimination, and often don’t have an outlet to talk about it. Recently, risk factors for stress, depression and anxiety have been stacking up for Black adolescents. First, COVID-19 took away their social interactions and important experiences like graduation or prom. Then they had to witness the George Floyd killing. We know that online race-bullying increases during times like this, and so it is quite possible that your child or adolescent may be experiencing race-based bullying on social media. As Black parents, we have to be proactive to help our young children and teens navigate these difficult times. Sometimes, part of doing so is helping them reach out for professional help and undermining the stigma of seeing a therapist.
Walking the walk
At Eleanor Health, a group of physician practices with expertise in mental health and addiction, where I’m the co-founder and Chief Medical Officer, we focus on delivering whole-person care – and that includes race and ethnicity. When individuals join the Eleanor Health community for care, we openly talk about experiences with racism and discrimination. We use standardized, valid questionnaires to measure the effect those experiences have had on our members. We look at our data by race and ethnicity so we can find opportunities to improve. And, all of our staff attend training on racism, oppression, culture and recovery as part of new staff orientation.
After the George Floyd killing, we made a commitment as an organization to become more actively anti-racist, providing our employees with an emotionally safe space to share their experiences with racism and the impact of George Floyd’s killing on them personally. We created a training and resources library to help us all become more culturally sensitive. We gave each employee a half-day off work to dedicate to anti-racism activism. We believe in supporting our own team in having these conversations and sharing their experiences so we can better support our community members with dignity and compassion.
We know it can be difficult to reach out for help or to start a relationship with a mental health professional. We believe it is our responsibility to make it easier. If you are struggling, I encourage you to check out Eleanor Health where you can join one of our free mental health support groups for individuals who identify as Black, Indigenous and People of Color (BIPOC), request a free consultation or schedule an appointment to get started with us.
It’s going to take many like-minded providers to deliver the needed healing and care Black people need not just now but long after this moment. They are out there – and soon, I hope, there will be more.
Horizon Blue Cross Blue Shield of New Jersey members have access to a large network of mental health providers, including Eleanor Health, for in-person or virtual visits. Find a doctor or therapist here.