Mclean Hospital

How Can We Break Mental Health Barriers in Communities of Color?

By Christine M. Crawford, MD, MPH

January 30, 2019

When I was in medical school and did my psychiatric rotation, I immediately knew psychiatry was my calling. However, when I announced to my friends and family that I had decided to become a psychiatrist instead of specializing in another field of medicine, the response I received was one of disappointment and, in some cases, disgust. One person asked why I didn’t want to become a “real” doctor. Another asked why I would want to work with “those” people.

It was a struggle for me to hear these things from the people closest to me—a group of individuals whom I knew to be compassionate, smart, and supportive to others. That’s when I truly understood the depth of mental health stigma in the black community. Ironically, as my career as a psychiatrist progressed, I came to learn that many of the individuals who responded most negatively to my career choice were the very people I was dedicating my life to helping—African Americans who silently live with mental illness for fear of being judged.

The stigma of mental health isn’t anything new to the black community—Dr. Martin Luther King Jr. reportedly had severe depression during periods of his life and refused psychiatric treatment, even when urged to seek care by his staff. Unfortunately, that scenario continues to be a common one today, with African Americans not seeking mental health care because of stigma.

We can all work together to recognize and address this challenge, but to do so, we must understand where it comes from and why it is so ingrained in our culture.

Deconstructing Stigma participant Dominique
McLean’s Deconstructing Stigma campaign, including participants like Dominique, is fighting mental health stigma

The root of mental health stigma among blacks can be traced back to slavery, when it was commonly thought that slaves were not sophisticated enough to develop depression, anxiety, or other mental health disorders. Bred from those historic misconceptions, we learned to ignore mental illness or call it other terms, like “stress” and “being tired.” These nuanced descriptions for depression and other mental illnesses that the black community has adopted and passed on from generation to generation leads to underestimating the effects and impact of mental health conditions and beliefs that a psychiatric disorder is a personal weakness. All these factors have created a culture that is fearful and uninformed about mental illness.

Things Can Change

Despite the lack of acknowledgement about mental illness in communities of color, we know that African Americans develop mental health conditions at a rate equal to anyone else but are far less likely to seek care. Statistics tell us that about 25% of African Americans seek mental health care, compared to 40% of whites. There are a number of factors that lead to this, including African Americans feeling marginalized, the lack of cultural sensitivity by health care professionals, and the reliance on family, community, and spiritual support instead of medical or psychiatric treatment—even when it is critically necessary.

Each one of us can make a difference in the lives of African Americans who need mental health support.

By recognizing that the black community has unique experiences when it comes to mental illness, we—as citizens of the world—are beginning to chip away at the stigma that permeates through the culture. Not just those of us in the mental health field, but everyone. There are things that we can all do in our everyday lives to become an ally to someone—especially in the black community—experiencing mental illness.

We can all work to:

  • Bring awareness and mindfulness to the use of stigmatizing language around mental illness
  • Educate family, friends, and colleagues about the unique challenges of mental illness within the black community
  • Become aware of our own attitudes and beliefs toward the black community to reduce implicit bias and negative assumptions

Deconstructing Stigma

McLean Hospital is recognizing and addressing the barriers that prevent African Americans from accepting mental illness as something that is treatable and nothing to be ashamed of. Through a collaboration with the Boston chapter of the NAACP, McLean’s Deconstructing Stigma campaign is working to showcase mental health in communities of color.

Local volunteers are bravely telling their mental health stories:

“Stigma is an evil roadblock that makes people feel ashamed of the struggle they are going through every day and makes them afraid to seek help.” – Ivy

“Mental illness does not discriminate. No matter what age, color, or religion, anyone can live with mental illness.” – Richard

“Mental illness in the black community has long been a touchy topic. The overriding belief is you don’t go to therapy or counseling or take medicine. You go to church. And you don’t talk about your business to anybody. You put on your big girl pants and keep it moving. That’s what I did, except I wasn’t going anywhere.” – Cynthia

This collaboration is one small step toward acceptance, and I am encouraged by the positive feedback it has seen so far in the Greater Boston area. But much more work can be done—by all of us.

We live in a diverse world, and each day we interact with people of a variety of backgrounds. The more we understand the unique differences that make us distinct, the more we will we come together in the understanding that there is no shame in having a mental illness—regardless of our culture and background.

Christine M. Crawford, MD, MPH, is a second-year child and adolescent psychiatry fellow at McLean Hospital as well as a graduate of the McLean-MGH Adult Psychiatry Residency Training Program. Dr. Crawford has a strong interest in mental health stigma within the black community and has been actively involved in developing mental health educational programs for multiple community-based organizations including the Boston chapter of the NAACP and the National Alliance on Mental Illness (NAMI). She also currently serves as the community outreach officer for the Residents and Fellows Committee for the MGH Center for Diversity and Inclusion.