Depression is one of the leading mental health challenges affecting Americans, including the African American community. The disorder affects more than 12 million women (12%) and more than 6 million men (7 percent) in the country within in any given period (National Institute of Mental Health, 2011 as cited in Ward, Wiltshire, Detry, & Brown, 2013). Ward et al. (2013) further suggest that African Americans are among the worst affected groups, with a lifetime prevalence rate of 10.4 percent. Evidence presented by Ward et al. (2013) shows that African women are more affected by depression than men. The prevalence rate among African American women is 13.1 percent compared to only 7 percent in men (National Institute of Mental Health, as cited in Ward et al., 2013). Some of the factors that explain the high prevalence rate of depression among African American women are low income and level of education. For instance, Ward et al. (2013) found that African American men with lower formal education attainment show higher rates of depressive symptoms than men and women with higher levels of education and high income.
Mental Health Service-Seeking Behaviors Among African Americans
Differences exist in mental-health seeking behaviors between African Americans and members of other racial backgrounds such as whites. At the same time, African Americans are the most affected by a variety of mental health challenges in the country. African Americans are believed to seek help from other sources outside the conventional mental health environment. Others remain reluctant to seek health whenever they need it due to a mental health crisis. The National Survey of American Life (NSAL) established that most African American women suffering from depression do not seek help, and mostly they seek support when their mental health issues become severe (as cited in Payne, 2008). Nonetheless, they often seek assistance from non-health care professionals. They receive services in non-mental health settings, such as from religious or spiritual advisors, social workers, and counselors. Payne (2008) posits that 30.5 percent of African American women seek help from non-health care professionals. The proportion is followed by those who seek help from mental health professionals. However, seeking help from mental health professionals is usually in severe cases of mental health problems such as depression.
Research focuses on the disparity between African Americans and whites regarding their tendency to seek mental health services. Buser (2009) revealed that regardless of the high prevalence of mental health problems among African Americans than whites, they still rate lower than whites in terms of their mental health-seeking behavior. The low rate of mental health-seeking behavior among African Americans has been attributed to various factors, such as their attitudes towards mental health services, availability of alternative resources to support coping with mental health problems, and the prevalence of racial bias in the services. However, Buser (2009) noted that most of the studies on the disparity between African Americans and whites concerning mental health services do not focus on subtle kinds of racism in mental health services. Research focuses on aversive racism, including microaggressions perpetrated by mental health professionals. Regardless, stigmas exist in the area of mental health in the United States, which should be explored further to improve service provision for African Americans affected by mental health challenges.
African Americans continue to suffer from the negative effects of mental health problems. Previous studies indicate that they suffer from a variety of mental health problems and at a more severe rate than whites (Buser, 2009). They also suffer longer than whites because of their reluctance to seek help from mental health professionals. The disparity between African Americans and whites persist in the country when the socioeconomic variable is controlled. According to Buser (2009), the disparity is associated with diverse issues, such as negative attitudes towards mental health services, the tendency to seek help from alternative sources, and the biases within the mental health system. Furthermore, Buser (2009) reveals emerging research on racial microaggressions in therapeutic encounters. As a result, African Americans avoid mental health professional settings because of discrimination and prefer to seek help outside the professional environment. The majority of the members of the community prefer to seek help from the church and religious leaders.
Barriers to Mental Health Care among African-Americans
Beliefs relating to mental health among African Americans may affect their mental health outcomes. Furthermore, various beliefs are evident among African Americans that affect their interaction with mental health services. Ward et al. (2013) use the common sense model to explain some of the salient factors that affect mental health among African Americans. The model suggests that people tend to have common sense beliefs and representations that are critical in their ability to cope with mental health challenges. The representations are various beliefs about symptoms or identity, causes, timelines, consequences, controls and treatments, illness, comprehension of illness, and emotional effect of a mental disorder. Whether the representations are formal or informal, accurate or inaccurate, they influence the selected interventions to control or eliminate illness or threat (the coping mechanisms).
Research in medicine, marriage, and family therapy has revealed various factors that reveal why racial and ethnic minority populations continue to be underserved in the American mental health system. According to Davey and Watson (2008), various studies have revealed socio-cultural variables that undermine the possibility of African Americans to seek mental health treatment. However, research has not revealed the actual role played by the factors in the tendency to avoid mental health treatment.
