Amid upheaval, a Black mental health crisis and surge in requests for care
By Katti Gray
A spate of police and vigilante slayings of unarmed African Americans and a global pandemic that has hit Blacks especially hard is fueling a surge in the number of Blacks seeking mental health counseling, including persons who never before have sought such care.
While there’s no firm data on the number of seekers, clinicians say they have plenty of anecdotal evidence. “My practice has never been this busy. And I’m hearing that from Black psychiatrists and psychotherapists all over the country,” said Dr. Sarah Vinson, of Atlanta, a private practitioner who teaches at Emory School of Medicine and Morehouse School of Medicine.
That uptick in Black patients represents a chipping away at many Blacks’ long-held stigmas against securing mental health care. Their doubts, in part, have been grounded in a belief that personal resilience — built up since slavery — will carry them through a mental health crisis. That uptick is spotlighting anew the nation’s longstanding shortage of Black psychiatrists, psychologists and clinical social workers. It also has ramped up questions of how well-prepared White clinicians, filling in gaps in a mental health workforce, are to handle Black patients.
“Objectively, it just isn’t true that a Black patient cannot be helped by someone who isn’t Black. But we still have so much difficulty in finding culturally competent service providers,” said Dr. Glenda Wrenn, a psychiatrist who teaches at Atlanta’s Morehouse School of Medicine and practices at Grady Memorial Hospital.
She continued: “If a patient comes in outraged over racial injustice, at some point you do want to have them move on from that topic. But if the clinician comes across as invalidating that reaction, that’s going to lead to a disconnect. … This is especially true for people seeking care for the first time: ‘How will you care for me? Can you relate to me? Do you believe what I believe?’ Historically, we’ve seen Black and other patients of color trying to educate clinicians of another color. And that simply should not be the patient’s job.”
The American Psychological Association has been particularly attuned to that conundrum during the current focus on racial inequity in America. It’s website is awash with resources for health consumers and clinicians, including the APA’s Multicultural Guidelines: An Ecological Approach to Context, Identity, and Intersectionality, initially published in 2017.
In these times, Blacks (and Asians) report more anxiety and depression
Before these current, race-riven crises, the federal Health Office of Minority Health had reported that African Americans were 20% more likely than non-Hispanic whites to suffer from mental illness
Today’s rising numbers of Blacks with mounting mental health problems was captured in the Census Bureau’s 2020 Household Pulse Survey, which launched in April 2020 mainly to gauge, among other everyday effects, the impact of coronavirus on the public’s mental health. That survey showed that, during the week following George Floyd’s murder, the tally of Blacks who screened positive for anxiety and depression spiked from 36% to 40%. That translated into 1.4 million people.
Additionally, an August 2020 report from the Centers for Disease Control and Prevention concluded that 8% of Blacks screened positive for anxiety in June 2019, but 34% did so in June 2020. The respective figures for depression were 8% and 34%. While Blacks accounted for the highest concentration of positive screenings, anxiety and depression also spiked for Whites, Latinos and Asians.
In the Household Pulse Survey, Asian Americans were second to Blacks in positive screenings for depression and anxiety, partly stemming from an increase in hate crimes against that group during COVID-19, with its origin traced to China.
Costs and lack of Black therapists remain barriers to care
Finding a therapist who is the right fit and at the right price was a challenge for many Black patients, even before today’s upheaval. Just 4% of the nation’s psychologists are Black, according to American Psychological Association’s most recent report, while it’s been estimated that roughly 2% of psychiatrists are Black. In raw numbers, that’s somewhere between 2,000 and 2,200 doctors, said Dr. Patricia A. Newton, a psychiatrist who is CEO and medical director of Black Psychiatrists of America. “There’s no way possible that that fraction of psychiatrists can meet the needs, which are greater now than ever.”
Also, according to 2017 report from the Council on Social Work Education, Blacks accounted for 21.6% of roughly 670,000 social workers. That included social workers with bachelor’s and master’s degrees who were employed in both clinical and non-clinical settings.
Compounding those shortages is the fact that, historically, many psychiatrists, psychologists and clinical social workers run cash-only practices. One estimate puts the cost of a psychiatric session at, as examples, $400 in New York and $375 in Boston.
Those who only accept cash argue that insurance reimbursements for their services are far too low. Still, some of those doctors and therapists do offer income-based, sliding-scale fees.
During COVID-19 lockdowns, CMS eased limits on telemedicine
In March 2020, the Center for Medicare & Medicaid Services broadened its list of medical services, including mental health care, that can be provided via telemedicine. Health care practitioners, according to CMS guidance, can address patients’ needs and concerns via “telephone, audio/video, secure text messaging, email, or use of a patient portal.”
Private insurers took similar action. “This is one of the bright spots of the pandemic,” psychiatrist Wrenn said. It gives patients more access, including to practitioners licensed to provide care in one state, even if they live in a different state altogether.
The American Psychiatric Association, Association of Black Psychologists, Black Mental Health Alliance, Black Psychiatrists of America , Black Emotional and Mental Health Collective, Therapy for Black Girls and Therapy for Black Men (that men’s group is offering free therapy right now) are among organizations maintaining lists of clinicians and providing other useful information. Amid the current pandemic and protests, several of them have been streaming on Facebook Live and YouTube.
Many Black churches have no-cost counseling ministries run by professionally trained and certified volunteer clinicians.
Each state is federally mandated to establish and maintain safety-net mental health service agencies, overseen and listed by the Substance Abuse and Mental Health Services Administration.
Some local chapters of the National Alliance of Mental Illness, which appointed an African American as its executive director in 2019, run support groups and provide educational tools for a diversity of communities.
How are White mental health care practitioners ramping up their cultural competence and how does that revamp change/affect their patient demographic?
What are Black patients' experiences with non-Black therapists?
What are the demands and constraints of federal, safety net mental health clinics in a given area? Here is the federal Substance Abuse and Mental Health Services Administration’s list of those sites.
What gaps in care are churches and other sectors of the Black faith community filling through what tend to be all-volunteer counseling services by trained professionals?
What are the effects of how Blacks present traumas, amid a pandemic and protest, and how do they overlay on transgenerational trauma and resilience?
Katti Gray (@kattigray) is AHCJ's core topic leader for behavioral and mental health. A former Rosalynn Carter Mental Health Journalism Fellow, Gray is providing resources to help AHCJ members expand their coverage of mental health amid ongoing efforts to de-stigmatize mental illness and to place mental health care on par with all health care.