Ethnic Disparities in Mental Health

A Look at African Americans

By Babe Kawaii-Bogue, MA*

Startled by the thunderous pounding on my office door, I jumped up to respond to the deep voice shouting through the door, “I’m gonna kill myself! I’m gonna kill myself!” Even though eight years have passed since this incident took place, I can still remember the expression on the man’s face as I swung open my office door. This African American man in his thirties exhibited a look of profound desperation as he struggled to hold back an inconceivable amount of inner pain. The man apprehensively revealed that his mother and two siblings were killed in a car accident a few week’s prior, and that he had no one supporting him with his recent loss. At this time, I was working in the mental health services division of Glide Memorial Health Clinic, which was founded in 1997 to address the comprehensive, unmet health needs of the homeless, uninsured, and government-insured inhabitants of the San Francisco Bay Area. I was drawn to Glide for its successful efforts in connecting African Americans with behavioral health and substance abuse services, with the intention of gaining a familiarity of community based interventions and preventative care.

Through my personal and professional experiences as an African American working in the field of mental health, I developed a keen awareness of the unmet behavioral health needs of African Americans. I represent one of many African Americans exposed to violence, poverty, a single parent, the child welfare system, malnutrition, familial incarceration, chronic health conditions, premature deaths, a family with limited education, and lack of access to quality behavioral and physical health care. Common chronic environmental stressors like these put African Americans at high risk for mental illness (United States Department of Health and Human Services, 2001). African Americans are afflicted with the highest rate of post-traumatic stress disorder of any ethnic group in the United States and the events leading to PTSD for African Americans tend to be persistent and chronic throughout the life-course (Roberts et al., 2011). Overall, research has shown that African Americans encounter a complex system of ineffective mental healthcare, with disparities existing in behavioral health severity, treatment utilization, accurate diagnoses, and treatment outcomes (Baker, 2001; Neighbors, 1989).

Currently, we recognize that African Americans are much less likely than non-Hispanic Whites to receive mental health and substance abuse treatment and less likely to receive these services for a treatment need prior to its severity (Breslau et al., 2005; Schmidt et al., 2006). We also understand that African Americans currently have lower rates of lifetime mental illnesses compared to non-Hispanic Whites, but that these illnesses are more severe and persistent, due to a lack of treatment (Breslau et al., 2005; Himle et al., 2009). For instance, in a national study, non-Hispanic Blacks were found less likely to use illicit drugs than Non-Hispanic Whites, equally likely to become dependent after initiating use, but more likely to remain persistently dependent (Warner et al., 2005).

While I was able to provide assistance and counseling services to the despondent man who came to my office door eight years ago and to many others since then, I wonder what might have happened if practitioners trained in cultural sensitivity and a local clinic aimed at meeting the mental health needs of African Americans did not exist. Would he have committed suicide? My encounters with individuals like him are constant motivations to continue examining cultural competency strategies for the delivery of behavioral health care within the African American community.

*Babe Kawaii-Bogue, MA is a Doctoral Student in the Joint Doctoral program in Social Work and Psychology at the University of Michigan

References:

Adebimpe, V. (1981). Overview: White norms and psychiatric diagnosis of black patients. American Journal of Psychiatry, 138(3), 279-285.

Baker, F. M. (2001). Diagnosing depression in African Americans. Community Mental Health Journal, 37, 31–38.

Breslau, J., Kendler, K. S., Su, M., Gaxiola-Aguilar, S., & Kessler, R. C. (2005). Lifetime risk and persistence of psychiatric disorders across ethnic groups in the United States. Psychological Medicine, 35(3), 317-327.

Himle, J.A., Baser, R.E., Taylor, R.J., Campbell, R.D. & Jackson, J.S. (2009). Anxiety disorders among African Americans, Blacks of Caribbean descent, and non-Hispanic Whites in the United States. Journal of Anxiety Disorders, 23, 578-590.

Neighbors, H.W., Jackson, J. S., Campbell, L. and Williams, D. (1989). Racial influences on psychiatric diagnosis: A review and suggestions for research. Community Mental Health Journal 25, 301–311.

Roberts, A. L., Gilman, S. E., Breslau, J., Breslau, N., & Koenen, K. C. (2011). Race/ethnic differences in exposure to traumatic events, development of post-traumatic stress disorder, and treatment-seeking for post-traumatic stress disorder in the United States. Psychological medicine, 41(1), 71-83.

Schmidt, F., McKinnon, L., Chattha, H. K., & Brownlee, K. (2006). Concurrent and predictive validity of the psychopathy checklist: youth version across gender and ethnicity. Psychological assessment, 18(4), 393.

U.S. Department of Health and Human Services. (2001). Mental Health: Culture, Race, and Ethnicity—A Supplement to Mental Health: A Report of the Surgeon General.

Warner, L. A., Kessler, R. C., Hughes, M., Anthony, J. C., & Nelson, C. B. (1995). Prevalence and correlates of drug use and dependence in the United States: results from the National Comorbidity Survey. Archives of General Psychiatry, 52(3), 219.