Working with African American/Black Patients
The Black Population & Its Significant History
The Black population in the U.S. encompasses both African Americans and more recent African and Caribbean immigrants. Approximately 42 million people in the U.S.—that is 13.2%—identify themselves as Black and another 1% self-identify as multiracial.
There are significant differences in the rates of access, diagnosis and treatment for African Americans that negatively impact their health.
Historical adversity—for example, slavery, sharecropping, and segregation, along with other means of race-based exclusion from health, educational, social and economic resources—has led to socioeconomic disparities in the Black Community.
Institutional racism extended beyond the realm of social injustice and the struggle for civil rights.
It also permeated American medical education, medical practice, and scientific research that remains to impact the community today. Research shows that African American or black patients are:
more likely to receive treatment for mental health in emergency and hospital settings;
misdiagnosed at a higher rate with schizophrenia spectrum disorders, and
less likely to be offered antidepressant therapy—even when they have access to insurance or financial resources.
These factors, in addition to low rates of access to mental health services for Blacks, can negatively impact their mental health and dampen their relationship with the mental health community.
Psychiatrists have a role in improving the lives of Black patients—which will involve thoughtful consideration of historical, sociocultural, and individual factors that influence the care that is provided to this patient population. To improve mental health care for Black patients, while reducing racial/cultural biases towards Black patients, psychiatrists may consider the following:
Re-assessing professional practices to gauge whether these practices connect with core values of Black culture, such as family, kinship, community and spirituality. Generalized or Eurocentric treatment approaches may not easily align with these vital components of the Black community.
Examining how perceived racial discrimination may contribute to hyper vigilance, anxiety, or depressive symptoms among Black patients. It's important to recognize—and understand—personal biases in care and consider that Black patients may feel dismissed/ignored by mental health professionals who misperceive expressions of emotion by Blacks.
Educating oneself on the experience of Black patients within the local community. Consider connecting with community organizations and leaders to learn more about the array of Black cultures within that community and opportunities to collaborate.
Actively listening and critically evaluating each relationship to build and strengthen your alliance with patients.
Properly screening and following through with quality assessments that utilize a bio-psychosocial model. This will help gather unabridged evaluations of patients and pinpoint the most appropriate diagnosis for patients.
Keeping talk therapy, the center of all treatment paradigms, from the start, and then providing consistency in care. This should always be fundamental considerations for mental health providers.