Issues of Mental Health
Despite many years of fighting against racism and discrimination, African Americans are still faced with these obstacles in all areas of their lives, including the search for mental healthcare. Finding culturally sensitive rehab programs remains a challenge, especially in a society where the fields of psychiatry and addiction treatment are dominated by the needs of white Americans. According to the National Alliance on Mental Illness (NAMI), African Americans are about half as likely to use mental health services as Caucasian Americans. The National Healthcare Disparities Report states that in 2008, only 50.6 percent of blacks who had a major depressive episode sought treatment, compared with 57.4 percent of Hispanics and 70.4 percent of whites. NAMI confirms that African Americans are 20 percent more likely than the rest of the US population to experience severe forms of mental illness, such as major depression, post-traumatic stress disorder (PTSD), and attention deficit hyperactivity disorder (ADHD), as well as higher rates of suicide among African American men.
When faced with a mental illness like depression or anxiety, African Americans may be more likely to turn to family members or spiritual leaders for support, rather than seeking mental healthcare from white practitioners. The relatively low number of black mental health practitioners, combined with a lack of cultural training among the predominantly white practitioners, contributes to distrust and a reluctance to seek care. Instead of getting help in the early stages of a mental illness, African Americans may wait until symptoms become more severe, requiring more aggressive treatment.
African American individuals also have higher rates of exposure to life events or conditions that can worsen mental illness or discourage treatment, such as the following:
- Racial discrimination
- Lack of healthcare coverage
Office of the Surgeon General, lack of insurance is one of the greatest barriers to mental health treatment, with nearly one-fourth of African Americans uninsured or underinsured. This barrier may be reduced by the Affordable Care Act, which makes mental health coverage and substance abuse treatment mandatory among most programs and increases the availability of care.
When mental illness is combined with substance abuse, the search for treatment may become even more challenging. SAMHSA estimates that in 2014, 3.8 percent of African Americans had some form of mental illness combined with drug or alcohol addiction, compared with the US average of 3.3 percent. Substance abuse can worsen the symptoms of mental illness and may make it more difficult for clinicians to diagnose serious psychiatric conditions like depression, anxiety, bipolar disorder, or schizophrenia. Mental illness combined with substance abuse, a condition known as a dual diagnosis or co-occurring disorders, must be addressed through an integrated treatment program that combines recovery services with intensive mental health treatment.
Treatment Needs among Black Clients
While rates of illegal drug use may be higher among African Americans, statistics show that more members of this group receive treatment at specialized facilities than Hispanics or whites. In 2013, the NSDUH reports that among those Americans who needed treatment for illicit drug use, 21.3 percent of blacks received treatment at a specialty facility, such as a clinic or rehab center, compared with 17.3 percent of the rest of the population. Similarly, more African Americans received treatment for alcohol abuse at a specialty facility than other groups (13.5 percent versus 7.6 percent).
Contrary to cultural assumptions about high rates of drug abuse among poor African Americans, the NSDUH indicates that African Americans with an income 100 percent below the Federal Poverty Level were actually less likely than other racial groups to need treatment for substance abuse. While African Americans with health insurance were less likely to need substance abuse treatment, 15.4 percent of those who did need treatment sought help, compared with 8.7 percent of other racial groups. However, a study of retention rates published in Psychiatric Services indicates that while admission rates for cocaine and alcohol abuse treatment are relatively high among African Americans, dropout rates and lack of compliance are also high.
In order to provide more effective, personalized substance abuse treatment and psychiatric care to African Americans, practitioners in this field must learn to address each client as an individual, considering all of the variables that affect his or her mental health. An article published in Minority Nurse points out that many clinicians do not consider the multiple sociocultural factors that can influence substance use or mental illness in African Americans when they assess and treat these patients. These variables include:
- Income level
- Cultural background
- Spiritual orientation
Spirituality, in particular, should be emphasized as a coping mechanism for African Americans, who have traditionally used their spiritual beliefs and religious practices as sources of strength and support in the face of adversity. Practitioners should also take into account the importance of the family and community in recovery, and the need to engage family members in the treatment process for African American clients.
A motivational approach to treatment may improve retention rates and encourage compliance with treatment among African Americans. Cultural Diversity & Ethnic Minority Psychology proposes that Motivational Interviewing (MI) may be an effective way to keep African American clients engaged in treatment and encourage them to adhere to their recovery program. MI is a client-centered clinical approach based on the principles of empathy and therapeutic collaboration.
The goals of this modality include:
- Helping the client overcome resistance to treatment
- Working with the client to identify personal motives for change
- Aiding the client in rebuilding self-esteem
- Helping the client develop self-efficacy, or the ability to cope with challenges effectively
Although research studies on the effectiveness of MI among African Americans in substance abuse treatment have not been conclusive, the preliminary results are promising. There is an urgent need in the fields of mental health and recovery services for an approach that reflects African American experiences and perspectives. Providing a supportive, culturally sensitive environment is the key to engaging these clients in treatment and helping them overcome the barriers to recovery.