A look at disparities in mental health services
Many in the field would say that the disparities in mental health services for African-Americans are detrimental to the state of black people’s public health.
Back in medical school, Dr. Carl Bell knew the least about mental health disorders, which is why he wanted to focus on psychiatrics rather than other medical practices.
He is now the CEO and president of the Community Health Council and director of the Institute for Juvenile Research at the University of Illinois in Chicago. He has dedicated much of his career to the treatment and prevention of mental health disorders among African-Americans—a service that remains underserved and underfunded.
“It’s really hard getting mental health services in black communities,” says Bell. “These services are a scarcity, because there is no consideration for poor people with mental illnesses.”
Bell says there is little to no research on how to properly treat blacks suffering from schizophrenia, bipolar disorder, depression, drug and substance abuse, and other mental illnesses, mainly because no one has devoted time to understanding the social and cultural issues affecting poor black communities. Access to good health care and modern treatment is a major factor as well.
A new national report by the Substance Abuse and Mental Health Services Administration (SAMHSA) reveals that 20% (45.9 million) of American adults age 18 and older experienced a mental illness last year. The rate of mental illness was more than twice as high among young adults ages 18-25 than it was for adults age 50 and up. And women were more likely than men to have been diagnosed with a mental illness in 2011 (23% vs. 16.8%).
Rates of mental illnesses in African-Americans are similar to those of other races. The limited research available suggests that African-Americans are more likely to have schizophrenia than any other group, notes Bell. In general, about four in 10 people who experienced a mental illness in 2011 received services, according to SAMHSA. Alone, only one out of three African-American patients who need mental health care gets properly treated.
Services that are available for blacks are commonly accessible in jails, prisons and child protective service agencies. The underlying reason is that these places are where many blacks end up due to their uncontrollable and misunderstood behaviors. This perpetuates a racial stigma that has existed for decades.
“This is America, where we’ve spent centuries saying whites are the majority and blacks are the minority, so who cares?” says Bell, who is African-American and has experienced discrimination as a general patient. “Go to a white community, and you’ll find private mental health services with modern technology. Go to a poor black community and…nothing.”
He adds, “It’s a lack of cultural sensitivity.”
Historically, prior to the ’60s, psychiatrists theorized that African-Americans could not get bipolar disorder, nor could they suffer from depression. A lot of the literature around psychiatric disorders in African-Americans was negative and racist, says Bell.
During the 1960s, all references to race and ethnicity in medical literature were dropped. All research was focused on the “general population,” i.e., upper- and middle-class whites. Mental health research did not incorporate understanding of racial and ethnic groups.
Small studies made an effort to improve mental health awareness for African-Americans over time. It wasn’t until 2001, when former Surgeon General Dr. David Satcher released Culture, Race and Ethnicity. A Supplement to Mental Health: A Report of the Surgeon General, that disparities in mental health were extensively addressed on a national platform.
“Before then, we didn’t know anything about mental health issues in black people,” says Bell.
Today, Bell credits the work of the University of Michigan, along with his own research and public health initiatives, to the improvement of mental health research for African Americans.
But there are disparities that remain, such as receiving quality care and mental health awareness. According to the National Institute of Mental Health, diverse communities are underserved by the nation’s mental health system. There are barriers to the access and quality of care—from insurance coverage to modern technology. Compared to the general population, African-Americans are more likely to stop treatment early and are less likely to receive follow-up care.
African-Americans are suspicious and reluctant to receive prescription treatment and medication. Bell says he does not blame them. “When is the last time blacks got the benefit of modern medical care?” he probes.
“Based on racism and discrimination, I can understand. Black people think there is a genocide plot to putting them on anti-depressants. If they are experiencing something, they first go to their pastor, then their general practitioner, then, maybe, a mental health person.”
He adds: “I receive skepticism when I treat African-American patients all the time. They always say, ‘You’re trying to put me on drugs.’”
To help change these behaviors, Bell has shifted much of his work to prevention rather than treatment. He has been aggressively campaigning to change the cultural insensitivity that resides in mental health services.
He has also worked with the Obama administration, which is moving to promote the use of mental health services through health reform so that people, families, and communities will benefit from increased access to care.
“The Obama administration gets it. A lot of stuff around prevention of mental health [illnesses] is included in health care reform,” says Bell.