Black and/or African American Communities

General Considerations and Risk factors

Mental Health Service Use:

  1. Compared with non-Hispanic whites, Black/African Americans with mental illness have lower rates of mental health service use including prescription medications and outpatient services, but higher use of inpatient services.
  2. Compared with the general population, Black/African Americans are less likely to be offered either evidence-based medication or psychotherapy.
  3. Compared with whites, Black/African Americans are: Less likely to receive guideline-consistent care, less frequently included in research, and more likely to use emergency rooms or primary care (rather than mental health specialists) to treat mental health issues.
  4. Historically, Black/African Americans have endured maltreatment and dehumanization in research and medical settings, leading to understandable mistrust about engaging with the medical/research community.
  5. The increased incidence of psychological difficulties in the Black/African American community is related to the lack of access to appropriate and culturally responsive mental health care, prejudice and racism inherent in the daily environment of Black/African Americans, and historical trauma enacted on the Black community by the medical field.

Mental Health

  1. Lifetime prevalence of PTSD is higher among Black/African Americans compared to other ethnic groups.
  2. Black/African American adults are more likely to have feelings of sadness, hopelessness, and worthlessness than are adult whites.

Health Care communication issues:

  1. Physician-patient communication differs for Black/African Americans and whites. One study found that physicians were 23% more verbally dominant, and engaged in 33% less patient-centered communication with Black/African Americans patients than with white patients.

(SCRIPTS) Questions to help assess and intervene around mental health concerns:

  • For you, what are the most important aspects of your background or identity?

  • Are there any aspects of your background or identity that make a difference to your problem?

  • Sometimes people have different ways of describing their problem to their family, friends, or others in their community. How would you describe your problem to them?

  • What troubles you most about your problem?

  • Who do you rely on in your home, family, or community to talk about these problems (if anyone)?

Recommendations:

  • Incorporate individual strengths: Encourage support from immediate and extended family of patient.

  • Incorporate patients’ spiritual and/or religious values into treatment as appropriate.

  • Incorporate community involvement and engagement into treatment

Resources