Two decades of life experience made a mental-health activist of Kai Koerber. When he was 16 and a student at a Parkland, Fla., high school, a gunman killed 17 people, including one his friends.
"I really did suffer a domestic terrorist attack, and that's not something that happens to you every day," Koerber says. But as a young Black man growing up in the South, Koerber had already faced threats of racial and police violence routinely, and those experiences, too, shaped his relationship with the world. He's coped with that stress, he says, through a lifelong practice of meditation. And after the school massacre, Koerber also sought emotional support from a therapist with a deep empathy for his personal traumas. "Finding a Black therapist really saved me some time, and there was more connection, in terms of the kinds of struggles that I might feel or the the kinds of ways I might think about certain scenarios," Koerber says. Now a rising sophomore at the University of California, Berkeley, Koerber says having access to good mental health care is critical to both preventing and dealing with the after-effects of violence.
Racism's burden
The need for mental health support is more evident than ever, especially among Black Americans, say people who study and experience the burden of racism. People of color were already dealing with heavy loads from a pandemic that continues to claim a greater proportion of Black, Latino and Native American lives and a greater share of jobs. Now there's the emotional reckoning following George Floyd's murder, which has stirred up a kind of collective trauma.
Meanwhile, the economic barriers to accessing mental health care have only increased.
Dr. Rhea Boyd says many members of the Black community feel emotionally raw and tapped out. "We haven't been asked to publicly bear our pain as frequently as we are now, and we haven't had to witness other Black folks publicly baring their pain about it as frequently as we are now," says Boyd, a Bay Area pediatrician who studies the effects of police violence.
She says racism's toll threads through the psyche, manifesting in many ways, and shaping the youngest of brains. She worries most about Black girls, for whom suicide risk is increasing — not just among teenagers, but among preteens as well.
The need for mental health support, in other words, is great. But the history of meeting that need is not, says Dr. Ruth Shim, a psychiatrist at the University of California at Davis. The American system's abuse of African Americans spans generations — from forced experimentation to committing black civil rights activists to mental institutions.
Misdiagnosis prevalent Misdiagnosis of Black people, Shim says, is still prevalent today — often by non-Black doctors who misread emotional cues like anger.
"We look at these things and call them 'disruptive behaviors,' we misdiagnose young people with things like 'conduct disorder' instead of the result of chronic trauma from racism," because many physicians haven't experienced it, Shim says.
For many Black patients, access to mental health treatment often comes in places of last resort: Jails, schools, emergency rooms. And studies show that African Americans tend to be given psychiatric diagnoses that are incorrect or especially severe or less treatable — such as schizophrenia instead of depression or bipolar disorder — and that can lead to inappropriate treatment. So, not surprisingly, Black patients who do get treatment tend to fare worse than white counterparts.
"I do think changing the workforce and changing the face of the workforce is probably the most critical thing that we can do now to start to address some of these issues," Shim says. The scarcity of Black mental health professionals in the U.S. is now an acute problem, says Dr. Altha Stewart, a Memphis psychiatrist who became the first Black president of the American Psychiatric Association two years ago.
"I get calls from people right now asking, 'Can't you refer me to a Black psychiatrist?' And because there are so few of us, I'm limited in how many of those people's referrals I can make to their satisfaction," Stewart says. And that contributes to a lack of faith in health care among African Americans.
Stewart sees some signs of hope. In recent years, Black celebrities in sports and entertainment — like former NBA star Ron Artest, radio personality Charlamagne Tha God and actress Taraji P. Henson — started openly advocating for the importance of mental health screening and support. She says more Black faith leaders in churches and mosques are partnering with programs that help them connect congregants to treatment.
But at the moment, Stewart says, in the aftermath of the killing of George Floyd, the need is simply too great. "This was one bridge too many, one act too many, one heinous crime too many. It's something too much."
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