Black men face unique barriers when it comes to seeking and receiving mental health care. Here are some of them.
Cultural Stigma
When it comes to mental health stigma in the Black community, many community members tend to adhere to an unhealthy definition of strength, particularly when it comes to Black men, says Derrick Gordon, PhD, a psychologist and an associate professor of psychiatry at Yale School of Medicine in New Haven, Connecticut.
“As folks of color, we’re supposed to be able to kind of endure independently. We’re supposed to have the capacity to kind of manage this on our own,” Dr. Gordon says.
“Black men are taught inherently to be strong and stoic, and there’s this idea of like John Henry–ism – this inherent need, or at least socialization, of Black men, to be strong and to outperform everyone and everything,” says Omotola K. Ajibade, MD, MPH, a psychiatrist and the founder of Ajibade Consulting Group in Atlanta.
“That’s really in order to not be perceived as weak,” says Dr. Ajibade. “Black men tried to hide their vulnerabilities, even from those who love them and would want to help nurture and heal some of those vulnerabilities.”
According to research published in the Journal of Black Psychology, certain faith communities, especially the Christian tradition, sometimes exacerbate negative stigma around mental health issues and care within the Black community, encouraging members to “pray about it” rather than also seek professional help.
“One of the biggest barriers that we encounter sometimes has to do with folks’ belief that, ‘if I have these mental health challenges, I don’t believe in my faith tradition as strongly as I should.’” Gordon says. He tries to reframe this conversation with clients so they can understand that it’s possible to rely on both psychotherapy and faith. “Those two things are not in opposition to one another,” says Gordon.
Medical Mistrust
Medical mistrust involves fear of harm or exploitation by medical professionals or institutions. This mistrust may stem from previous negative experiences, familial narratives, or systemic inequities such as racial biases and other discriminatory practices.
“There are generations of things that have happened to Black people before and since, that all contribute to the nature of mistrust. Especially when you think about mental health, you also have to think about the fact that mental health issues are not divorced from the societies that birthed them.”
Another historical example is drapetomania, a fabricated mental illness that was once said to be what led enslaved people to run away, says Ajibade. Coined in 1851 by Dr. Samuel Cartwright, drapetomania was seen as a legitimate disease and used to justify slavery in the 19th century.
“The idea that you would want to escape your own dehumanization and oppression was seen by the mental health community as an illness,” says Ajibade. “When you’ve had generations of this medical gaslighting come and go, you tend to not trust the system at large.”
“‘Medical gaslighting’ [is] an act that invalidates a patient’s genuine clinical concern without proper medical evaluation, because of physician ignorance, implicit bias, or medical paternalism,” according to research published in the American Journal of Medicine. This often results in dismissal of symptoms and concerns, including the refusal to adequately test or investigate a medical issue, the same research states.
While drapetomania is now seen as pseudoscience, the racism and dismissal that gave rise to it is still prevalent within the medical community, research shows.
In addition to historical trauma, socioeconomic disparities, and medical trauma, Black men also face medical gaslighting, according to Ajibade.
Examples of this from earlier studies showed how medical professionals held beliefs rooted in racism, such as the notion that Black patients have higher pain tolerances, leading to biases within treatment and assessments.
Because of factors like this, it’s important for providers to make a hesitant patient comfortable once they arrive for care. “Once you get them through the door, they recognize that they can share themselves with you and you don’t judge them, and that this can be reparative and helpful to them — it creates a safe space,” Gordon says.
Ajibade agrees. “I go to work every day knowing that I participate in a system that has contributed to numerous harms against people that look like me,” he says. “But, I also know that we have the capacity to act differently and to use those very same tools to help heal people rather than harm them.”
Lack of Representation
Black men make up just under 6 percent of active therapists in the United States, according to the American Psychological Association.
These numbers, in conjunction with some prevailing negative ideas about mental health, can contribute to the overall lack of investment or accessibility to mental wellness for Black men. “A lot of folks think that mental health is a ‘white people thing,’ but it’s a fundamental part of the human experience,” Ajibade says.
Part of Ajibade’s work includes supporting clients within the correctional system. He shared an encounter with a patient’s family member that recognized his last name as Nigerian and asked for his help.
“The mere fact that he recognized my name as a Nigerian and we sort of speak the same language lifted a huge weight off of his and his family shoulders — he knew that someone was going to see about his loved one. That’s something that no textbook is going to teach you,” he says.
“Representation really matters, especially if we’re trying to increase access to these kinds of supports and services,” Gordon says.
“I have worked with men of color across the diasporas, and we have to be thinking about the way representation shows up, and how it can be so powerful to have them hear their own stories, to tell their stories,” Gordon says.
Insurance Barriers
With the exception of peer-run spaces, mental health support often doesn’t come cheap. Instead of solely focusing on professional licensure, peer support groups are led by individuals who have lived experience.
But for those who opt for more traditional therapy arrangements, it can be difficult to finance. Many individuals aren’t able to pay for sessions out-of-pocket and rely on their health insurance coverage to foot at least some of the bill. According to a report from KFF, Black individuals are uninsured at rates higher than that of their white counterparts.
Even for those with healthcare coverage, accessibility issues arise, especially if you’re interested in connecting with a provider that shares your cultural background or identity. Not every practitioner is paneled with every health insurance carrier. This means that if you’re going through your health insurance, you are picking from a smaller pool of people, rather than any professional within your state.
Because the number of Black male therapists is already small, the extra limit of insurance coverage can significantly impact your options for a practitioner that looks like you.
And, some experts don’t take insurance at all. There’s an understanding that this can make it hard on clients, but the reality is that getting paneled with insurance carriers can serve as a barrier for practitioners as well. “Some people don’t take insurance because there’s so many hoops to jump through,” Gordon says.
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