With protests against racial violence and injustice continuing across the country, many non-Black individuals are seeking to better educate themselves on Black experiences and put action behind their allyship. An anti-racist practice requires seeing, understanding, and validating disparate realities where they exist, and that extends to differences in mental health: due to systemic inequality and a legacy of racial trauma, Black Americans are more likely to experience certain mental health challenges, but less likely to be accurately diagnosed or receive appropriate treatment.
In order to better understand the impact of historical and temporal inequality, we interviewed Black therapists across the country on the state of Black mental health. We hope these reflections serve to help non-Black folks expand their understanding of Black mental health and advance causes that foster Black well-being and resilience.
1. Public acts of violence can have lasting mental health effects
Witnessing first-hand or having intense exposure to violent events can lead to emotional and psychological trauma, says clinical psychologist Dr. David Dove. In comparison to their White peers, studies have demonstrated Black Americans experience higher levels of post-traumatic stress disorder (PTSD).
Media coverage of high-profile killings of Black individuals – like those of George Floyd, Ahmaud Arbery, Breonna Taylor, and the many who came before them – may be triggering for members of the Black community. Within a week of Floyd’s publicized death, for example, the Census Bureau found that symptoms of depression and anxiety experienced by Black Americans increased to 41% – higher than any other racial or ethnic group in the country.
Race-related stress and trauma can lead to physiological, psychological, and emotional distress – all of which far outlast the news cycle associated with each act of violence. According to Dr. Dove, symptoms of racial trauma may include:
Physiological changes: Muscle tension, gastrointestinal troubles, etc.
Worsened executive functioning: Distracted, less able to concentrate or self-organize
Emotional distress: Feelings of distrust, vigilance, helplessness, guilt, shock, anger, and shame
Psychological disruption: Increased cognitive distortion, self-criticism, rumination, etc.
Behavioral changes: Primarily avoidance, procrastination, or escape (substances, eating, sex, etc.)
Chronic stress symptoms: Including, but not limited to, cardiovascular health issues
Mental health issues: Depression, anxiety, and existential hopelessness
2. Systemic racism causes Black folks to be at higher risk for misdiagnoses and under treatment
Due to a historically traumatic relationship with the healthcare system, many Black individuals who struggle with mental health challenges fail to access support when needed, says NYC therapist Amanda Jurist.
Those who do seek care also face the risk of going misdiagnosed. Men of color, for example, are commonly stereotyped as angry, says Jurist. “What one clinician may interpret as justified anger due to inequality and systemic oppression, another may view as pathological.” Similarly, one empirical study revealed that Black Americans may be over-diagnosed with schizophrenia, and under-diagnosed with mood disorders.
On a broader scale, this trend in misdiagnosis makes it more difficult for Black people to access mental health care: the percentage of Black Americans who receive mental health treatment is only about half that of their White peers.
3. Racial trauma is felt at both community and personal levels, and transmitted across generations
Racial trauma is complex and multifaceted in nature, says Dr. Dove, and can be conceptualized on two levels: historical and contemporary.
On the one hand, there are inherited or historical factors, including biological, familial, societal, and cultural trauma. In addition, personal experiences of racism and discrimination can cause deep distress in the present day.
Across generations, this accumulation of traumatic events has required the development of survival skills including fleeing, bracing, freezing, or disassociation that present as similar to the symptoms of depression, anxiety, and traumatic stress.
At the same time, healing processes have also emerged: “Standing with and for our lives, turning toward, changing what we can, tapping into individual and collective power and wisdom, and flexible boundaries is necessary,” says Dr. Melba Sullivan, a clinical psychologist in NYC. “Now more than ever, our ancestors want us to thrive.”
4. Having fewer Black mental health professionals makes it harder for Black folks to find a good therapist fit
A lack of available Black therapists is a potential obstacle to seeking treatment, says Nikole Barnes, a therapist in Rhode Island.
In the United States, although the Black community makes up 12% of the population and accounts for 19% of those affected by mental illnesses, only 4% of the psychology workforce is Black.
Shared identity is one of the most prioritized aspects of the therapist search – and this is no less true for Black individuals, meaning the lack of available Black providers can have a real impact on Black individuals' ability to seek care. At the same time, previous experiences or fear of misunderstanding and micro-aggression may make a Black individual less likely to seek therapy with a non-Black therapist.
