It's difficult to uproot the stigma therapy has in minority communities. It's difficult to evolve in a culture that believes prioritizing mental health is a sign of weakness. It's difficult to let go of the notion that you must be strong when dealing with trauma. But the epidemic of mental health in minority communities is a serious problem we cannot in good conscience continue to ignore.
If the fact that between 1993 and 2012, suicide among African American children across the United States nearly doubled doesn't bring you into a genuine state of despair, I'm not sure what will. To make matters worse, in 2015, research found that there were significantly more suicides among black children ages 5 to 11 than in their Caucasian peers. This was the first study to observe higher suicide rates for black people than for Caucasians in any age group.
For black teens ages 10 to 19, the rate of suicides is three times higher in males than in females. And let this statistic settle in: Black adolescents and young adults have the highest rate of suicide of any age group of blacks. Suicide was the third-leading cause of death among blacks ages 15 to 19, fourth among those ages 20 to 29, and eighth among those ages 30 to 39. It would be impossible to claim this has nothing to do with the fact that mental conditions in minority communities are go largelt untreated, causing countless racial and ethnic disparities.
The reality is one in five American adults experiences a mental health issue in a given year. So it's time for us to tackle the issue head-on: We reached out to Joy Harden Bradford, MD, a licensed psychologist and the founder of Therapy for Black Girls, a platform that provides resources for women of color; and Dion Metzger, MD, a board-certified psychiatrist, professor, and health media expert who has been featured on The Doctors, the HLN network, and in The New York Times. They both happen to be women of color who are committed to breaking these barriers.
When asked to explore the inception of this epidemic within minority communities, Bradford addresses the start of slavery. "When you look at the history of this field in our country, it's very 'straight white male,'" explains Bradford. "All of the founding fathers and people who invented the field of psychology and psychiatry are white men. We, of course, were not even represented on the foundation levels of therapy. People running away from their slave owners used to be considered [to have] a mental illness; it was coined drapetomonia. Psychology has developed with historical roots of race in our country."
Metzger points out that taking care of your mental health has historically been perceived as a lack of strength. "Culturally, mental problems were considered a sign of weakness," says Metzger, who notes that this is especially true within African American and Latino cultures. Therapy was thought of as something rich, weak people do. It was considered a luxury people only did if they weren’t able to cope with a problem by themselves. Since the idea of mental health was shunned in slavery altogether, this has trickled down into devaluing mental health in minority communities today.
Often therapy and mental health concerns in minority communities are tied to religion and faith. "It's the idea that if you pray about it, you'll feel better," explains Bradford. "Or the idea that if you're struggling with mental illness, you have a weak relationship with God. Many of those factors keep people from reaching out for help. Saying, 'Pray about it' or 'You'll get over it soon' is not enough. We don't just pray about a broken leg; you actually have to go to the doctor to heal. Prayer won't always be enough, and that also may not be as important to everyone."
Metzger agrees: "With the church, it's like if you have to go to therapy, you're not praying enough—it's mutually exclusive," says Metzger. People never thought about the option of what if God gave you the resource or therapy? They saw it as you're turning away from God if you're going to therapy rather than leaning on God. They saw [therapy] as something that was competing with religion rather than something that [worked alongside it]. You can use your spirituality and bring that into therapy, rather than either/or."
How did we come to the notion that prioritizing our mental health signals that we're not strong? Bradford uncovers the truth: "Culturally, we've been conditioned to be afraid to admit that we're struggling—this is especially true for black women. The idea of being a 'strong black woman' keeps a lot of women from actually reaching out for help," explains Bradford.
"We're so busy taking care of other people that we miss taking care of ourselves. We're tending to family members and friends, which makes us miss symptoms that are going on for us. I want to make sure people of color especially are taking time to assess what types of things are going on in their lives and how they can be making different decisions that might lead to them living healthier, happier lives," Bradford continues.
But what does it take for people of color to realize that they need to seek professional help? "Black women in particular will get to a crisis point before they reach out, as opposed to when they first notice something is off," says Bradford. "It will be when they finally can't pull themselves out of bed or something serious happens. One of the very lit things about being a black woman is the feeling that we can persevere no matter what. Like, if you give us an obstacle, we will definitely overcome it 12 times over."
"Because we work so hard and strive for excellence, we miss symptoms," she continues. "We're pushing ourselves because we're not wanting to sit with the discomfort of what's truly going on with our mental health. We have to be careful not to get so caught up in being excellent for everyone else that we aren't prioritizing ourselves."
Fewer Therapists of Color
"The field of therapy is still majority white," Bradford says. "Even though in the directory I created for Therapy for Black Girls there are over 600 therapists, mostly black women, the field is still majority white. If people of color finally get to a place where they want to talk to someone, more often than not, I hear that people want someone who looks like them. If you can't find someone who looks like you that you’ll connect with, that can become a barrier for you reaching out for services."
