People of color face significant barriers to mental health services
Richelle Concepcion still remembers the name she was called after trying to stop a White kid who was picking on younger peers on the swim team in high school.
“Shut the f**k up, you Oriental b*tch!” that kid yelled at her so many years ago.
Though Concepcion, a Filipina American, wasn’t the only person teased by that kid at her school in San Francisco, she was the only one called a racial slur.
“After that event, I spent time ruminating on the experience and went over scenarios in my head about what I could have said back, whether I was indeed what he called me, etc.,” said Concepcion, now a psychologist at Tripler Army Medical Center in Honolulu, via email.
The racially motivated event and long-term subjection to stereotypes were two of many experiences “that inspired my work, as I tend to be very cognizant of the experiences of my patients who identify as people of color,” she added.
Mental health issues affect everyone, but people of color — Black, Latinx, Asian and Native American people — have higher rates of some mental health disorders and face greater disparities in getting help than White people. Those issues are primarily due to lack of access to services resulting from institutional discrimination, interpersonal racism and stigma — which can all harm the psyche of people of color in places where they are not the majority.
Such disparities have existed for decades, but “what we’re seeing is that some of the stresses that are associated with being a member of a marginalized group have been exacerbated during the pandemic,” said Brian Smedley, the American Psychological Association’s chief of psychology in the public interest and acting chief diversity officer.
43% of US adults with mental health conditions are estimated to receive treatment; the figure is 33% for Hispanic and Latino adults.
Source: 2018 National Survey on Drug Use and Health
During the pandemic, many people have experienced mental health stressors such as unemployment, sick and lost loved ones, disrupted social lives, insecurity about the future and a lack of internal peace — all of which threaten people’s socioeconomic status and stress levels. And minorities already disproportionately experience those misfortunes.
“There’s a high likelihood that (the pandemic) is also affecting mental health and well-being for these populations as well,” added Smedley, who leads the APA’s efforts to apply the science and practice of psychology to the problems of human welfare and social justice.
Why some people of color are in such distress
The mother of Maximino Avila — or Wachinhin Ska (“White Plume”) in Lakota, the eponymous language of the Native American tribe — “died an addict on Market Street” in San Diego when White Plume, now 33, was a child.
“My first introduction into intergenerational trauma was realizing that’s what (my drug addiction stemmed from) after I got sober,” White Plume, who is an activist in his community, said. “I didn’t realize I had been experiencing it my whole life coming from my mother.”
Intergenerational trauma describes how oppressive events “that impacted one generation tend to be carried over, as far as feelings, in later generations,” said Jacque Gray, a research associate professor in the University of North Dakota’s department of population health and associate director of the Center for Rural Health for Indigenous programs. Belonging to a minority can come with numerous sources of stress.
Native Americans have higher rates of substance abuse and depression (PDF) in comparison to other races, Gray said.
“American Indians have been through multiple traumas over the last 500 years,” she added, including loss of land and culture. They’ve had to abstain from wearing their traditional clothing, eating their traditional foods and speaking their established languages.
A history of alcoholism, drug addiction, poverty, homelessness, isolation and sexual harassment haunted White Plume and his family. That trauma and the need to dissolve the dissonance between reservation and mainstream life led him to experiment with alcohol and other drugs.
“It made me feel superhuman,” White Plume recalled. “That roller coaster really made me feel like I had a sense of power and awakening and that I could really change the reservation with my hands. And I didn’t have to change the reservation through my hope.
“It just made me feel like I didn’t have to go through the trouble of actually getting well and sober and OK with who I am.”
Modern political developments that encroach upon the lands and rights of Native Americans are traumatizing, Gray said. And on average, less than 50% of Native Americans finish high school — education is one of the determinants of the quality of one’s mental and physical health.
Latinx people also face discrimination, in their case based on their languages, ethnicity and class, said Jasmine Mena, an assistant professor of psychology and affiliated faculty in Latin American studies at Bucknell University in Lewisburg, Pennsylvania.
“The impact on their mental health is never positive,” Mena said. “It impacts self-esteem and substance use, and it’s associated with many (negative) outcomes.”
Political events and discourse regarding immigration can be harmful to mental health even for those who are documented, because they still become targets, Mena said.
