African Americans distrust the mental health system … how can we fix this?

“I don’t see you as Black. I just see you as a regular person.”

“I’m not sure we need to focus on race or culture to understand your depression.” 

“Don’t be too sensitive about the racial stuff. I didn’t mean anything offensive.” 

I hope these are not statements we are making to our African American clients. If we are, they won’t be a client for long.

During a recent “Smart Sex, Smart Love” podcast, I had the opportunity to talk with Darcia Miller, an African American therapist and colleague at The Center for Relationship and Sexual Health. She wanted to share her thoughts about why African Americans are not seeking mental health therapy, and if they decide to do so, how we can be effective therapists for them. I asked Darcia to write this article so I could share it with other therapists.

Here is an excerpt from my “Smart Sex, Smart Love” podcast, written by Darcia:

What happens in an African American household, stays inside that home. Problems often are swept under the rug and definitely not discussed in public or with a therapist. No one airs their dirty laundry to an outsider. By doing so, African Americans are acknowledging they cannot handle their own problems.

In addition to keeping problems closeted, there exists a sense of fear and distrust. If African Americans seek professional mental health, CPS or the police ultimately become involved, many families have learned. They come to us for help, believing they have found a safe place to talk, only to face betrayal when CPS comes knocking on their door over an issue discussed in therapy.

Generation after generation, black families have taught their children to be fearful of the world; don’t draw attention to yourself and your family. They constantly live in a survival mode. Will my child return home safely? Will the police show up unexpectedly at my house? Families believe the world is an unsafe place, and these beliefs continue one generation after another. 

In addition to dealing with the stigma and judgmental attitude of others, African Americans often are unaware they have a diagnosable mental illness because it is taboo to discuss these types of issues at home … or anywhere. As a result, these concerns go untreated and unresolved, compounding the problem even more.

According to Mental Health America, approximately 13.2 percent of the US population are African American. Of this group, more than 16 percent had a diagnosable mental illness in the past year. This means more than 6.8 million African American people could benefit from mental health therapy. In addition, according to the National Alliance on Mental Illness, African Americans make up 40 percent of the homeless population in our country. That’s a lot of people who made need mental health services but cannot afford them.

We are supposed to trust the mental health system because it helps people, it protects them and provides resources, but will it really be safe, will it really help African Americans who have no reason to place their trust in a service originated by whites for whites?

African Americans share the same mental health issues as the rest of America, but often carry greater concerns as a result of racism, prejudice, ignorance and economic disparities. There also remains this fear they will not receive adequate help because their therapist is white and may not understand their particular needs.

In addition, mental health therapy is not a priority for most African Americans. Work, family responsibilities and finances overshadow the need for therapy. It is pushed onto the back burner and forgotten. 

What can we do to create a safe, non-judgmental environment for African American clients to talk freely, honestly and openly with us?

Here are a few suggestions:

1. Be honest with your words and actions. Transparency is key.
2. Educate yourself. Don’t expect your clients to educate you and don’t ask them to. It is not your client’s responsibility. Your first session could be your last if you don’t handle it effectively. Conduct a Google search, pick up a book, listen to podcasts, take some online trainings. Learn on your own. Your client doesn’t want to spend the session giving you a history lesson. Commit to an ongoing practice of learning, and focus these efforts outside the therapy session, not while you are interacting with your clients.
3. Understand that your own personal biases may impact the therapy you provide. Be willing to undertake an honest self-examination of your own attitudes about race, including your own pre-conceived thoughts and stereotypes. 
4. Increase your cultural competence. You will gain a greater understanding and empathy for your patient’s experience, which will produce better treatment outcomes. African Americans will look for those subtle cues to determine if you have any racist attitudes. 
5. Reduce fears about therapy. Do your best to create a safe and open environment by dispelling myths, building trust, and discussing specific goals and expected outcomes so your clients feel comfortable and safe.
6. Offer telehealth services to reduce the discomfort of walking into a mental health facility.
7. Be careful not to stereotype. Don’t make assumptions about a client’s background based on research about their race or culture. This definitely will undermine your credibility.
8. Don’t be a racial colorblind therapist – one who sees all clients equally, regardless of race or culture. A colorblind approach “blinds” the therapist from observing how race can affect a client’s experiences. It is important that therapists validate the client’s interpretation of the event or situation and see the depth to which racism may be embedded in the issue.
9. Don’t be afraid to openly discuss your differences. This may help clients feel they can talk freely about race or racism. 
10. Don’t force the fit. If the client feels you are not the right fit as a therapist, respect their choice.

We need to move forward as a mentally healthy community. The more we can learn about other races and other cultures, the more effective we can become as therapists. Treatment is a partnership between the client and the therapist, and it only can be successful with mutual respect and trust.