Acknowledging A History of Systemic Racism In Mental Health Treatment

This July marks BIPOC Mental Health Awareness Month and to honor it we are shining a light on the history of systemic racism that has led to the current mental health crisis for Black people in the United States.

Since the dawn of slavery in this country until today, the experience of Black people has been marked by trauma and oppression. Our mental health industry was built upon and has operated within a system of institutional racism and injustice.

Now, it is our burden and our responsibility to learn, acknowledge and educate ourselves on our industry’s history and truth.

The Foundation

Historical dehumanization of Black people began with the enslavement of hundreds of thousands of human beings stolen from their homes and their lives and brought to the North American continent to build the new world economy. What started in 1619 as chattel slavery put into motion the forces of institutional racism that still persist in American society today.

While the emancipation proclamation of 1863 legally ended slavery, it simply gave way to the enslavement of Black people in new forms, including sharecropping and convinct leasing well into the 20th century. Local and state Jim Crow laws that enforced segregation in the Southern United States continued for over 100 years until 1965, and only ended as result of the efforts of the Civil Rights Movement.

Today, slavery and formal segregation has been replaced by the mass incarceration of Black people and race-based exclusion from essential economic, social, and health opportunities and resources.

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The Ramifications On Black Americans’ Lived Experiences & The Black Mental Health Crisis

Black Americans’ lived experience has been shaped by generations of formal, institutional and systemic racism. As a result of these traumas, the current Black mental health crisis that exists is complex, deep-set and perpetuated by issues of socio-economic inequity, limited access, mental health criminalization, as well as a history of misdiagnosis and poor treatment.

Socio-Economic Inequity & Black Mental Health Treatment

In our industry, we know that individuals that are impoverished, experience homelessness, are incarcerated or have substance use concerns are at an increased risk of mental health issues. Black and African American people in this country, as a result of systemic racism and mass incarceration policies, are more likely to fall within these categories.

As of the 2018 census, 1 in 5 Black and African American people in the United live in poverty and they make up 40% of the US prison population (when they comprise only 13% of the total American population).

The tragic result is evident in the data.

The CDC National Health Statistics shows that Black and African American people living below the poverty line are twice as likely to report serious psychological distress than those living over 2x the poverty level and are more likely to have feelings of sadness, hopelessness and worthlessness than adult white Americans.
A 2018 National Survey on Drug Use & Health by SAMHSA found that 16% of Black and African American people reported having a mental illness and 22.4% reported a serious mental illness in that year.

Unequal Access to Mental Health Resources and Representative Care

Even for those Black Americans who want to seek out help for their mental health concerns, access remains scarce and problematic.

11.5 % of Black and African Americans vs. 7.5% of white Americans are still uninsured, despite the institution of the Affordable Care Act. In a 2018 study by the Kaiser Family Foundation, researchers found that 58.2% of Black and African American young adults ages 18-25 were not receiving treatment for their healthcare needs in that year and nearly 90% of young Black Americans over the age of 12 with a substance use disorder were not receiving treatment.

And even if financial barriers can be overcome, the problem of poor racial representation among mental health providers remains. The American Psychological Association’s Center for Workforce Studies Data reported that in 2015 about 86% of psychologists in the United States were white, 5% were Hispanic, 5% were Asian and just 4% were Black. This was far less diverse than the US population as a whole at that time which was 62% white and 38% racial/ethnic minority.

A History of Mental Health Criminalization, Misdiagnosis and Poor Treatment

Further compounding these issues is a history of scientific racism. For hundreds of years, Black Americans have had their actions and experiences mislabeled, controlled and contained by the medical community in power. Whether it was escaping slavery or advocating for civil rights, physicians were quick to label these Black responses to oppression as a byproduct of psychiatric illness.

In 1851, Samuel A Cartwright coined the condition, ‘drapetomania’; what he described as a ‘treatable mental illness’ that caused black slaves to try and flee captivity. In the wake of the emancipation and reconstruction era, the idea that the “black psyche was immoral and inherently criminal” was popularized as a way of justifying Jim Crow segregation laws and mass incarceration, a process that took place not just in prisons but in psychiatric hospitals that ‘functioned more like prisons than places of treatment’.

Fast forward to the 1960s, and we see Civil Rights activism being labeled as a pathology rather than a natural response to suppression and racial injustice. A 1968 article in the Archives of General Psychiatry described schizophrenia as a ‘protest psychosis’ in which Black men developed “hostile and aggressive feelings and delusional anti-whiteness”. That same year, the American Psychiatric Association changed the definition of schizophrenia to include ‘aggression’ where it previously had not.

Not at all surprisingly, 2017 statistics by the American Psychological Association show deep disparities in mental health diagnosis and treatment in the United States. Black and African American people are more often diagnosed with schizophrenia and less often diagnosed with mood disorders compared to white people with the same symptoms. They are also offered medication or therapy at a lower rate than the general population. Stigma, judgment, misinformation and a lack of knowledge around mental health issues are pervasive in society in general, but this is particularly notable in the Black and African American community as shown in research by Ward, Wilshire, Detry and Brown (2014) and others. There is also a noted preference among Black and African American individuals to turn to faith and a spiritual community as a source of strength around emotional challenges rather than choosing to seek out medical professionals. This preference is no doubt the result of longstanding prejudice and discrimination within the healthcare system and a general distrust of providers who often lack cultural competence.

Despite progress made over the years, the impact this history has had on the mental health of Black and African American people cannot be understated. While the Black American mental health history is still an under-researched area, what is clear is that there is a very long way to go towards providing the mental health care, access, and support Black and African Americans need and deserve.

Please note: We acknowledge that there exist more complete resources and histories on black mental health than what is outlined here, and we encourage anyone reading this to seek out works by Black historians and writers Quintard Taylor, Ibram X Kendi, Diana Ramey Berry and Kali Nicole Gross (among so many others) and to explore The New York Times 1619 project.

Key Sources

Resources for White People

Linked Resources for Black and African American Communities: