Exploring Black Mental Health: 6 Ways Clinicians Can Support Black Individuals
February is Black History Month - a month dedicated to celebrating Black accomplishments and contributions to American society as well as honoring the sacrifices of African Americans throughout history.
This month, as we should every month, we reflect on the past and look for ways to construct a more equitable and accessible future for people of color. There’s no better place to start than the field of behavioral health.
To most, the behavioral health industry is viewed as fairly progressive and inclusive. It is important, however, to recognize that the industry has perpetuated deep inequalities in the treatment of Black individuals throughout history. So much so that the American Psychological Association released a statement a few years ago acknowledging the role it has played in perpetuating racism, racist stereotypes, and lack of accessible services to people of color. That same year, The National Association of Social Workers also published a similar apology.
To advance the field of behavioral health and work toward high quality and equitable care for all, organizations everywhere first have to acknowledge the industry’s transgressions to people of color. Together, we must design a path forward that is inclusive and takes into consideration the cultural differences in environment, symptoms, and strengths of Black Americans.
The hard truth is that people of color are disproportionately affected by racial trauma and mental health concerns while also being the least likely to receive treatment.
Reasons for this include stigma, lack of resources, lack of access, lack of trust in healthcare professionals, racist encounters in the healthcare system, and lack of cultural humility.
Statistics show that Black Americans are more likely to experience persistent emotional distress, yet only approximately 1 in 3 will receive treatment or seek services. If they do see a mental health care provider, they are likely to terminate services early.
Further, Black Americans are far too often misdiagnosed with serious mental health issues, starting as early as childhood. A recent research study found that even Black women’s symptoms of depression present differently from those outlined in the DSM-5 TR – as they are more likely to exhibit symptoms of increased sleep disturbance, self-criticism, and irritability rather than low or sad mood.
Black individuals face systemic racism daily - much of which is not evident to others - and often have to navigate institutional systems with limited knowledge.
With this in mind, it is imperative that behavioral health providers understand intersectionality and how intersecting identities can influence and shape how a client may present. By increasing understanding around the everyday experiences of people of color and increasing awareness around the inequalities they face, providers can better advocate for their patients and help those individuals learn to better advocate for themselves.
Below are six ways clinicians can adjust their practices to better account for the experiences of Black individuals.
(1) Actively practice antiracism.
Confusing as it may sound, being “antiracist” is not the same as simply not being racist. Being antiracist is actively fighting against racism. “Racism takes several forms and works most often in tandem with at least one other form to reinforce racist ideas, behavior, and policy.” (Source)
Learn more about antiracism and how to practice it using the resources listed under Learning Opportunities.
(2) Move from a model of ‘cultural competence’ to one of ‘cultural humility.’
The concept of “cultural competence,” which is widely taught in medical schools, health-related professional associations, and government entities across the country, is inherently problematic. It reinforces generalizations about cultures and suggests an end point–as if one can learn all there is to know and understand about any culture.
Many people of color that have attended therapy with a clinician who was not from their culture indicate experiences that do not feel safe where the clinician had to either be educated on their culture or assumed to apply situations to the client based on their identity - which was not always accurate.
Cultural humility, on the other hand, approaches treatment from a learning and compassionate lens, assuming the individual is the expert and one can never know all there is to know about another person’s culture–but you can continuously learn, self-reflect, and evolve over time.
Venn diagram on cultural competence vs. cultural humility
by Dr. Nathalie Edmond, PsyD
(3) Acknowledge the power imbalance in the room. Even if you are a clinician of color, you have an implicit role of privilege from your position. Simply by being there, the client is being vulnerable with you.
When working with Black clients (or any client with a marginalized identity), be consciously aware of the power imbalance in the room. Ask the client how they feel about working with a clinician who is of X identity and allow the client to share.
In your practice, try directly acknowledging your privilege and invite clients to correct you or share when they feel like you have used your privilege and power in the therapeutic space or relationship inadequately or inappropriately.
Alternatively, consider introducing an activity in which the client completes an exploration of intersectionality to describe, acknowledge, and write down all of their identities. This can help individuals become more aware of themselves and how navigating through the world impacts those identities. It can also help you, as their clinician, acknowledge and better understand their experiences.
(4) Use the power of storytelling to understand the client’s perspective.
