Black History Month – African Americans and Mental Health

Ranna
Parekh, MD, MPH

As we celebrate Black
History Month, we reflect on African Americans’ place in US history. At the
APA, we give thanks to psychiatrists – such as Jeanne Spurlock, MD, Solomon
Carter Fuller, MD, Chester Pierce, MD, and a long list of Solomon
Carter Fuller Award recipients--whose great contributions continue to
influence our medical field.  It is also
a time when we are reminded of the unique mental health challenges facing the
black community and the importance in working together toward improved access,
assessment and treatment.  

The history of African
Americans predates slavery; however, its legacy and the ongoing discrimination
continue to impact the lives of African Americans today. Emotional strength, strong social connections, and
determination have enabled many African Americans to overcome adversity.
 Yet African Americans, just like people of all racial/ethnic backgrounds,
experience mental illness.

While rates of mental
illness in African Americans are similar to those of the general population,
African Americans receive less care and poorer quality of care and often lack
access to culturally sensitive care. For many reasons, African Americans face
particular obstacles in getting help for mental health concerns. Racism,
discrimination, cost or lack of health insurance, or distrust of the health
care system may prevent some African Americans from getting the help they
deserve. Stigma about mental illness can also pose a barrier, and blacks are
much less willing than whites to use medicines for a mental illness.

Also, African Americans
sometimes express mental illness and emotional distress differently than
others.  For example, among people with depression, blacks are more likely
than whites to complain of body aches or other physical symptoms. 

Racism
and discrimination have multiple effects on mental health.  Victims of
discrimination experience feelings of unfairness when dealing with mental
illness and those feelings make it difficult for them to do anything about it. 
In addition, the anticipation of discrimination, the perception of being in an
environment of discrimination, or seeing others being victims can contribute to
greater ongoing stress and anxiety.  

Chester M. Pierce, MD, emeritus
professor of education and psychiatry at Harvard Medical School and founder of
the eponymous Division of Global Psychiatry at the Massachusetts General
Hospital is to receive APA’s 2015 Human Rights Award. His life’s work included
studying people living in extreme conditions. In 1970, he coined the term microaggessions to help people
understand the continuing stain of racism experienced by African Americans.
Microaggressions are brief, everyday exchanges
that send denigrating messages that are not overt discrimination – the person
may not even be aware of the denigrating action. Being continually subjected to
these microaggressions takes a toll on physical and mental health. 

This is also
compounded by the economic effects—blacks have much higher unemployment and
poverty rates than whites.  In January 2015, the unemployment rate for black
 men over 20 was more than twice that of
white men (11.4% vs 5.2%) and the unemployment rate for black youth age 16-19
was significantly higher than white youth (30% vs 17%). 

Also, African-American men are less likely to seek help for medical problems and
mental health concerns often become secondary to any medical concerns. Physical
conditions and conditions affecting the mind are connected in many
ways--problems that first affect the mind can later increase one’s risk for
physical problems, such as diabetes, high blood pressure, or malnutrition. And
physical conditions, such as a disease or an accident, can affect the mind
(i.e., emotions, thinking, and mood). African Americans have a much higher
risk than white Americans for many types of chronic diseases, such as diabetes
and heart disease.

The California Mental Health Services Authority has developed a 

video and discussion guide about young black men and
mental health. 

Beyond the Beat and the Lyrics --
Understanding the Impact of Stigma and Discrimination on the Mental Health
Status of Transition-Aged African American Males,"  is intended to raise
awareness and stimulate conversation.

Mental disorders are
nothing to be ashamed of. They are real medical problems, just like heart
disease or diabetes. As with these illnesses, there is help available and much
you can do to support or improve your health. Like all people with mental
illness, African Americans, do recover and go on to lead productive and
fulfilling lives.

Ranna
Parekh, MD, MPH, is the director of the Division of Diversity and Health Equity
at the American Psychiatric Association