Black people have higher rates of depression, anxiety and sleep and digestive problems, studies have found. Racially discriminatory events have led Black people to be in a state of high arousal — which means a heightened level of situational awareness and vigilance, said Helen Neville, a professor of educational psychology and African American studies at the University of Illinois at Urbana-Champaign.
“Racial battle fatigue,” Neville explained, is the burden that results from regular exposure to prejudiced information; prodding regarding racial events; and people invalidating their experiences.
That means they’re anticipating discriminatory encounters based on their race before such events happen. The daily instinct to interpret social situations and decisions through a racial lens is stressful, and that awareness is just one form of racial trauma experienced by Black people.
“Racial battle fatigue” is the burden that results from regular exposure to prejudiced information; prodding from people regarding racial events or wanting to become educated or allies; and people invalidating their experiences, Neville explained.
Microaggressions cumulatively take their toll, and so do emotional and physical responses to vicarious and direct experiences with racial violence and racism. Centuries of racial terror, violence and oppression have also left an indelible mark on the Black psyche.
The most common sources of stress for United Kingdom-based people of color are social and economic, said Eugene Ellis, a psychotherapist and the director of the Black, African and Asian Therapy Network in the UK.
“People of colour (are) more likely to experience poverty, have poorer educational outcomes, higher unemployment, contact with the criminal justice system and challenges accessing and receiving appropriate professional services,” Ellis said via email.
Asian Americans are discriminated against for their looks, languages and culture. They also face a great amount of family and social stress by having to represent their family well and embody two cultures: that of their heritage and “American” in the US or “British” in the UK.
“Your success is reflective upon your family’s success,” said Concepcion, the clinical psychologist, who is also president of the Asian American Psychological Association.
Lack of access to crucial services
The mental health profession has been underfunded and difficult to access for decades, Smedley said, and communities of color face additional geographic and financial barriers to getting help.
Native American communities that are geographically disconnected are often forgotten or underserved, Gray said, and it takes time to train and implement providers who specialize in treating Native American people. It’s also taxing on time and money for both providers and patients to travel to and from reservations.
“Native Americans are so overlooked all the time,” White Plume said. Although he sought addiction treatment near his South Dakotan reservation, he knew San Diego was the more viable option.
“It just makes me feel like I’m really invisible and to the point where it feels comfortable being more invisible,” White Plume added. “Hence the strong, silent type. The whole manifest destiny feels like it’s … been in action against me since I was born.”
Native Americans also have the highest rate of poverty in the US in comparison to other races. Due to location and lower-income status, Black people sometimes lack access to mental health services. Latinx people might also if they’re under- or uninsured, Mena said, especially if they’re undocumented immigrants.
Can psychologists who don’t look like you understand you?
Martin Diaz, a Mexican American university student from Fontana, California, has long struggled with depression and anxiety, but has never felt comfortable seeking help from his campus mental health services. One hang-up was that the predominantly White psychologists might not be able to empathize with his experiences as a Latinx person.
“I went in there, but then I got overwhelmed by just seeing a bunch of White faces. So I quickly left,” Diaz said. “It was nothing new to me, the same old thing whenever I would try to access a resource. I feel if there’s more inclusivity within these services, especially at a school that prides itself for being diverse … that would’ve been so much better not just for myself, but for other marginalized communities as well.”
86% of psychologists in the US workforce were White in 2015.
Source: APA's Center for Workforce Studies, 2015
Diaz’s perception of his local mental health services is accurate, according to data that shows that the mental health workforce doesn’t look like the rest of the population. In 2015, 86% of psychologists in the US workforce were White.
The UK, too, is facing a “desperate shortage” of mental health providers of different races and ethnicities, Ellis said.
Language and cultural barriers are almost greater deterrents to getting help than inadequate access. Some people of color want to be treated by people who “get them,” and many mental health professionals aren’t trained in cultural humility, Neville said. That means that they don’t have the openness to realizing that the patient is knowledgeable about his experiences, so they can actually learn from and sympathize with him.
“Cultural humility also impacts your awareness of structural issues that might impact your client’s life outside of the therapy room and how that might impact their current presenting concern,” Neville added.
In the US, there are federal efforts in the works to diversify the mental health profession, Smedley said. The US Substance Abuse and Mental Health Services Administration funds the American Psychological Association’s Minority Fellowship Program that reduces barriers to opportunities for training.
Well-meaning family members can do harm
Underlying Diaz’s anxiety and depression was unintentionally perpetrated mental abuse by family members who also had unchecked mental health issues.