Many cultures of color are familiar with storytelling as a therapeutic exercise. This can come in various formats such as oral storytelling, writing, poetry, and music. Offering this outlet can provide a way for clients to recount experiences and their impact on them in a safe and familiar manner without being too direct or abrasive in the therapeutic process.
Therapists can utilize ‘Narrative Therapy’ techniques which view the client separate from the problems and destructive behaviors they engage in. Narrative Therapy explores the power of language to help clients make sense of their own experiences, understand how interactions shape their reality, and understand how people can have different realities despite sharing an experience.
To learn more about the power of utilizing storytelling and narratives in therapy and how it impacts the brain, read ‘Telling Our Own Story: The Role of Narrative in Racial Healing’ by the W.K. Kellogg Foundation.
(5) Utilize an inverted diagnostic model that is holistic.
As previously noted, Black individuals are often overdiagnosed with serious mental health issues. One way to combat this issue, according to Drs. Jocelyn Markowicz, PhD and Bill Johnson, PhD., in their course Centering Anti-Racism in Counseling with African American Men, is to start with the least possible diagnosis first and seek evidence to change that initial diagnostic impression. This helps challenge our natural assumptions and expectations about what we think the client is experiencing or how they present.
This is also why it is important to evaluate clients from a holistic perspective and understand that a patient may present with symptoms and racial stressors that are uncontrollable and unchanging. You should ask about common, but “nontraditional” forms of trauma as well, such as racial trauma, religious trauma, and environmental trauma–all of which can greatly influence and impact health.
The Mirah platform includes several measures to assess trauma, including the Racial Trauma Scale (for Mirah customers this can be found in the Guides section of your Mirah site).
(6) Become more educated and aware of the experiences of Black people. Listen and allow them to share without interjection and taking the safe space from them.
We can all benefit from learning more about the experiences of others and challenging our own biases and prejudices. Particularly important for clinicians, organizations, and their leaders, doing so creates awareness of the challenges that shape the daily lives of others, including their own employees and clients.
Learning Opportunities
Regardless of your race or profession, below is a list of resources for beginning to broaden your own cultural awareness.
Participate in continuing education and training opportunities. Read about issues that focus on diversity and the experiences of Black individuals in the context of behavioral health.
Attend the Multicultural Assessment Conference founded by Dr. Tanisha Drummond, Dr. Shalena Heard, and Dr. Linda McGhee. The conference was designed to educate clinical professionals on the art of clinical assessment. It covers topics such as culturally competent assessment measures, implications of cultural diversity in assessment (e.g., race, ethnicity, SES, religion, trans health needs, sexual orientation), and the unique presentation of various disorders in culturally diverse children and adults. Follow their Facebook page for updates and consider joining their private Facebook group.
If you work with youth, take the free, virtual training titled Youth Racial Trauma First Aid Training by Steven Kniffley Jr., PsyD, MPA, ABPP and the Collective Care Center.
Receive training in the Kniffley Racial Trauma Therapy Model (KRTTM) training program.
Attend the Racial Trauma: Assessment and Treatment Techniques for Trauma Rooted in Racism seminar by Monnica T. Williams, PhD.
Read Managing Microaggressions: Addressing Everyday Racism in Therapeutic Spaces by Monnica T. Williams, PhD.
Read and follow Nathalie Edmond, PsyD to learn more about anti-racism and trauma for learning opportunities and training as an individual, clinician, and/or organization.
Learn more about race, racism, and racial trauma.
Watch Racial Identity and Antiracism by Dr. Nathalie Edmond, PsyD.
Watch How to Be an Antiracist and/or read the book How to Be an Antiracist by Ibram X. Kendi.
Read Being Anti Racist by the National Museum of African American History and Culture at the Smithsonian.
Read The Racial Healing Handbook: Practical Activities to Help You Challenge Privilege, Confront Systemic Racism, and Engage in Collective Healing by Anneliese A. Singh.
Watch What is Structural Racism by the Othering & Belonging Institute.
Take the implicit bias test by Project Implicit to understand what your implicit biases are and become more aware of them.
For leaders and organizations, listen to this podcast episode about engaging with diversity, equity, and inclusion in the workplace.
Seek consultation from a clinician who specializes in working with Black clients, especially when it comes to issues of race and culture.
Authored by Tierra Ledet, M.Ed., LPA, a licensed mental health professional specializing in assessment, education, & advocacy. She is the founder of Mentalli.
