By Nashira Kayode
It's no secret that Black men face a unique set of circumstances in our world; economic, health care and educational disparities, as well systemic racism and social injustice. These factors create a world in which Black men often feel like society does not value their lives, let alone their thoughts and feelings. This has resulted in Black men being less likely to seek treatment for mental health services, and when they do, they are more likely to receive inadequate care.
The ultimate consequences have been devastating for the Black community. Suicide is the third leading cause of death for Black or African American men ages 15-24. The mental health crisis is particularly evident in the case of Black men; in 2018, the suicide rate for Black or African American men was four times greater than for African American women.
There is significant research and statistical data documenting the problems that lead to Black and African American men lacking sufficient access to quality mental health services. However, the solutions, such as cultural diversity and cultural sensitivity, are so broad it’s hard to understand what benefit they provide. Here are what these broad concepts actually look like in practice.
There are many specific tasks and skills clinical providers can implement to increase Black and African American men’s successful participation in mental health services. The following factors should be considered:
Clinicians should acknowledge that everyone has personal biases, and responsible practitioners must take steps to recognize and identify such biases. This needs to be done in a more specific manner than just introspection. Using tools, such as the Implicit Association Test (IAT) from Project Implicit, which assesses biases such as “skin tone” and “race,” should be used to identify areas of concern. Once identified, individual practitioners and agencies can take steps to specifically address the concerns of bias on an ongoing basis — including follow up assessments.
Black Americans are often over diagnosed with severe mental illnesses, such as schizophrenia, and they are underdiagnosed for mood related disorders, like depression and anxiety. They are also less likely to be offered medication for their diagnosis, even when appropriate and covered by health care.
Implementing evidence-based screening and assessment tools that follow a biopsychosocial spiritual model — a treatment modality that takes into account biological, psychological, social and spiritual factors when assessing and treating an individual — will increase the efficacy of culturally sensitive diagnosis and treatment. These types of tools, such as the Cultural Formulation Interview (CFI) from the American Psychiatric Association (APA), assist by focusing clinical attention on the patient's perspective and social context. This should be used in conjunction with the DSM-V. For example, Black men may express fear and caution regarding government agencies. This fear and caution could be seen as “paranoia” or irrational fear — if taken out of context from the Black experience in the U.S. If a practitioner were to interpret this perspective as a symptom like paranoia and turn to the DSM-V, they could diagnose a patient with schizophrenia. However, given the context of the Black experience of witnessing policy brutality, discrimination, unethical medical experiments, etc. such beliefs and fears are not irrational. Therefore, a schizophrenia diagnosis would be incorrect. Using tools that center the client perspective, rather than the clinician perspective, account for this critical context.
Active listening is important to all successful treatment, but it is even more crucial when working with Black clients in order to build rapport. Treatment interventions should validate and empower the client, normalize their feelings and empathize with the unique struggles they face in regards to racism and discrimination. Clinicians must understand and accept the impact these factors have on the presenting problems and symptoms that have led them to your care.
Practitioners should also strongly consider implementing specific interventions that have shown to have more successful treatment outcomes, like talk therapy, narrative therapy and talking and healing circles.
Talk therapy provides the client an opportunity to discuss feelings and emotions. This is especially vital to Black men who often do not feel they have the opportunity to express themselves and be vulnerable in addressing their lived experience.
Narrative therapy provides both the client and clinician the opportunity to separate the client from the problem. This technique, which relies on a client expressing a problem using storytelling, allows them to externalize — rather than internalize — damaging beliefs. After a client articulates a particular challenge, the clinician then helps them to explore other “storylines” to solve the problem. Using this model, the client is protagonist of the story —the designated “expert” — which allows for them to provide context and meaning to their unique life situations, so that they are not diagnosed incorrectly. This is especially important for this population that often fears that their trauma will be seen as only a mental health problem.
Healing circles are cost effective and have been shown to have timely results in reduction of symptoms. These groups provide clients with an opportunity to share their lived experience in a nonjudgmental environment. Ultimately, allowing clients to share their lived experience provides validation and creates a sense of community.
Clinicians should actively incorporate patients’ spiritual or religious values into treatment, as appropriate. Although research indicates that younger generations (namely Millennials and Gen Z) are less religious than older generations, Black Americans continue to place a higher importance on spirituality as composed to other groups. Additionally, evidence suggests that spirituality is often a protective factor for Black Americans fostering hope and resiliency.
If we do not address Black men's mental health, we risk further inequality and marginalization of this population. As Black men are already more likely to be overlooked and underserved in the health care system, not addressing their mental health needs can lead to greater disparities in access to care, poorer quality of life and long-term damage to physical health and well-being. We must ensure that Black men have access to culturally competent mental health services and that their voices are heard in the conversation about mental health.
Furthermore, failing to meet the mental health needs of Black men also risks the well-being of their families and larger communities. Mental health issues lead to increased risk of poverty, substance abuse and violence and incarceration — factors that already disproportionally affect Black communities. It's time we consider mental health for this population a priority. Clearly, we can no longer wait to do so.
Dr. Nashira Kayode is a therapist, consultant and author based in Southern California. Dr. Kayode has practiced in the mental health field for more than 17 years and is an expert with the State of California Board of Behavioral Sciences. To learn more about Dr. Kayode or mental health visit her website.
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