Stigma, lack of knowledge, over-reliance on religion can all impede treatment

First of a three-part story

Many African Americans are not receiving the treatment they need from the mental healthcare system. And while there are problems with the system that put African Americans at a disadvantage, there are issues at the individual and community level that also hinder them from getting the help they want and need.

On the individual and community level, there is a consensus that the primary barrier for Black Americans seeking help for mental illness is stigma and knowing where or to whom one should go for help.

“The primary barrier is stigma, even if it’s self-stigma,” said Rozenia Fuller, a member of the executive board of the Hennepin County Mental Health Advisory Council and a member of the Minnesota State Advisory Council on Mental Health. “But also [it helps to find] someone who is not judgmental but is knowledgeable enough to say, ‘You know what? I think you might need to go in to get some professional help.’”

For those in the African American community who want professional help, there are numerous obstacles within the mental healthcare system as well as at the community level.

“When people do access health or mental health care, there is, I can tell you for many people, a profound lack of knowledge,” said Cynthia Fashaw, director of Children’s Programs and Multicultural Outreach at the National Alliance on Mental Illness (NAMI) Minnesota.

“And the way that the mental health system and the physical health system is set up, it presumes that you’re at a certain point on the continuum. That you have a certain amount of mental health and medical literacy.”

This sentiment was echoed by Nichelle Clater, a 53-year-old African American woman with schizoaffective disorder residing in West Saint Paul who serves as the outreach coordinator for the directors of NAMI Ramsey. She felt that a lack of medical literacy was a problem when she began showing symptoms of her mental illness.

“I was 19 and…my mental illness was a sudden onset,” Clater said. “It’s not like I led up to it. So when it was sudden like that, I didn’t know what to do.”

While there are individuals in the African American community who fault the mental healthcare system for presuming that everyone has the medical literacy necessary to get the care they need, part of the problem stems from the ways in which the African American community views and approaches mental health issues.

According to the African American Community Mental Health Fact Sheet published by the NAMI Multicultural Action Center in 2004, mental illness is frequently stigmatized and misunderstood in the African American community. In addition, African Americans have a tendency to rely on family, religious and social communities for emotional support, rather than turning to health care professionals.

“Some of us go to church and we try to pray it [mental health issues] away,” Clater said. “So my advice would be…don’t feel like you don’t have enough faith. It’s okay, [and] it’s not any different than if you have diabetes or cancer. You would go to the doctor and you would get the help you needed.

“The problem is there’s stigma with mental illness in every community, but I think it’s worse in the Black community. There’s just stigma, and that’s what keeps people from getting the help they want and they need.”

This tendency to rely too heavily on the church for mental health treatment exacerbates the African American experience of mental illness in a way that Fashaw argues is different than the White experience.

“I think the stigma may reach more heavily into…the spiritual aspect of handling mental illness,” Fashaw said. “In the African American community…when people have mental health issues they seek help from clergy. They seek help from their minister [or] their pastor. And so I think that very often people don’t progress beyond going to their minister or their pastor.”

Next: cultural incompetence among mental healthcare providers

Daniel Abramowitz is an MSR journalism intern and a student at Macalester College. He welcomes reader responses to dabramow@macalester.edu.