A report by the Institute of Medicine found that these health disparities demonstrate a complex problem that includes aspects of bias, discrimination, and stereotyping. They reported, "Mental health care occurs relatively frequently in emergency rooms and psychiatric hospitals." African Americans are overrepresented in emergency and inpatient services. What this means is that African Americans disproportionately use these services instead of mental health care clinics and other centers. The National Survey of American life found that 10.1% of African American used some form of mental service within the past year; this includes 31.9% of African Americans who meet DSM-IV criteria (Diagnostic Statistical Manual, which is what psychologists/psychiatrists use to diagnose psychological disorders; this article came out before the new DSM-V). Other studies have highlighted similar disparities. African Americans have a greater mental illness-induced "disease burden" than White Americans, meaning that they experience more disabling forms and experience them for longer times. Of African Americans diagnosed with depression, 57% experience chronic depression. Additionally, African Americans have lower odds of receiving evidence-based treatments. These disparities continue into the studies that assess treatment quality and effectiveness. African Americans are underrepresented in efficacy studies (whether the treatment works in ideal situations).
So, what may be factors in these disparities? First, there are the additional threats to African American wellness aside from those shared by the general population. These threats include:
Stigma associated with being African American
Stress and trauma
Racism and discrimination
The second issue involves the challenges of understanding African Americans' mental health. Aggressive African American behavior tends to be viewed as more of threat by powerful institutions. Stereotypes about African Americans may lead them to be viewed as psychologically unsophisticated and unlikely to suffer cognitive stress like depression. African American spirituality or cultural mistrust may lead to diagnostic errors by therapists or counselors who lack knowledge of and experience working with African American populations. Social inequity and socioeconomic factors also contribute to health disparities and inferior treatment.
Given that many of these resources are not available for African Americans at adequate levels, I wanted to do my part to at least pass along some of the resources I have come across to help people take better care of themselves. While I do have a Ph.D. in psychology, I am not a licensed therapist so do not take this as legitimate psychological counseling/therapy. I am only summarizing and sharing resources that I have found. It may not be radical change, but I do think it is important to get information out to people in whatever ways you can in order for them to begin helping themselves.
Dimensions of African American Health (Edwards, 1999)
Ideological/Beliefs – possessing a sense of spirituality, including the need for a belief in God and being in touch with a greater power or Supreme Being, having a strong cultural identity, and being proud of one’s cultural heritage, being practical and having common sense
Moral Worth – showing self-respect, positive self-esteem, demonstrating a sense of honesty, and responsibility and being true to oneself and others; expressing true respect and compassion for others
Interpersonal style – communicating and interacting well with others to develop, maintain and strengthen healthy relationships; being assertive and able to demonstrate respect for others while still expressing oneself and one’s true feeling
Competence – having capacities such as intelligence, being flexible and resilient, pursuing educational growth and possessing skills to survive
Determination – being determined and demonstrating the capacity for willpower and self-control, including being goal oriented
Unity – maintaining or possessing a sense of inner peace; having good self-knowledge and understanding; as well as striving to be one’s best
Health/Physical – being in good physical health, including having a healthy diet, taking care of one’s appearance and appreciating one’s own sense of beauty
Approaches to Studying the Mental Health of African Americans
Service utilization data – has been used as an indicator of psychopathology. Current service use data offers limited info about differences in actual rates of psychopathology between cultural groups
Epidemiological studies – better for understanding psychopathology rates than service utilization studies. It is the study of the rates of the incidence and prevalence of health/mental health conditions in population. Can help to explain similarities and differences between ethnic and racial groups in types and rates of psychopathology
National Survey of Black Americans – provides mental health info on African Americans. Provides opportunities to examine within-group differences of mental health issues among African Americans
Africultural Coping (Utsey et al., 2000) – an effort to maintain a sense of harmony and balance with the physical, metaphysical, collective/communal, and the spiritual/psychological realms of existence.”
Cognitive or emotional debriefing – adaptive reaction to manage perceived environmental stressor. It might involve having a discussion with a supervisor about a coworker who is contributing to racial stress
Spiritual-centered coping – based on a sense of connection with spiritual elements in the universe and with the Creator. It could involve connecting to one’s higher power and praying as a way of dealing with racial stress.
Collective coping – group-centered activities. This could be getting together with other African Americans and discussing and planning an activity.
Ritual-centered coping – use of rituals to manage a stressful situation. It might involve rituals such as playing certain types of music and lighting candles to deal with stress