Mental health stigmas disproportionally impact African Americans

At the age of 15, Gemikia Henderson didn’t know what a father’s love felt like.

“I remember thinking, ‘This can’t be the life that God gave me. There’s no way that this is the life I’m supposed to have. I can’t get a new family. I could run away, but what would I run into if I do?’” she said softly.

Gemikia, who is African-American and was born and raised in Richmond, Calif., has struggled with poverty and emotional abuse from her family for her entire life.

One of her main sources of healing and hope is the church.

From an early age, Henderson felt alone. She cut herself as a form of release and contemplated suicide. No one knew of her feelings of overwhelming despair — not one teacher, family member or friend. And those who did suspect something might be wrong told Henderson simply to “get over it.”

She didn’t start seeing a therapist until she was 24.

“I didn’t go to a therapist because I didn’t want to be crazy,” she said. “I didn’t have access to a counselor or mentor at school, and I don’t like hospitals for traumatic reasons.”

Today, at 25, Henderson has found ways to alleviate the pain that makes her body swell with anxiety. As is the case for many African-Americans, church for Henderson is the ice that makes the swelling go down.

“I go to church every Sunday,” she said. “I pray, I write, I take walks, and I reach out to people who see the good in me despite my past.”

For African-Americans, church represents more than praising a higher being. It’s where most black people feel a sense of belonging, complete acceptance, love and comfort. It is home.

“Yes, church has been a saving grace for the African-American community, especially coming out of slavery,” said Lydia Vincent-White, community engagement manager at the Center for Youth Wellness in San Francisco. “It was not just church, it was family. It was where you got food. It was a community, a safe haven.”

By contrast, many African-Americans feel a palpable distrust and disgust toward the medical establishment and social service agencies. That’s little wonder, given this nation’s tragic history of medical experimentation on unsuspecting black men and women.

Experts point to a number of other reasons why many in the black community turn first to the church and not to the medical system for mental health care. These include systemic racism and, within many black families, a “get over it” attitude. Many also find access to proper health care out of reach financially or a burden when their first priority is simply surviving.

There’s also the fear of children being taken away. According to a report by Alfiee Breland-Noble, assistant professor of psychiatry at Georgetown University Medical Center, many black parents and guardians say their unwillingness to send their child to a school doctor stems from the fear that social services will intervene.

African-Americans are less likely to receive care consistent with psychiatric guidelines, less frequently included in research and more likely to use emergency rooms or primary care rather than mental health specialists, according to the American Psychiatry Association.

Only one in three African-Americans who need mental health care actually get it, and those who do are less likely to receive proper medications or outpatient services. There also is the feeling, pervasive in the African-American community, that seeking mental health care is a sign of weakness, said Vincent-White.

Unjust mental health care can be traced back to before the abolishment of slavery.

In 1851, Dr. Samuel L. Cartwright identified “drapetomania” as a mental illness causing slaves to run away. He prescribed “therapeutic” whipping interventions.

In 1932, 600 poor African-American men signed up with the U.S. Public Health Service to be treated for “bad blood.” They never received treatment. In fact, they unknowingly signed up for the Tuskegee Study of Untreated Syphilis in the Negro Male, in which doctors and researchers studied the progression of the deadly venereal disease. It wasn’t until 1972, when an article published by the Associated Press criticized the researchers and doctors for their unethical research that the study ended. President Bill Clinton apologized for the horrific abuse 20 years later.

Experts say centuries of scientific racism is a root cause of distrust in medical professionals among African-Americans. Instead of going to doctors, black people turn to friends, family and the community for healing.

But that too often results in substandard care. Another glaring problem: 11 percent of African-Americans are without health insurance, compared to 7 percent of non-Hispanic whites.

“I have definitely developed a relationship with God, and it is the greatest thing,” said Tyler Riley, 22, from Kansas City, Mo.

Riley was 9 when her grandmother died. In the aftermath, she watched helplessly as her mother’s mental health plummeted.

“I lost myself in a way I never thought I could,” she said.

Later in life, Riley had to will herself to attend classes at the University of Missouri. A breakup with a boyfriend sent her spiraling, and at her worst, she attempted suicide. Finally, in 2017, Riley was diagnosed with major depressive disorder. She turned to her mother for comfort and support, but instead got the opposite.

“Although my mother struggled with mental health issues herself, I think the last thing she wanted was that struggle for me. She couldn’t understand why the breakup affected me the way that it did.”

As a salve, she turned to spirituality to comfort and guide her. She credits the church with putting her on a path to healing.

“People of color are more comfortable in church,” said Annette Taylor, a licensed marriage and family therapist in the Bayview District of San Francisco. “There is a need for culturally competent therapists and services that are affordable.”

 

Taylor offers free therapy sessions at her church. Although she sees only a handful of patients from her church a year, she feels that simply having affordable services available is a big step in the right direction.

“Churches and pastors are readily accessible,” said Marquez Gray, director of community leadership at HOPE SF, which assists residents of public housing. “You still have to make an appointment, but it’s likely not as hard. You don’t need health insurance and it’s confidential.”

Gray also is a pastor at City Life Church on Bayshore Boulevard. But he’s never considered establishing mental health services at his church.

“I don’t know if I would ever label it ‘mental health services.’ It just doesn’t feel right,” he said. “But one thing that I know we have to be as a church, and what we always have been about, is healing.”

Dr. Ruth Shim, an African-American psychiatrist and director of cultural psychiatry at the Department of Psychiatry and Behavioral Sciences at UC Davis, spends much of her time thinking about the role of culture as it relates to inequities in black mental health.

Shim started her career at a hospital in Atlanta, serving a very poor and sick clientele.

“I started to notice that patients of color were treated differently. It was easy for me to see that given my background,” she said.

Shim’s published research points to a number of factors putting African-Americans at a higher risk of developing a mental illness: poor access to care; unemployment/underemployment and job insecurity; food insecurity; poorly built environment; housing insecurity; adverse early life experiences; discrimination/social exclusion; poor education; and poverty/income inequality.

Gray, of HOPE SF, said there’s a general lack of awareness within the black community over what mental health is. And Shim said too often improvements are stymied by the politicization of care.

Riley said the first step in getting care for her depression was to have an honest dialogue with herself.

“You have to be honest with yourself in order to forgive yourself. You have to be honest with yourself in order to overcome hurt. You have to be honest with yourself in order to start some dialogue within the community.”

By Myah Overstreet