Growing up in a military family, Aisha Shabazz moved many times throughout her childhood. Though the move to Delaware in 2000 was the most trying. In the past, she made friends quickly and had a sense of belonging. Now thrust into a school of a couple thousand kids, the then 15-year-old was a bullied outsider. The experience left her dejected and disconnected. 

A nurse, noting her demeanor during a physical for the track team, suggested she see the campus counselor. “She asked my parents to come in for a family session because I was exhibiting signs of depression,” says Shabazz, a licensed clinical social worker (LCSW). “My dad refused to attend and my mom arrived and was pissed the whole time. It made no sense to me. If someone is telling you that your daughter is struggling with a major life change, why would you refuse to hear what they had to say and express frustration about it?” 

Now that she’s a therapist, Shabazz sees this scenario play out in her own Media, PA, practice, where she focuses on anxiety relief and confidence building. The notion of mental illness has long been cloaked in shame and embarrassment for the Black community. While this population is 20% more likely to experience serious mental health issues like generalized anxiety disorder and major depressive disorder, a condition marked by persistent feelings of sadness, worthlessness, guilt, and thoughts of self-harm, they are also less open to seeking professional help. Experts across the country believe longstanding misconceptions about mental health have created barriers to care that are as complex as they are harmful. 

Omerine Aseh, MD, was just 12 years old when her brother was diagnosed with schizophrenia at 22. “I know what it is like to hear whispers and get looks from your peers, friends, and community when one person in your family has a mental illness,” says Aseh, a family physician in Texas. “It is often assumed that the entire family has a form of this illness or that future generations will have the illness.” 

The reason is a misunderstanding of what mental health actually is, suggests Tyish Hall Brown, PhD, a child and adolescent psychologist and director of the behavioral health program at Howard University in Washington, DC. On TV shows and in the news media, a mental health patient is typically portrayed as someone in crisis, she explains. More commonly, however, patients use talk therapy or a combination of talk therapy and medication to help them cope with stressors or pressures that are affecting the way they feel on a consistent basis. It’s also a tool to build up your skill set in preparation for a huge life transition rather than just a way to manage a severe breakdown.

Still, many in the Black community are reluctant to go to therapy or counseling, preferring religion as their primary coping strategy. With 8 in 10 Black Americans identifying as Christian, it’s no surprise that religion has a tremendous influence. 

When Jasmin Pierre was diagnosed with major depressive disorder, friends and family offered one solution: God. “Some just tell me, it’s not even real, you’re not depressed,” she shares. “You just need to pray, just go to church.” It’s the proposed remedy for a myriad of mental health disorders. Some ministers may even tell parents that a child’s attention deficit hyperactivity disorder will go away by making them go to church more or that anxiety is a result of a weak connection with the Lord. 

“This just reinforces that idea that if I’m dealing with this, then my faith must not be strong enough, not that I have a mental health condition,” says Houston-based Vaughn O’Neal, LCSW. While this is still a pervasive problem, more churches across the country have begun to partner with clinicians to talk to congregations about how spirituality and mental health support can actually go hand in hand. 

Another hurdle therapists confront is a deeply ingrained wariness of the medical field, according to Lateefah Watford, MD, chief of behavioral health services at Kaiser Permanente in Atlanta. Historical atrocities like those of antebellum surgeon James Marion Sims, who pioneered gynecological procedures by practicing on enslaved Black women without anesthesia, and the notorious Tuskegee Experiment, in which the U.S. Public Health Service kept syphilis treatment from Black male patients in Alabama, understandably breed mistrust. 

Recent studies show that Black women have a greater chance of pregnancy-related deaths. Their death rates are three to four times higher than other races regardless of income or education level. Statistics like this highlight how profound the inequalities truly are. In this sense, Watford says, the medical field has been a longstanding place of oppression and trauma.

“One of the things I always like to point out about all those incidences is that they were condoned by the government,” offers Isaiah Pickens, PhD, assistant director of the service systems program at the UCLA-Duke National Center for Child Traumatic Stress. “And what I mean by that is either the government didn’t prosecute the people who perpetrated these offenses early on while they were happening, or they didn’t protect the victims of these offenses. That creates what we call a breach of the social contract, which is the belief that the institutions who are supposed to protect me will actually protect me.”

