“It has to become a part of the structure of community care.”
Black Tennesseans cope with stigma around mental health care–and accessing professionals
Like every Black parent, Dr. Tobi Amosun knew the day would come for her children to hear “the talk.”
When her son was five, Amosun explained to him that the world operated differently for little Black boys, and that he would need to behave carefully around authority figures and learn to de-escalate a situation.
“This is an experience that is unique to men that women don’t necessarily go through,” she said.
Amosun, a pediatrician and assistant commissioner of the Division of Family Health and Wellness through the Tennessee Department of Health, witnessed how the past two years and a combination between the COVID-19 pandemic and societal disparities affected Black communities in Tennessee.
Historically, Black communities experience higher rates of comorbidities through genetics or poverty, made worse by a lack of healthcare inaccessible to those in low-paying jobs. But as the pandemic continued through its second year, conditions worsened for many Black Americans, who were most likely to have low-paying, essential worker jobs, most likely to be in contact with the infected, and most likely to experience unemployment and underemployment.
The Centers for Disease Control and Prevention reported that communities of color experienced higher rates of anxiety, depression and COVID-related deaths compared to their population portion.
And as a pediatrician, Amosun saw firsthand how the pandemic affected children.
One in 300 Black children had lost a primary caregiver to COVID in the last two years, compared to one in 500 non-Black children.
“We always knew that those disparities existed, but it really almost uncovered for everybody how dramatic those disparities are,” she said, adding that only Native American communities experienced worse rates of parental loss.
Now come the repercussions
As rates of anxiety and depression have increased among all races, demand for mental health services has skyrocketed as both children and adults seek help.
Many Americans were shocked to learn that former Miss USA Cheslie Kyrst, who was Black, committed suicide after allegedly jumping from a New York City apartment building on Jan. 30.
But as demand for mental health services increases, the topic still carries stigma in Black communities: 63% of Black Americans believe mental health conditions were a sign of personal weakness, according to the National Alliance on Mental Health.
In 2020, of the 1,220 Tennesseans that died of suicide, 8.4% were Black, up from 7% from the previous data cycle.
“There’s a sense of shame. There’s a sense about being discriminated against, and there’s a sense of not wanting to talk about it with people,” said Amosun.
Health care professionals are also starting to look into the long-term effects of COVID. Over the last two years, an entire generation of children have lived through the same traumatic experiences, such as isolation, learning interruptions, family members dying of COVID and rising rates of domestic violence.
Black children living in the city were more likely to experience learning loss after schools transitioned to remote learning, along with any other unintended consequences, such as missed meals at school and adding additional financial strains on working parents unable to find caregivers.
“As a pediatrician, I worry about my patients because a majority are Hispanic or Black and it’s one of those things that I worry about what the eventual repercussions will be,” said Amosun.
Any long-term stress factors can lead to mental health issues, but it is still too early to tell about the effects on children, she added. This generation of children isn’t the only group to have experienced a traumatic event, like the generations before them who lived through several world wars and the Great Depression. Today’s professionals are armed with the data collected from those generations, giving them a head start on helping children to deal with any negative effects.
But as Black Americans were less likely to seek help before the pandemic, similar factors may prevent many from getting the help they need.
Racism plays an important role in mental health
Black communities developed a mistrust of the U.S. healthcare system after learning that they were used for experiments without consent. In the infamous Tuskegee syphilis study, hundreds of Black men were used to study the long-term effects of syphilis instead of receiving care. In another case, scientists used cells from Henrietta Lacks, who had died at 31 from cervical cancer, to make key discoveries in many scientific fields without notifying or compensating her family.
In 2020, 7 out of 10 Black Americans reported having been mistreated by the healthcare system, according to the Commonwealth fund.
Racism plays two roles in mental health. Black Americans experiencing being treated or perceived as “less than” due to the color of their skin can be a constant stressor in someone’s life, cause excessive trauma and can influence suicide rates. This discrimination also affects their ability to access evaluations and treatment.
I have been told by parents that they actively look for professionals that look like them, because they know certain conversations you don't have to have or explain when you are from a similar culture.
– Dr. Tobi Amosun, Tennessee Department of Health
Additional barriers come from health insurance tied to employment, along with mental health providers being more likely to accept only private insurances or cash.
TennCare, the state’s Medicaid program, is not widely accepted among mental healthcare providers, said Amosun.
But for those Black Americans seeking help, high demand for mental health services makes it harder to find treatment.
