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A new study looking at barriers to mental health services among Blacks/African Americans in the hopes of finding ways to remove these barriers has found that Black people with a college education do not seek mental health care even when they think they should. 

“Being Black is not the problem just as race is not the problem,” study author Sirry M. Alang told us. “It is racism that is the problem.”

The study is titled: Mental Health Care Among Blacks in America: Confronting Racism and Constructing Solutions, and was written by Alang from the Program in Health, Medicine, and Society, Department of Sociology and Anthropology, at Lehigh University, in Bethlehem, Pennsylvania.

“I chose this topic because compared to Whites, Black people are less likely to seek  treatment for mental health problems, given the same health insurance, income, education, symptoms and mental health literacy,” Alang told us. “In addition, when they do seek mental health care, the services they receive are of poor quality compared to the services White people receive. I wanted to find out what was driving this inequity.” 

Alang knew from previous research that cost is a major factor, and that for some people, mental health services were either not readily available or were not appropriate and that services did not take into consideration the specific needs and perspectives of individuals.

“So I was hoping to hear much more of this and how it plays out among Blacks,” Alang told us. “I expected racism within the mental health service system to play a significant role; mostly interpersonal racism in the form of provider bias and racial micro-aggressions.”   

Alang used secondary data from the National Survey on Drug Use and Health that was collected by the Substance Abuse and Mental Health Services Administration. Among Blacks who said they needed mental health care but did not receive it, Alang examined the reasons that they provided for not receiving care. 

“I also looked at factors – socio-demographic, need, health status, health insurance – that were associated with reasons for unmet mental health needs,” Alang told us. “In the second phase of my research, I held focus groups with Black people, including Black mental health providers to really discuss the results from the survey in the context of racism.”

In the focus groups, Alang asked directly about how racism is connected to unmet need and to the other reasons given for unmet need in the survey. Alang also asked about how to address racism. From the focus groups, Alang found that historical and present day racism explains why Blacks/African Americans with a college education do not seek mental health care even when they think they should. Alang says Black people do not want to experience double discrimination (discrimination based on race and mental illness discrimination).

“This is a particularly significant fear among Blacks in higher socioeconomic positions where they are evaluated by Whites and side-by-side White colleagues,” Alang told us. “Because mental health systems have punished and criminalized the behaviors of Black people, historical institutional betrayal has led to mistrust in mental health systems.”

Alang says that in addition, black people might not seek mental health care because they want to avoid exposure to racial micro-aggressions in mental health settings in addition to the race they face in their daily lives. 

For the most part, Alang wasn’t surprised with the results of the study.

“I knew racism played a factor,” Alang told us. “But what I was surprised by is that institutional and interpersonal racism experienced elsewhere such as at work, school, on the streets, prevented people from using mental health services because they expected to be treated unfairly in/by the mental health system as well.” 

Alang says if we want to address the unmet need for mental health care or untreated mental illnesses among Black populations, we must address racism. In order to address racism, Alang says we must continue to learn about how it manifests within the delivery of health services.

“It is important to teach about the history of racism in medicine to clinicians, and to teach how racist ideas including racial micro-aggressions affect the use of mental health services,” Alang told us. “It is easier to talk about racial inequities in mental health than to talk about racism in mental health. We have to change that. There is nothing inherent about being Black that places black people at risk for untreated or under-treated mental illnesses...So for Black people, it is the negative experiences associated with being Black that leads to poor mental health outcomes. If we really want to talk about reducing risk for untreated mental illness among Blacks, we aren’t going to ask Black people to change their race. But we certainly can change how institutions and individuals make it harder for Black people to seek mental health care.”