The stigma influencing the family’s resistance to talk about their problems and get help “stems from a conservative outlook,” Diaz said. “From the colonization and how there were forced ideals on us.”
Overcoming the challenges of immigration has created “false stories that we’re hard workers and that there’s nothing wrong with us,” he added. “It’s very taboo for older generations to discuss their emotions and everything. That just creates more generational trauma.”
Diaz’s family members aren’t alone in their reticence. A history of stigma has made speaking up about mental struggles difficult for most people. But the intergenerational traumas experienced by people of color have led to rigid perceptions of both the reality of mental disorders and how they should be resolved. Consequently, sometimes both the source of mental troubles and the barrier to getting help come from within a person’s own home.
Asian Americans are often burdened with appearing as the “model minority” and representing their family well, so they’re less likely to speak up about their mental struggles. They report fewer mental health conditions than their White counterparts, but are more likely to consider and attempt suicide.
Asian Americans are “very invested in working on it through self or kind of saving face, because we are a very collectivistic community,” Concepcion said. “When you think about a person in a family or community unit experiencing behavioral health issues, it’s almost deemed as if you are bringing down the community if it comes out that you’re seeking help.”
Religion and stigma can be both coping mechanisms and the solutions others imply will fix mental challenges.
“There is that belief that you leave it in God’s hands,” Concepcion said. “If you’re having an issue, you don’t talk to a behavioral health provider. (You) pray to God or see the rosary or something like that … and God will take it off your shoulders.”
A pandemic brings new challenges
The all-encompassing nature of the pandemic has aggravated disparities for communities that were already vulnerable. They don’t have the same safety net that has allowed some to work from home, care for their children and maintain wellness.
Unemployment triggered by the outbreak has disproportionately affected people of color. At the same time, they largely comprise the people who are considered essential workers — they’re faced with the stress of being at risk for contracting coronavirus but being unable to provide for themselves and their families if they don’t work.
“Seeing the devastation of the pandemic in Black communities reinforces past racial traumas I have experienced,” Neville, who is Black, said. “It’s been hard to shake.”
These communities strained by job loss, essential work, school closures and unavailable child care might suffer a multigenerational impact, Mena predicted. That’s because adults need time and energy to keep children educationally engaged and thus have a chance at future educational and occupational success — which can partly influence one’s mental health. In comparison to White people, Black, Latinx and Native American people have higher rates of serious illness and death from Covid-19.
During this pandemic, Asian Americans have been dealt a unique subset of discrimination — since coronavirus outbreaks began in China, some people have blamed them for the crisis.
Staying well while systemic change is underway
The onus for eliminating mental health disparities is on the profession and institutions. But there are things people of color can do to keep upright in environments that make mental wellness a challenge.
Diaz paints and writes poems to express his emotions.
Neville gets involved in social activism, saying it can help people of color to tap into their sense of agency and change the environment in which they experience racism. It’s a “promising pathway to improving health” on an individual and community level since it pushes to create greater societal equity and promotes health more broadly, Neville said.
Older generations “have not only survived, but they have thrived,” Neville said.
She also relies on her “support system for affirmation and nurturance.” As a psychologist, Neville knows that sharing experiences allows people to understand the valid social issues causing their pain and express how they’re responding to them. Open dialogue can also educate people about mental health, which is crucial to eliminating stigma. Instead of signifying weakness, openness can be a demonstration of strength and possibly encourage others to ask for help.
The parents and elders of people of color have likely experienced discriminatory treatment, and more severe forms of it, that affected their health. Asking the older generations how they dealt with it and how they think people of color can move forward — if they are willing to share their experiences — “can instill a sense of hope for a better tomorrow,” Neville said. Older generations “have not only survived, but they have thrived.”
Developing a sense of pride in one’s heritage and what it has contributed to the world can also boost well-being, Neville and Concepcion said.
“‘Wellbriety’ and coming to the idea that I had to get back to my spirituality was the No. 1 thing to start healing myself and my tribe,” said White Plume, who has been sober for three years and spends his time serving his Native American community. “Now I help myself and my tribe way more than I ever did in any of my addiction.”
If your loved ones aren’t supportive, know that you’re not alone, Concepcion said. In addition to professional help, there are organizations, Facebook groups and online wellness spaces created by other people of color who are waiting to take individuals under their wings.
By: Kristen Rogers, CNN