5. Stigma can make it harder for Black folks to seek mental health care
Research shows that in the United States, Black individuals face significant disparities in mental health diagnoses and treatment; in addition to the systemic barriers to care, there are also interpersonal and cultural factors.
Jurist emphasizes the role stigma plays within Black communities and families in preventing treatment. “In many families, from a very early age, there is an unspoken rule that whatever happens in your house stays in your house,” she says.
Such stigma extends beyond the family, adds Dr. Kristel Carrington, a psychiatrist in NYC. The potential tensions within religious faith institutions regarding mental health treatment can be a barrier she explains, “as it causes an internal conflict in those who would otherwise seek treatment but fear it somehow speaks against their sense of faith.”
6. You can show support by checking in on your Black friends, colleagues, and loved ones
The importance of White and other non-Black people of color taking time to intentionally listen and elevate Black voices, rather than capitalize space with their thoughts and guilt, cannot be understated. That said, the words and actions of non-Black folks can also demonstrate solidarity and support.
If you’re not sure where to start, this honest and straightforward Twitter thread suggests ways you can help hold emotional space for friends, colleagues, and loved ones who are in the Black community with open-ended questions and affirmations such as:
- "What can I do for you?"
- "Is there anything you need right now?"
- "I am here if you need someone to listen."
7. There are organizations advancing Black mental health that you can support
There are small steps you can take to help to turn the tide against injustices and inequalities in the mental health world. One way is by donating to or raising awareness for organizations that advance Black mental health, such as the following:
- The Loveland Foundation, which provides financial assistance to Black women and girls seeking therapy
- The Black Journalists Therapy Relief Fund, which provides financial assistance for Black journalists facing financial hardship to access therapy.
- Dive in Well’s crowdfunding effort to amplify diverse voices in wellness.
- The Black Mental Health Alliance, which connects communities of color to behavioral health professionals.
8. Put in the work to understand your personal biases and privilege
While urgent action is vital, so too is an ongoing commitment to personal examination and difficult conversations.
Eliza Jaquez recommends that non-Black folks question their biases through research and self-study. She suggests looking into local anti-racist organizations, as well as the work of authors such as Ibram X. Kendi.
Therapy can also be a space for non-Black folks to explore their own racial identity, privileges, and biases, while processing the difficult emotions that may come up, such as sadness, solidarity, defensiveness, anger, and guilt. Therapy is a safe space to uncover where self-beliefs and perceptions of others are rooted, and your therapist can guide you through this exploration in a non-judgmental environment.
Here are some additional resources to get started:
Books and articles
- White Fragility: Why It's So Hard for White People to Talk About Racism by Robin DiAngelo, PhD
- The New Jim Crow by Michelle Alexander, the history of mass-incarceration in the United States
- Between the World and Me by Ta-Nehisi Coates, a letter from father to son on being Black in the United States
- Citizen by Claudia Rankine, a lyric on being Black in the United States
- How to Be an Antiracist by Ibram X. Kendi (plus titles from his Anti-Racist Reading List)
- Are Prisons Obsolete? by Angela Davis, an exploration of prison abolition
Podcasts
- Let’s Talk About Whiteness (Krista Tippett, with Eula Biss)
- Seeing White (John Biewen, with regular guest Chenjerai Kumanyika, PhD)
Movies and videos
- 13th - Ava DuVernay, a documentary exploring race, justice, and mass incarceration in the United States
- How Studying Privilege Systems Can Strengthen Compassion Peggy McIntosh, a TEDx talk on issues of privilege through the lens of race, gender, and class
- Black Feminism & the Movement for Black Lives Barbara Smith, Reina Gossett, Charlene Carruthers; a panel on Black Feminism
- Reimagining Policing with former President Obama
Resources on black mental health
- Black and African-American Mental Health: Disparities in Diagnosis and Treatment
- 7 Mental Health Tips For Black Folks From Black Therapists
There are many ways that non-Black folks can step up as an active ally, paying respect to and validating the many fights that have preceded this one. And, despite painful legacies, as Dr. Sullivan says, “It is as important to acknowledge the resilience and resistance of Black people. We wouldn't be here if that wasn't the truth of who we are.”