“We’re seeing astronomical numbers of teenagers looking for care. Everyone overall is looking for mental health care,” said Amosun.
She also noted that as a Black professional, she was part of a small number of doctors of color. About 5% of physicians identify as Black, according to the Association of American Medical Colleges.
In the mental health industry, only 4% of therapists were Black, and 2% of psychiatrists were Black.
“I have been told by parents that they actively look for professionals that look like them, because then there’s certain conversations you don’t have to have or explain when you are from a similar culture,” said Amosun.
And the fear of discrimination is preventing people from seeking help when they need it, she added.
Bridging the gap
Seeing the need, nonprofits and community organizations have made efforts to remove some of the barriers to mental health services.
At the Refuge Center for Counseling, located in Williamson County, senior staff, contract therapists and professional volunteers work alongside student interns to offer counseling on a sliding scale, which allows patients to pay based on their income.
On average, clients pay around $50 per appointment but can pay fees as low as $25. Each year, the Refuge Center holds fundraisers and receives donations to make up the difference.
“We have about 20% of our clients that fall below the poverty line,” said Amy Alexander, founder of the Refuge. “For us, it’s a beautiful mix of being able to help people that might not be able to receive the help in other places but also providing services that are so high quality and excellent that people who could afford to go to other places still choose the Refuge.”
But high demand means new clients may need to wait before receiving assistance. On any given week, 80 to 170 people are on the waiting list, with waiting times being anywhere from two to six weeks.
“One of the important messages to send is that maybe don’t wait until you’re in crisis to start receiving services for your emotional wellness,” she said, adding that they offer virtual sessions to anyone in the state.
In Memphis, community leaders are working to create their own mental health infrastructure.
Jacqueline Oselen helped organize the Memphis Black Healers Collaborative (MBHC) in the belief that the solution, care, support and treatment to mental health care needs to be “by us and for us.”
Identifying the barriers to Black mental health is key, said Oselen, including removing stigmas, addressing affordable housing and poverty, and identifying for those who have insurance but don’t know how to identify the right therapists.
“Because so many of those factors disproportionately affect Black communities when it comes to mental health then that concern is amplified because they are all stigmas that exist that have existed for generations around mental health simply because a person is seen as crazy if they say something is wrong with them,” she said.
In recognizing the need for more Black professionals, the group is also working to identify practitioners of color in the area and encouraging them to help bridge the gap between insurance and mental health care providers.
“So really trying to identify those barriers to care, barriers to access and seeing how we can guide solutions for those,” said Oselen.
MBHC is also working with other community organizations focused on mental health.
The Coalition for Youth Mental Health was created in response to students seeking more mental health services in schools.
In 2020, more than 100 youths collaborated with BRIDGES, a youth-leadership organization, to empower them in identifying what they want to be changed their communities. They later presented their case before the Shelby County commission and were able to receive funding.
Addressing mental health after the pandemic
State officials have recognized the need to increase accessibility to mental health services.
At the moment, TennCare has 752 locations that offer outpatient mental health services, including 14 Community Mental Health Centers and 2,290 individual mental health providers in-network with at least one of their health plans. Recognizing that some providers don’t accept TennCare, Medicaid or Medicare, state officials are discussing ways to expand their network and retain therapists, according to TennCare spokesperson Amy Lawrence.
Otherwise, in a post-COVID world, the healthcare industry will need to step up, said Amosun, and healthcare facilities are already starting to train primary care physicians, pediatricians and other professionals to fill gaps, target those at risk of being suicidal and accept sliding scales or public insurance.
Amosun is currently working on a mental healthcare access grant on a state level.
“Obviously getting the primary care physicians health trained themselves is important but we have to figure out ways to get people (connected). The clinic where I work has those licensed therapists embedded in the clinic and we’re trying to get a second one embedded, and that’s been a really big bonus for our population because if we have someone who’s struggling, we can just walk them down the hall and knock on the door,” she said.
But on a societal level, change will have to happen over a long period of time, even just to see more Black professionals enter the field.
Tennesseans need to recognize how history has played a part in generational trauma, said Oselen.
Children need to be taught how to deal with their emotions in order to stop cycles of race-based stress and trauma, all in an effort to make mental health become a way of life. .
“It’s going to take culturally-sensitive approaches where individuals trust that those who are seeking to help them have their well-being in mind and not doing it for adverse reasons, monetary gain or political clout. And it’s going to take financial resources over the long haul. It has to be a long-term strategy over community wellness,” said Oselen.
“It has to become a part of the structure of community care,” she added.
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