Mental Health

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


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 Medicine35(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 medicine41(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 assessment18(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 Psychiatry52(3), 219.

Mental Health

SAMHSA Launches Mental Health Campaign for the African American Community

(From the SAMHSA news release, 2/23/10)

The Substance Abuse and Mental Health Services Administration (SAMHSA), working in collaboration with the Ad Council and the Stay Strong Foundation, announced today the launch of a national public service advertising (PSA) campaign designed to raise awareness of mental health problems among young adults in the African American community. The new PSAs were unveiled at a Black History Month event at Howard University this morning to coincide with the first annual HBCU National Mental Health Awareness Day. The launch was telecast to colleges and universities nationwide.

Mental illnesses, including depression, anxiety, bipolar disorder and schizophrenia, are widespread in the U.S. and often misunderstood. According to SAMHSA, in 2008 there were an estimated 9.8 million adults aged 18 or older living with serious mental illness. Among adults, the prevalence of serious mental illness is  highest in the 18 to 25 age group, yet this age group is also the least likely to receive services or counseling.  In 2008, 6.0 percent of African Americans ages 18-25 had serious mental illness in the past year. Overall, only 58.7 percent of Americans with serious mental illness received care within the past 12 months and the percentage of African Americans receiving services is only 44.8 percent.

“Raising understanding and attention to these issues within the African American community will provide greater opportunities for those needing help to receive effective mental health services,” said Kathryn A. Power, Director of SAMHSA’s Center for Mental Health Services.

Created pro bono by Grey Worldwide through the Ad Council, the campaign aims to promote acceptance of mental health problems within the African American community by encouraging, educating and inspiring young adults to step up and talk openly about mental health problems. The television, radio, print and Web ads feature real personal stories of African Americans dealing with mental health problems, and they aim to engage those in the community to support young adults who need help. The PSAs direct audiences to visit a new website,, where they can learn more about mental health problems and how to get involved.

Click here to read the press release.