Communities of Color and Mental Health Stigma

Image Source: Screenshot from youtube video linked

The Daily Show: Mental Health Stigma in the Black Community

This week I have a clip from The Daily Show bringing a little humor to a serious issue within communities of color: mental health stigma. Take seven minutes, go spend some time with Trevor, then come back.

Trevor breaks down three main issues that communities of color face in experiencing mental health challenges, with the first being misdiagnosis. Children and teens of color are more likely to get diagnosed with diagnoses relating to disruptive behavior than white children and teens. While children and teens commonly act out somehow, it’s important to note that depression in children and teens generally looks like disruptive, defiant, or irritable behavior. Unfortunately, stigma seems to ignore that fact when it comes to figuring out what to do with many children and teens of color who are struggling: getting them help or unreasonably disciplining them. Wouldn’t it make your depression worse if someone told you that you were problematic for having it, rather than empathizing with you and trying to get you appropriate help? From first hand experience working within juvenile justice facilities where most of my clients were teens of color, this issue with misdiagnosis has been shown to be problematic with long term outcomes for children of color with challenging life situations. Their “defiant behavior” could be a trauma reaction, depression, a stress reaction, or a result of their caregivers working overtime to keep food on the table and having less time and energy to give to their children. Their behavior being recognized as depression, a trauma reaction, or a reasonable reaction to hard life circumstances could have significantly changed the perception on how their behavior needed to be dealt with. In working with juvenile justice youth, it absolutely breaks my heart to see beautiful, smart, capable teens hit rough patches due to events out their control, and then get then sucked in the to unjust criminal justice system rather than be offered plain mental health support. Thankfully, at least in Los Angeles County, juvenile justice programming is taking baby steps to move away from the incarceration model and more towards an intensive treatment model for these kids, but it will be a slow process to work towards a new regular system of intervention. I wish that these drastic changes to the system would move faster. Devastatingly, other systems such as the adult criminal system and the foster care system aren’t much better in terms of seeing disproportionate numbers of people of color because of the different lenses in which our society evaluates the riskiness of certain behaviors across racial or social groups.

The second issue Trevor addressed was difficulty finding culturally competent therapists, noting that only around 4% of psychologists are black. It’s difficult enough to get into therapy in the first place, and I feel highly empathic towards those who tried to get help and found themselves as misunderstood in their therapy room as in society. That’s so incredibly hard- how are people supposed to heal under those circumstances? As a field, cultural competency is definitely an area where we mental health professionals can do better, so we can better serve our communities, especially communities as diverse as Los Angeles. As a white therapist myself, I am so grateful to all my beautiful clients of color and clients from different social groups over the years that allowed themselves to be vulnerable with me so I could get to know their stories. I have found that I really enjoy working with clients to overcome effects of stigma and also working with clients that don't have much in common with me on paper. We are all worth getting to know, and getting that support!

The third issue Trevor addressed was the internal stigma about mental health in communities of color, speaking directly about the black community. “It is shameful to talk about anxiety, depression and trauma… mental health issues are a white people thing… you don’t need to see a therapist, you need to see a preacher... just buck it up!”. From getting to know people from diverse backgrounds, I know these types of statements aren’t completely unique to just the black community (For more on that read in the comments in the video link, so many from different cultures share their experiences!). As if struggling with mental health concerns isn’t hard enough, on top of that many of us have a layer of shame for struggling in the first place that can make our challenges even harder to address.

This video was mostly geared toward the black community, but I know that other cultures experience similar challenges around mental health issues, and also social groups such as those with LGBTQ+ identities. I’m so sorry to those who haven’t gotten what they needed, whether it wasn’t being able to go to therapy at all or not finding a therapist who was actually helpful. Some tips for identifying someone who can help you through cultural or social mental health stigma:

1. The therapist doesn’t put you into a box. Just because you identify as Black, LGBTQ+, Jewish, or a part of any other cultural or social group, doesn’t mean your experience is the same as everyone else in that group. The therapist should have a general understanding of cultural and social trends and use it as only a resource to get to know you and your needs, not as the manual on how to provide treatment you. You are more dynamic and multifaceted than just a person from type of culture, religion, or other social group.

2. With above said, the therapist you should definitely have that general knowledge of trends within each culture or social group they are trying to serve. For example, relating machismo culture in Hispanic culture to the stigma surrounding identifying as LGBTQ+, and understanding how this cultural norm makes coming out and being out more challenging for Queer Hispanic people. This knowledge doesn’t necessarily have to be first hand through the therapist’s personal life, but they shouldn’t be completely shocked when you tell them about your cultural or social concerns. If they seem like they are willing to dive in and learn with you, maybe you don’t need to ditch them quite yet. But if they continue to show that confusion and seem disconnected to you, it’s okay to try someone else.

3. And then with that second part said, finding a therapist who is humble in knowing that they are NOT the expert on you, YOU are the expert on you. (Actually, this goes for 100% of mental health clients, no matter your issue you seek therapy for. If your therapist thinks they are the expert on your life, they need to check their ego at the door. Understanding common issues to offer insight and pretending they are an expert on your specific story are two separate things.). Your therapist should apologize to you when they make any sort mistake, especially those in which they make you feel misunderstood.

4. It is sometimes tempting to try to find a therapist who looks like us and seems like they have experienced the same things as us, and that works- sometimes. We can learn a great deal from someone who was once in our shoes. Other times it can actually be harder to get great, personalized services from someone who has had very similar experiences to you, because they might see you through their own personal lens instead of a clinical or professional lens. Long story short, they could end up offering you information and healing techniques catered to themselves personally because they could think you have the same experience as them, instead of getting to know how you are personally responding to the issue. For example, no two immigrants will have the same exact story or reaction to the process. It could have been much more emotionally challenging on one person than it is for another, and that first person could, for example, need completely different coping tools. A therapist from a personal background that is a little different from you on paper may be able to offer a less biased therapy experience, and make the services more professional instead of more personal. It may take some time to find someone with a balance between experience and non-bias.

Just like making friends, sometimes finding a good therapist for you is a trial and error process. If you have a chance to have a free consultation with a therapist before you see them for a paid session, I would take them up on it! Also, in some mental health centers, it is common to just be assigned to a therapist. If the match isn’t a good one, speak up and ask to be reassigned. You deserve to feel heard, recognized, and understood, even if the first therapist (or first 10 therapists) aren’t the right match.

Working within communities of color and diverse social groups has not only enriched me so much as a therapist, but so much as a human being. It’s my goal to provide services that are culturally as competent as possible, and I’m always seeking to learn more. You all are valuable and deserving of competent support. If you’ve been set back by stigma, I hope I get to hear your story and offer you some support to overcome your challenges.