The research focused on the beliefs inherent in the African American community that influence their attitudes towards the illness and the possibility of seeking mental health treatment. Although findings relating to the topic are mixed, most of the studies reveal that members of the community view mental health as greatly stigmatized. The mindset has a major impact on their treatment-seeking behavior (Ward et al. 2013). Fripp and Carlson (2017) add that stigmatization causes mistrust towards the system, which keeps African Americans from seeking mental health services. Various studies have focused on disparities, stigma, and mistrust that inspire members of the community to resist seeking help. Nonetheless, there is inadequate research on how peoples’ attitudes affect their engagement in mental health. Fripp and Carlson (2017) studied the association between attitudes, stigma, and help-seeking behavior. The result of the study revealed that the presence of stigma affects the decision to seek counseling. If a person has a favorable attitude towards an activity, he or she is most likely to engage in that activity. On the contrary, if one has a negative attitude, he or she is likely to avoid such activity.
Attitudes towards mental health are influenced by the outlook of society towards mental health. Fripp and Carlson (2017) suggest that negative beliefs and attitudes towards mental health are inherent within the African American community and affect the behavior of the members towards the services. African Americans face negative treatment within the mental health system that affects their attitude towards it. Traditionally, African Americans have experienced discrimination within the health care system, which discourages them from seeking services. They encounter microaggressions (that is, insults and invalidations) within the society and by the systems expected to provide them with mental health services. Therefore, Davey and Watson (2008) further reveal that the health care setting is another barrier to mental health care support for African Americans. Davey and Watson (2008) reveal that the American mental health system is inadequately designed to serve the needs of the ethnic and racial minority populations. Regardless of the increasing importance of reaching traditionally under-served populations in the country, the system remains ineffective in meeting their needs. The study revealed a need to redesign the mental health system to become culturally and racially sensitive.
Besides the stigmatization view of mental health problems among African Americans, Ward et al. (2013) reported the tendency to view the issue as a weakness. African Americans, particularly adults consider mental health illnesses such as depression as a weakness. Consequently, adults from this minority group remain away from mental health settings regardless of suffering from a variety of mental health problems. In addition, those who seek support from the mental health system tend to do so when it is too late and when the conditions have progressed. Besides remaining underserved within the mental health system because of their beliefs and attitudes, African Americans are also at a higher risk to drop out or have a premature termination of mental health services compared to members of other racial and ethnic groups (Fripp & Carlson, 2017). Since they mistrust the system and might encounter microaggressions, they are most likely to terminate mental health treatment before receiving complete assistance.
Regardless of the evidence of the barriers to seeking mental health treatment, some studies report positive beliefs and attitudes towards seeking help. However, the beliefs and attitudes do not necessarily translate to the actual treatment-seeking behavior or action. For example, compared to Caucasians, African Americans are more likely to believe in the role of mental health professionals in supporting individuals with mental illnesses. However, African Americans are also likely to believe that mental illness can heal without any intervention. The belief that the problem will clear on its own is one of the reasons they are less likely to seek mental health intervention as coping mechanisms (Ward et al., 2013). Therefore, most members of the community wait for health care problems to end without any professional intervention.
The Role of Religion and Spirituality
Religion and spirituality are some of the common coping mechanisms among African Americans. Neely-Fairbanks, Rojas-Guyler, Nabors, and Banjo (2018) elucidate that the church has always played an important role in the spirituality of the members of the community. The institution has always affected various aspects of their lives. Many African Americans attend church services, take part in private and public prayer, watch or listen to religious programs, and utilize encouraging and religious coping strategies. Spiritual involvement of African Americans remains a major source of support in mental health challenges. The church provides important networks to African Americans and a source of encouragement
According to Ward et al. (2013), African American women commonly utilize religious beliefs as coping mechanisms whenever they encounter mental health problems. More African Americans than members of any other community use religion to cope with mental health challenges. The commonly used religious coping mechanisms include prayers and having a close relationship with God. They use the church as a source of encouragement when suffering from mental or physical health challenges. Traditionally, the Black church has played an important role as a source of worship, emotional expressiveness, civic meetings, pastoral care, educational endeavors, and counsel (Neely-Fairbanks et al., 2018). Religious leaders are normally the first responder when members of the community suffer from mental health issues. The clergy provides the important “cultural bridge between the formal healthcare system and recipients of care” (Kramer et al., 2007, p. 124, cited in Neely-Fairbanks et al., 2018), and play a critical role in helping African Americans to overcome mental health challenges.
