Identity and Cultural Dimensions - Black/African American

What happens at the intersection of mental health and one’s experience as a member of the Black community? While the experience of being Black in America varies tremendously, there are shared cultural factors that play a role in helping define mental health and supporting well-being, resiliency and healing.

Part of this shared cultural experience — family connections, values, expression through spirituality or music, reliance on community and religious networks — are enriching and can be great sources of strength and support.

However, another part of this shared experience is facing racism, discrimination and inequity that can significantly affect a person’s mental health. Being treated or perceived as “less than” because of the color of your skin can be stressful and even traumatizing. Additionally, members of the Black community face structural challenges accessing the care and treatment they need.

According to the Health and Human Services Office of Minority Health, Black adults in the U.S. are more likely than white adults to report persistent symptoms of emotional distress, such as sadness, hopelessness and feeling like everything is an effort. Black adults living below the poverty line are more than twice as likely to report serious psychological distress than those with more financial security.

Despite the needs, only one in three Black adults who need mental health care receive it. According to the American Psychiatric Association’s Mental Health Facts for African Americans guide, they are also:

• Less likely to receive guideline-consistent care
• Less frequently included in research
• More likely to use emergency rooms or primary care (rather than mental health specialists)

Barriers To Mental Health Care

Socioeconomic Disparities
Socioeconomic factors can make treatment options less available. In 2018, 11.5% of Black adults in the U.S. had no form of health insurance.

The Black community, like other communities of color, are more likely to experience socioeconomic disparities such as exclusion from health, educational, social and economic resources. These disparities may contribute to worse mental health outcomes.

Stigma
Negative attitudes and beliefs towards people who live with mental health conditions is pervasive within the U.S. and can be particularly strong within the Black community. One study showed that 63% of Black people believe that a mental health condition is a sign of personal weakness. As a result, people may experience shame about having a mental illness and worry that they may be discriminated against due to their condition.

For many in the Black community, it can be incredibly challenging to discuss the topic of mental health due to this concern about how they may be perceived by others. This fear could prevent people from seeking mental health care when they really need it.

Additionally, many people choose to seek support from their faith community rather than seeking a medical diagnosis. In many Black communities in the U.S., the church, mosque or other faith institution can play a central role as a meeting place and source of strength.

Faith and spirituality can help in the recovery process and be an important part of a treatment plan. For example, spiritual leaders and faith communities can provide support and reduce isolation. However, they should not be the only option for people whose daily functioning is impaired by mental health symptoms.

Provider Bias and Inequality of Care
Black people have historically been negatively affected by prejudice and discrimination in the health care system in the US. And, unfortunately, many Black people still have these negative experiences when they attempt to seek treatment. Provider bias, both conscious and unconscious, and a lack of cultural competency can result in misdiagnosis and inadequate treatment. This ultimately can lead to mistrust of mental health professionals and create a barrier for many to engage in treatment.

Black people may also be more likely to identify and describe physical symptoms related to mental health problems. For example, they may describe bodily aches and pains when talking about depression. A health care provider who is not culturally competent might not recognize these as symptoms of a mental health condition. Additionally, Black men are more likely to receive a misdiagnosis of schizophrenia when expressing symptoms related to mood disorders or PTSD.

How To Seek Culturally Competent Care

When a person is experiencing challenges with their mental health, it is essential for them to receive quality care as soon as the symptoms are recognized. It is equally important that the care they receive is provided by culturally competent health care professionals.

While we recommend seeking help from a mental health professional, a primary care professional is also a great place to start. A primary care professional might be able to provide an initial mental health assessment and referral to a mental health professional if needed. Community and faith organizations may also have a list of available mental health providers in your area.

When meeting with a provider, it can be helpful to ask questions to get a sense of their level of cultural awareness. Providers expect and welcome questions from their patients or clients, since this helps them better understand what is important in their treatment. Here are some sample questions:

• Have you treated other Black people or received training in cultural competence for Black mental health? If not, how do you plan to provide me with culturally sensitive, patient-centered care?
• How do you see our cultural backgrounds influencing our communication and my treatment?
• Do you use a different approach in your treatment when working with patients from different cultural backgrounds?
• What is your current understanding of differences in health outcomes for Black patients?

Whether you seek help from a primary care professional or a mental health professional, you should finish your sessions with the health care professional feeling heard and respected. You may want to ask yourself:

• Did my provider communicate effectively with me?
• Is my provider willing to integrate my beliefs, practices, identity and cultural background into my treatment plan?
• Did I feel like I was treated with respect and dignity?
• Do I feel like my provider understands and relates well with me?

The relationship and communication between a person and their mental health provider is a key aspect of treatment. It’s very important for a person to feel that their identity is understood by their provider in order to receive the best possible support and care.

More Information

• If finances are preventing you from finding help, contact a local health or mental health clinic or your local government to see what services you qualify for. You can find contact information online at findtreatment.samhsa.gov or by calling the National Treatment Referral Helpline at 800-662-HELP (4357).

NAMI’s Sharing Hope Program

Sharing Hope is a one-hour program to increase mental health awareness in Black communities by sharing the presenters’ journeys to recovery and exploring signs and symptoms of mental health conditions. The program also highlights to navigate the mental health system.

"Sharing Hope: An African American Guide to Mental Health" provides mental health information in a sensitive manner through personal stories. Recovery is possible, and this booklet tells you where to find more information, seek help and be supportive. You can buy hard copies through the NAMI Bookstore.

