Black Access to Mental Health Care Not as Simple as It Seems
Chandra White-Cummings, Managing Editor
During the years that Barack Obama was President, the statistics regarding numbers of African Americans experiencing mental/emotional and/or psychological distress did not change much. Blacks still report being in serious psychological distress at a rate about 10% greater than non-Hispanic whites. Serious psychological distress is a measurement of likelihood of having a “diagnosable mental illness and associated functional limitations”. The assessment most widely used for this measurement is the Kessler “nonspecific distress scale” and uses six (K6) to ten (K10) questions, each with five possible responses. The K6 has become the preferred version because although it has fewer questions it has proven to be just as reliable as the 10-question version. A score greater than 12 on the K6 scale indicates emotional or mental disturbance that probably warrants attention and treatment. Now that Donald Trump has become President, indications are that those numbers might only increase.
Odds are good that the average African American has never been evaluated with the K6 or K10, or any other official mental health assessment for that matter. But self-disclosures on social media, conversations where black folk have always had them—churches, salons and barbershops, informal get-togethers—and now even books like Benilde Little’s memoir Welcome to my Breakdown reveal that anxiety, depression, Bipolar disorder, and other mental illnesses are things that yes, even Blacks are dealing with. It’s therefore a welcome sign that self-care has exploded as a meaningful and viable form of help for those experiencing challenges to their mental and emotional health. Some types of self-care are mostly feel-good remedies, things like window-shopping, binge-watching a favorite show, or redecorating a room that could use a seasonal refresh. Other types of self-care offer a little more substance and are evidence-based behaviors proven to have longer, more sustained demonstrable effect on brain function and mood. Sleep, exercise, meditation, prayer, and even reading fit this category. Besides being a solid cultural expression of Kujicichagulia, the self-determination principle of Kwanzaa, intentionally practicing self-care is also a self-preserving response to a mental health care system too slow to change, too expensive for many, and too inhospitable to black and brown faces.
The popular narrative has been that African Americans don’t see psychiatrists or other therapists and counselors mainly because they don’t trust the medical profession, stigma shames people into isolation, and treatment is financially out of reach often even for the insured. Not to say that any of those statements is untrue; they just don’t tell the whole story. The distrust of medical practitioners is due in part to a dangerous and deadly history of experimentation and hyper-scrutiny on one hand and outright neglect on the other. Blacks definitely are reticent to admit or discuss mental and emotional problems and still have an irrational fear of being labeled ‘crazy’. And insurance coverage can still leave an insurmountable payment gap for people to close. But a more fundamental problem underlying these issues is access—there aren’t nearly enough black mental healthcare providers to meet the need.
The Bureau of Labor via its Occupational Information Network (O*NET ONLine) service reports the following 2014 employment data for mental health related professions:
Therapists – Marriage & Family 34,000
Counselors – Mental Health (excluding social workers, psychologists, and psychiatrists) 128,200-135,000
Psychiatrists- 28,000
Psychologists – Clinical, Counseling, and School 155,000
Mental Health & Substance Abuse Social Workers (Clinical) 118,000
These numbers are not race or gender-specific so then the question becomes how many black mental health practitioners are potentially available to treat African Americans with mental health illness. Not as easy to determine as you might think.
State licensing boards are not permitted and do not collect race information on mental health professionals. Membership in professional groups and associations is better than nothing but even many of the websites for black professionals don’t provide information about how much of the profession is represented by their members, and often not even how many members they have. The National Association for Mental Illness (NAMI) in a fact sheet created as part of its partnership with Alpha Kappa Alpha sorority, indicates that 3.7% of American Psychiatric Association members and 1.5% of American Psychological Association members are African American. Nonetheless, membership in a professional group is a subset of a subset because not all licensed professionals are also members in associations.
There are alternative ways to receive treatment for mental disorders including peer support and other types of support groups, but for those persons who truly require the knowledge and training that is only provided by a licensed mental health professional, where do Blacks go and what is the answer for them? Governmental agencies and policy groups push cultural competence as a solution to close the access gap for blacks seeking treatment. The idea is that while a psychologist may not be black, she can be taught cultural understanding and empathy through specialized education. The Office of Minority Health defines cultural competence as being able to function effectively in a cross-cultural setting taking into account a patient’s language, customs, beliefs, values, and institutions. Part of the established standards of culturally-competent care is that the care be “respectful of and responsive to” those beliefs, practices, and needs. Cultural competence has gained traction in important policy and public health discussions, but enforcement of national standards is challenging. Moreover, the addition of linguistic considerations to the cultural competence model has diverted some of the earlier focus from blacks to language-diverse communities like Hispanics, Filipinos, and other ethnic groups.
The provider shortage and increasing demand might cause more people to reconsider their insistence on ‘buying black’ when it comes to mental health treatment, but it can still be a hard sell to convince African Americans to put their mental health in the hands of someone who doesn’t look like them. Dr. Nekeshia Hammond, principal of Hammond Psychology & Associates, 2017 President of the Florida Psychological Association, and author of The Practical Guide to Raising Emotionally Healthy Children says that cultural competence and same-ethnicity providers are important but “it is not recommended that someone not receive the care they need because there are not enough African-American mental health professionals in your area."
Perhaps arguments similar to those made to Blacks who are hesitant to date or marry non-Blacks; there is something to be said for simply connecting with someone despite differing race or gender. In that regard Dr. Hammond believes, “The reality is that one of the most important factors in a therapist-client relationship is a positive connection”, and she suggests people “look for a therapist who is culturally competent, but also place emphasis on someone you can trust and [with whom you can] feel comfortable discussing your concerns.”
Before access becomes the issue, it’s necessary to understand if professional care is warranted, what type of mental health professional will best meet the individual need and how to find one.
Part two of this series will discuss those issues.