Payne (2008) is another researcher who has established the tendency among African Americans to seek help for mental health problems from the church. The researcher asked the question about whether preachers discuss depression problems from the pulpit. The response to the research question was that preachers do discuss the issue from the pulpit. In the few sermons that the researcher analyzed, it was determined that preachers use various concepts in discussing depression, sadness, and grief. They discuss various issues, including “severe hardship, molestation, death of loved ones, and terminal illness” (Payne, 2008, p. 225). However, the study determined that they usually discuss situational depression, but not necessarily clinical depression. Payne (2008) failed to confirm whether preachers would discuss clinical depression as defined by DSM-IV TR (Diagnostic and Statistical Manual for Mental Disorders, Text Revision IV—A.P.A 1994, as cited in Payne, 2008, p. 225). Therefore, questions persist regarding the possibility of African Americans receiving effective health for clinical depression.
Recommendations in Research
Research shows that African Americans remain underserved population in the mental health system in the United States. Intervention researchers and clinicians should design effective approaches of overcoming such hindrances to increase participation of ethnic and racial minority in the mental health system. Policymakers should create inclusive and culturally sensitive frameworks to inform mental healthcare in the country. Professionals should transform parts of the healthcare system, which can change the relationship between care providers and recipients. Interventions should include altering the views and attitudes of the providers and the ways they engage with individuals from ethnic and racial minority groups. Furthermore, they should address the factors that hinder access to healthcare, including “beliefs, attitudes, and attributions, cultural mistrust, engaging the local network and improving primary care” (Marlene & Watson, 2008, p. 32). Notably, some studies recommend systematic changes followed by behavior change campaigns to create awareness about the improvement in mental health services and the need to seek help for related issues.
Gaps in Research
Although researchers have made considerable efforts to address the issue of African Americans being underserved population within the American mental health system, gaps still exist in the literature regarding multicultural individuals’ involvement in the system (Fripp & Carlson, 2017). For example, research is not complete regarding the actual reasons for the African Americans being underserved in the country’s mental health system, whether the reasons are inherent in individuals, the community, or the system, or whether all the factors explain the problem.
Conclusion
The literature review focused on previous research performed on the mental health challenges among African Americans. The first part of the review is on the mental health service-seeking behaviors among the community which indicated that they tend to avoid the services. The section leads to a discussion of the barriers, including mistrust, stigma, and the biased nature of the mental health system. The studies revealed that African Americans prefer to seek mental health assistance from religious and spiritual sources. The research includes recommendations to improve mental health in the country and to encourage the participation of people with such conditions in the health care process.
References
Buser, J. K. (2009). Treatment‐seeking disparity between African Americans and Whites: Attitudes toward treatment, coping resources, and racism. Journal of Multicultural Counseling and Development, 37(2), 94-104.
Davey, M. P., & Watson, M. F. (2008). Engaging African Americans in therapy: Integrating a public policy and family therapy perspective. Contemporary Family Therapy, 30(1), 31-47.
Fripp, J. A., & Carlson, R. G. (2017). Exploring the influence of attitude and stigma on the participation of African American and Latino populations in mental health services. Journal of Multicultural Counseling and Development, 45(2), 80-94.
Neely-Fairbanks, S. Y., Rojas-Guyler, L., Nabors, L., & Banjo, O. (2018). Mental illness knowledge, stigma, help-seeking behaviors, spirituality and the African American Church. American Journal of Health Studies, 33(4), 162-174
Payne, J. S. (2008). “Saints don’t cry”: Exploring messages surrounding depression and mental health treatment as expressed by African-American Pentecostal preachers. Journal of African American Studies, 12(3), 215-228
Ward, E., Wiltshire, J. C., Detry, M. A., & Brown, R. L. (2013). African American men and women’s attitude toward mental illness, perceptions of stigma, and preferred coping behaviors. Nursing Research, 62(3), 185–194.
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