By Lisa Rhodes
Ten years ago, Janet Robinson (not her real name), a 40-year-old black woman with bipolar disorder, was hospitalized in Northern Virginia after a psychotic episode. Before Robinson was released, a social
worker, who was arranging her outpatient treatment services, asked whether she would like to work with a black psychologist.
Robinson said yes.
“I felt relieved when he asked,” Robinson says. “I did not know how to ask him for it.”
Robinson, who now lives in Maryland and works as a registered nurse, has been in treatment with a black female psychologist for a decade. She also works with a black female psychiatrist.
Robinson says working with mental health professionals of the same race is important to her and has been an asset in her recovery.
“I can identify with them. They look like me,” Robinson says. “I admire their credentials and expertise and I respect them.”
Robinson is an example of what many in her situation feel in regard to mental health providers: many of those who seek mental health treatment prefer to work with professionals of their own race.
In “Just Be Straight With Me: An Exploration of Black Patient Experiences in Initial Mental Health Encounters,” a study published in the October 2011 issue of the American Journal of Orthopsychiatry, the researchers write that “research supporting race concordance suggests that when black patients are treated by black providers, they report positive treatment outcomes.”
The study found that blacks are more likely to remain in care and comply with their treatment plan when they are treated by black professionals because “they feel more accepted, understood, and perceive the provider to be more culturally sensitive.”
However, while black patients may prefer to work with black mental health professionals, there is a shortage of African American psychiatrists and psychologists—preventing many patients from having access to them.
According to American Medical News, a publication of the American Medical Association, in 2001-02, black professionals made up only 2.6 percent of mental health clinicians in the U.S. This is despite the fact that 20 percent of black Americans seek mental health specialty treatment within a 12-month period, according to a 2007 national survey published in the Archives of General Psychiatry.
Today, blacks make up 3.7 percent of members in the American Psychiatric Association and 1.5 percent of members in the American Psychological Association.
Annell Primm, M.D., MPH, deputy medical director and director of the Division of Diversity and Health Equity of the American Psychiatric Association, says the reasons for the lack of black psychiatrists are varied.
“[The] barriers contributing to the dearth of black psychiatrists and other psychiatrists of color include limited educational opportunities, lack of exposure to mentors in psychiatry, low rates of application and acceptance into medical schools, high costs of college and medical school tuition and the significant loan repayment burden,” she says.
Tiffany Townsend, Ph.D., senior director of the Office of Ethnic Minority Affairs of the American Psychological Association, says that in 2008, people of color made up only 24 percent of Ed.D. and Ph.D. degree-holders in psychology, despite making up 36.3 percent of the U.S. population, quoting data from the National Science Foundation and the 2010 U.S. Census.
“In other words, this is not just a ‘black’ issue,” Townsend says. “There is an increased demand to diversify recruitment and retention of scholars of color to ensure [that] psychology’s workforce reflects and effectively addresses the mental health needs of the United States’ increasingly diverse population.”
Citing research that has found that an insufficient number of students and scholars of color are accepted into and complete doctoral programs, Townsend says that to ensure that blacks and other minorities are eligible to pursue a doctorate in psychology, there must be diversity at the undergraduate level.
“Researchers have found the departure of need-based financial aid and rapid increases in tuition to be significant factors influencing the ability of students of color to attend undergraduate institutions,” Townsend says.
But financial aid for higher education is only part of the problem. Townsend says researchers have also found that minorities who live in low-income communities, which are more likely to have failing schools at the K-12 level, may experience difficulty gaining acceptance into college and graduate school.
In addition to the disparities in education, there is also a mistrust of medical and scientific institutions in the black community due to such historical abuses as the Tuskegee Syphilis Experiment and the case of Henrietta Lacks.
“Psychiatrists have been viewed historically as not being relevant to the African-American community, which has tended to rely on family and the family community for support in times of emotional distress,” Primm says. “Many believed that psychiatric services were for people of European descent.”
Townsend says the stigma associated with the mental health field also decreases the likelihood that African Americans will seek help from a mental health professional. “Many communities of color view mental illness as a weakness or a character flaw,” she says. “For instance, African-Americans are more likely than European-Americans to believe that individuals suffering from mental illness, particularly schizophrenia, are violent or dangerous.”
The shortage of black mental health professionals means that blacks who do seek help must often decide whether to seek treatment with clinicians from different ethnic groups.
However, this is not as negative as it may sound. In the aforementioned study “Just Be Straight With Me,” the researchers wanted to discover what happens during an initial mental health encounter between a black patient and a nonblack provider that leads the patient to describe it as a “good or poor experience.”
The findings, based on face-to-face post-intake interviews, found that every individual talked about a previous experience from health or mental health care or from nontreatment-related social interactions with others. Nearly three-quarters reported that they felt listened to and understood and also trustful of the provider, and 64 percent talked about feeling safe to disclose personal information to the provider.
The researchers write that “while the previous literature has demonstrated the advantages of race concordance, based on our findings, achieving good racially discordant encounters is also possible.”
Individuals must feel comfortable, safe, able to trust the provider, listened to, understood and respected by the provider. As a result, blacks may “feel out” or “scan” a provider to test the waters. The researchers write that this “should not be considered a display of difficulty or resistance” and instead should “be considered a strength or a sign or resilience, not pathology.”
To foster cultural sensitivity within the mental health field, both the American Psychiatric Association and the American Psychological Association offer cultural competency training for their members.
Josephine Johnson, Ph.D., a black psychologist and member of American Psychological Association with more than 30 years of experience in the field, says cultural competency is critical.
“Culturally responsive treatment is essential for many reasons. It respects that Eurocentric models may not be effective in working with other populations,” Johnson says. “It calls upon the provider to recognize that he or she may bring biases regarding what is healthy functioning based on his or her culture.… It allows the therapist to view the treatment relationship as a ‘mutual’ learning environment.… Cultural competency is an ethical mandate.”
Curtis Adams, M.D., a black psychiatrist and member of American Psychiatric Association with 20 years of experience, says the suspicions many blacks have of the medical profession present opportunities for him to dispel the fears of some black patients.
“It presents a teachable moment that, with my efforts at educating them, can lead to a better overall outcome,” Adams says.
To encourage more blacks to enter each field, both associations offer minority fellowship programs, along with other programs designed to encourage minority practice in the areas of HIV/AIDS and addiction.
The American Psychiatric Association organizes the Doctors Back to School program in local middle and high schools where its annual meetings are held in order to encourage an interest in careers in medicine and psychiatry.
The American Psychological Association sponsors the Promoting Psychological Research & Training in Health Disparities Program to help ethnic minority-serving postsecondary institutions and early career faculty of color to engage in health disparities research.
Janet Robinson says she is fortunate to have a mental health team that she describes as being “like family” and who have her best interest at heart.
“They know which avenues I should take,” she says. “I take an active part in my own care.”
Lisa Rhodes is a mental health writer and a member of NAMI Prince George’s County in Maryland.
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