Metzger also stresses the importance of representation in her field. "Therapy discourages a lot of people of color because they want a therapist who looks like them," says Metzger. "It's not a matter of racism; it's a preference. If you're a young black woman, there's a high chance that you're not going to feel that connection if you're going to an older white male therapist. Especially if you're already dealing with racial issues, it's hard for you to open up and be vulnerable because they're so different from you. Having a comfortable rapport with your therapist is so important. If we don't have enough therapists of color, that's a barrier."
Going back to the alarming statistics of black men having the highest suicide rates, a lot of that has to do with gender norms in our society. "With men, they're even more likely to be ridiculed for it because of masculinity," Metzger explains. "According to cultural rules, they just aren't supposed to get depressed and are supposed to provide for their families. On the women's side, it's always encouraged to talk to your friends and it'll pass."
"When you look at the way masculinity is defined in our country, it doesn't lend itself to black men and minority men reaching out for help," Bradford continues. "They're supposed to be a pillar of strength who has it all together and never lets anyone see them sweat. There isn't a lot of space created for people to come forward and say that. There are some changes with people moving forward to make those changes, but we definitely have a long way to go."
Beyond gender, even discussing mental health within minority families has a hushed history. "It goes to how we're typically socialized in our families. I've had conversations with patients who are worried about talking with families," Bradford says. "And the ones who've had them are questioned. In a lot of ways, when people do try to come forward their feelings and experiences, they are invalidated because we don't understand mental health. We think it's a personal failure, or if we pray hard enough that we shouldn’t struggle in that way, and that's not how anything works."
When you think of economic disparities within minority communities, it's understandable why the idea of seeking professional help is considered a luxury. "The issue is that insurance does not pay for therapy like it pays for other things," Metzger explains. "Most people who need weekly therapy have to pay for it out of pocket, and that excludes a whole socioeconomic status of people. Specifically, insurance companies are more likely to pay for a psychiatrist visit to talk about medicine to treat you quickly rather than 10 sessions of therapy. They see medication as being a faster option that doesn't require as many sessions—[insurance] is looking more at dollar signs. It's like insurance is choosing for us because of coverage. It's a part of a system that's really messed up."
Bradford agrees with the financial burden healthcare has on underprivileged families. "Even if you have insurance, it covers mental health, and your copay is $25 a session, for some families that's still a serious strain on the budget," explains Bradford. "If I have to choose between feeding my kids and going to therapy, you know what choice I'm going to make. When therapy is not seen as a priority or a value in our community, there's a real concern for mental health being accessible for people. There are communities that are offering services at a fraction of the cost, but a lot of those organizations are understaffed and not able to serve the whole community, so we need more resources."
Bradford decided to start her community, Therapy for Black Girls, after watching the Black Girls Rock Awards Show on BET the first year it was televised. "I wanted to get people just as excited about mental health as this award show did for black women," says Bradford while reflecting on her mission behind her organization. "I created the website as a way to make mental health more relevant and accessible. I wanted to create a space where people could get mental health information in a way that felt relatable to them."
The site has a large directory of over 600 therapists spread across the states, making it manageable to find a health expert in your area. There's also a podcast featuring Dr. Bradford and guest therapists who cover everything from grief to managing your anxiety. Dr. Metzger often recommends Ourselves Black and the National Alliance on Mental Illness as dependable resources on the internet for seeking professional help.
"We need to continue to have conversations in our circles," encourages Bradford. "Someone in your circle may have to take the lead and encourage you to seek help. Someone being brave enough to talk to their friends and family and share that they’re struggling may inspire someone else. You have to then make sure you’re being responsive and sensitive to someone who does share that they’re struggling. I'm encouraged by the shift and people becoming more open about therapy. It really normalizes it. Similar to you having a mani-pedi appointment, you have a therapy appointment."
"With the rise of suicide, there's been a change with people started to accept and go to therapy," Metzger explains. "We've made progress within the last five years. It's definitely become more accepted and more likely to be a topic of discussion rather than being swept under the rug. We need to keep it in the discussion so more people will learn about it."
Metzger also addresses the rise of the acceptance of therapy in the media, which has shifted the culture. "Culture is very influenced by the media. I always find a surge in people seeking out my help when I see TV shows or celebrities talking about therapy. For example, ABC's show Black-ish had an episode about postpartum depression. All of a sudden, I got an increase in calls of people wanting to talk about it because they've dealt with the same experience.
"Because mental health is seen more in the spotlight of storylines in movies, television, documentaries, and in the conversations in the media, it's being more normalized. People can identify with it, which is making them more likely to seek treatment." ■