In Black communities, that breach continues with stop-and-frisk policies, racial profiling, and police shootings of unarmed Black people. In late August, a video surfaced of police placing a “spit hood” over the head of a handcuffed 41-year-old Black man in the midst of a mental health crisis. He died a week later from what the medical examiner’s officer described as “complications of asphyxia in the setting of physical restraint.” It demonstrated a startling reality: Someone in distress may be treated like a criminal when they need help the most. The solution boils down to training, asserts Pickens, who launched iOpening Enterprises, which creates professional development programs that teach schools, police departments, and other organizations about how trauma and mental health impact people. 

It’s critical to find a culturally competent counselor. For some, that means finding a Black therapist. While a Black provider may be preferred, it’s not always the most practical option since only 4% of social workers and 2% of psychiatrists and psychologists are Black. A shared racial background also does not always guarantee a shared experience. 

It’s about a certain comfort level, a shared experience that makes sharing easier, says O’Neal, the Houston social worker who specializes in treating Black men. “It can be refreshing on both sides,” he admits. “People have a sigh of relief because they can let their hair down and just be themselves. I’ve noticed that we both end up relaxing to a certain extent, and dropping a little Ebonics into the conversation, you know, that sort of thing.”

It’s important to remember kids also carry around emotional trauma. Historically, Black teenagers have had lower suicide rates than whites, but a 2019 study found a dramatic rise in self-harm attempts by Black teens, especially among boys. While the researchers did not explain why, experts theorize that teens’ exposure to constant images of racial violence and racial and economic disparities have an impact. It creates a heightened sense of anxiety and worry. On the positive side, however, “Younger people are more open to therapy because they are more open to sharing all the aspects to their lives,” Shabazz says. “Social media has its faults, but it does allow people to expose aspects of their personality that they wouldn’t otherwise. And the older generations don’t have a model for that. Therapy is more of an intimate way of sharing more avenues of your identity without it being so out in the open and public for the whole world to see.” 

Ensuring access to care is critical. While Black young adults have higher rates of mental health issues, they are less likely than whites to receive services. Clinicians note that less access to adequate health care and the financial burden of treatment are factors. Fortunately, there are low-cost avenues for help. The first step is to reach out to your insurance company or Medicaid provider to find out exactly what coverage is available. Most plans offer a certain number of sessions. Next, explore groups like OpenPathCollective.org that have partnerships with therapists who provide psychotherapy sessions between $30 and $60. InclusiveTherapists.com also offers connections to teletherapy at reduced fees and low-cost and not-for-profit services.

The most important thing clinicians and patients alike are doing is normalizing the conversation about mental illness. Celebrity testimonials are especially impactful. Taraji P. Henson openly discussed her struggles with depression. [For more details, check out our May 2020 issue with her on the cover.] Jay-Z talked about going to therapy. Serena Williams shared her battle with postpartum depression. 

Hearing this from admired public figures greatly reduces the stigma, but so does the empathy and action of everyday people. Because of her own experience, Pierre developed the app The Safe Place to bring awareness, education, and acceptance to the topic of mental health. Online support systems like TherapyForBlackGirls.com and SteveFund.org offer group therapy, community resources, and articles on how to cope with racism, police brutality, economic disparities, and violence. These resources teach the Black community that therapy can help reinforce the aspects of our lives that are working well, but also be a tool to help people rebuild after a crisis or a setback. “We have come a long way, but we still have a lot more work to do,” Pierre adds. “It’s all about normalizing the conversation and showing people with mental health disorders that they are not alone. There is help and they are never alone.”

It’s not just about access to services, but access to high-quality treatment. Keep in mind, free doesn’t necessarily equal good and neither does paying top dollar. Here are some tips for helping you find the right mental health clinician for your needs from Aisha Shabazz, LCSW. 

• When you are trying to figure out if a therapist will be a good fit, go on their website to see if the information they are presenting feels authentic to you. “There are a lot of folks out there who are phoning it in. They don’t really mean what they say or practice what they preach. See if what they are putting out there in the world is something that resonates.” 
• During a consultation with a therapist, ask: How are you going to help me in session? What are we going to do now that I’ve shared why I’m coming to therapy? If you like what you hear, move forward. 
• You don’t have to stick with a therapist if you feel like they are not right for you. If they are not meeting your needs, it’s OK to make that change. “There are a lot of people who give up after having an uncomfortable experience with a therapist. Just because one therapist isn’t a good fit, doesn’t mean there isn’t one out there that will be.”