Black Mental Health Resources

Please note: The resources included here are not endorsed by NAMI, and NAMI is not responsible for the content of or service provided by any of these resources.

Black Emotional and Mental Health Collective (BEAM)
Group aimed at removing the barriers that Black people experience getting access to or staying connected with emotional health care and healing. They do this through education, training, advocacy and the creative arts.

Black Men Heal
Limited and selective free mental health service opportunities for Black men.

Black Mental Health Alliance — (410) 338-2642
Provides information and resources and a “Find a Therapist” locator to connect with a culturally competent mental health professional.

Black Mental Wellness
Provides access to evidence-based information and resources about mental health and behavioral health topics from a Black perspective, as well as training opportunities for students and professionals.

Black Women’s Health Imperative
Organization advancing health equity and social justice for Black women through policy, advocacy, education, research and leadership development.

Boris Lawrence Henson Foundation
BLHF has launched the COVID-19 Free Virtual Therapy Support Campaign to raise money for mental health services provided by licensed clinicians in our network. Individuals with life-changing stressors and anxiety related to the coronavirus will have the cost for up to five (5) individual sessions defrayed on a first come, first serve basis until all funds are committed or exhausted.

Brother You’re on My Mind
An initiative launched by Omega Psi Phi Fraternity, Inc. and NIMHD to raise awareness of the mental health challenges associated with depression and stress that affect Black men and families. Website offers an online toolkit that provides Omega Psi Phi Fraternity chapters with the materials needed to educate fellow fraternity brothers and community members on depression and stress in Black men.

Ebony's Mental Health Resources by State
List of Black-owned and focused mental health resources by state as compiled by Ebony magazine.

Hurdle
Provides culturally sensitive self-care support and teletherapy for Black men and their families. Currently in pilot program available only to residents of MD, VA and DC. Residents of other states can join their waiting list and will be notified when Hurdle is available in their state.

Melanin and Mental Health
Connects individuals with culturally competent clinicians committed to serving the mental health needs of Black & Latinx/Hispanic communities. Promotes the growth and healing of diverse communities through its website, online directory and events.

Ourselves Black
Provides information on promoting mental health and developing positive coping mechanisms through a podcast, online magazine and online discussion groups.

POC Online Classroom
Contains readings on the importance of self care, mental health care, and healing for people of color and within activist movements.

Sista Afya
Organization that provides mental wellness education, resource connection and community support for Black women.

Therapy for Black Girls
Online space dedicated to encouraging the mental wellness of Black women and girls. Offers listing of mental health professionals across the country who provide high quality, culturally competent services to Black women and girls, an informational podcast and an online support community.

The SIWE Project
Non-profit dedicated to promoting mental health awareness throughout the global Black community.

The Steve Fund
Organization focused on supporting the mental health and emotional well-being of young people of color.

Unapologetically Us
Online community for Black women to seek support.

Self-Care For People Of Color

We recognize that many mental health conditions are being triggered as a result of the coronavirus, the economic crisis and repeated racist incidents and death.

Learn more about mental health conditions including anxiety disorders, depression and posttraumatic stress disorder.

• Article on coping with anticipatory grief
• Article on coping with traumatic stress
• Article on Racial Battle Fatigue

Treatment Directories

• Association of Black Psychologists Directory
• Inclusive Therapists
• Innopsych
• LGBTQ Psychotherapists of Color Directory
• National Queer and Trans Therapists of Color Network
• Psychology Today Directory of African American Therapists
• Therapy for Black Men

Educational Resources On Racism And Inequality

Understanding the context of racism and recent events

• Video on understanding racism and the reactions to the death of George Floyd and many others
• Video on understanding the perspectives of your colleagues of color
• Article on “White Privilege: Unpacking the Invisible Knapsack”
• List of Anti-Racism resources

Understanding the context of racial inequality that impacts mental health

• APA Best Practices on working with Black patients
• APA Mental Health Facts for Black Americans (2017)

Understanding and addressing the social determinants of health that impact mental health

• Article on improving the health of Black Americans and the overdue opportunity for social justice
• Video on understanding the social determinants of health and toxic stress
• Video on the social determinants of toxic stress, specifically race and ethnic toxic stress
• APA Stress & Trauma Toolkit for treating Black Americans in a changing political and social environment
• The Robert Wood Johnson Foundation Page on Achieving Health Equity — Information about why health equity matters and what you can do to help give everyone a fair shot at being as healthy as they can be.

Ways To Take Action As An Ally Or Champion For People Of Color

• Article on being a white ally through word, actions and power
• Article on being a white ally for racial justice
• Community based organizations to partner with: Color of Change, Black Lives Matter, Campaign Zero, Innocence Project

Books to Read

• White Fragility: Why It's So Hard for White People to Talk About Racism by Robin DiAngelo, PhD
• How To Be An Antiracist by Dr. Ibram X. Kendi
• Eloquent Rage: A Black Feminist Discovers Her Superpower by Dr. Brittney Cooper
• Me and White Supremacy by Layla F. Saad
• So You Want to Talk About Race by Ijeoma Oluo
• The Fire Next Time by James Baldwin
• The New Jim Crow: Mass Incarceration in the Age of Colorblindness by Michelle Alexander
• The Next American Revolution: Sustainable Activism for the Twenty-First Century by Grace Lee Boggs
• The Warmth of Other Suns by Isabel Wilkerson
• When Affirmative Action Was White: An Untold History of Racial Inequality in Twentieth-Century America by Ira Katznelson

Call the NAMI Helpline at