The Culture of Mental Health Stigma in Communities of Color
Ayorkor Gaba, PsyD, is a clinical psychologist and project manager at the Center of Alcohol Studies, Rutgers University, as well as a clinical supervisor at the Rutgers Psychological Clinic. She has a private practice in Highland Park, New Jersey and is an American Psychological Association-appointed representative to the United Nations. She is an alumna of Project L/EARN, a project of the Robert Wood Johnson Foundation and the Institute for Health, Health Care Policy and Aging Research at Rutgers University.
Mental illness affects one in five adults in America. A disproportionately high burden of disability from mental disorders exists in communities of color. Research has shown that this higher burden does not arise from a greater prevalence or severity of illnesses in these communities, but stems from individuals in these communities being less likely to receive diagnosis and treatment for their mental illnesses, having less access to and availability of mental health services, receiving less care, and experiencing poorer quality of care. Even after controlling for factors such as health insurance and socioeconomic status, ethnic minority groups still have a higher unmet mental health need than non-Hispanic Whites (Broman, 2012).
There are a number of factors driving these statistics in our communities, including attitudes, lack of culturally and linguistically appropriate services, distrust, stigma, and more. In our society all racial groups report mental health stigma, but culturally bound stigma may have a differential impact on communities of color. Stigma has been described as a cluster of negative attitudes and beliefs that motivate the general public to fear, reject, avoid, and discriminate against people with mental illnesses (President’s New Freedom Commission on Mental Health, 2003). Stigma in the general public often leads to internalized stigma at the individual level. Several studies have shown that internalized stigma is an important mechanism decreasing the willingness to seek mental health treatment.
For example, a recent study comparing Asians’ and Caucasian Americans’ implicit and explicit attitudes toward mental illness found that Asian Americans showed stronger negative implicit attitudes toward mental illness than Caucasian Americans. Asian Americans also explicitly endorsed greater desire for social distance from mental illness than Caucasian Americans (Cheon & Chiao, 2012). Similar findings have been identified for different ethnic and racial minority groups.
In my clinical practice I have been struck by the amount of ethnic minority clients who did not seek help, acknowledge their symptoms, and/or disclose their participation in treatment because of culturally bound stereotypes. For example, the cultural stereotype of the strong black woman promotes unflagging toughness, strength, self-reliance, and denial of self-needs, and has a distinct cultural history (Beauboeuf-Lafontant, 2005 & Romero, 2000). In working with clients I have seen how the characteristics associated with this stereotype may be adaptive in many situations, but may also serve as a barrier to seeking mental health treatment.
These stereotypes and stigma impact how communities of color interact with, provide opportunities for, and help support a person with mental illness. It also impacts how a person in these communities experiences and expresses their own mental health issue and whether they disclose these symptoms and seek help.
So, how do we begin to combat these cultural stereotypes and stigma? This is a complex question that requires shifts at the societal, institutional, community, and individual levels. Below is a non-exhaustive list of some things we can do:
1. Share your story. People often do not seek help because they feel alone in their struggles and have internalized negative stereotypes. By sharing your experience with similar problems and treatment seeking, you help to normalize their experience and may make it more acceptable to seek help. Recently, while facilitating a therapy group for young adult African American males, a group member mentioned how impactful it was to hear a Puerto Rican DJ on a local hip hop radio station, Cipha Sounds of Hot 97, discuss his own experience with therapy on the radio.
2. Speak out. If you have a background in mental health, do a presentation/talk at your local community organization (i.e. church, mosque, Boys & Girls Club, etc.). Remember mental health encompasses mental wellness as well, so integrate information about resilience, prevention, and cultural practices which have been linked to mental wellness (i.e. Buddhist Meditation).
3. Advocate for improved and diverse representations in the media. Media play a significant role in perpetuating stigmatizing stereotypes of people with mental health problems. Contact your media outlets when you are concerned about their representations of mental health.
4. Increase your awareness. July is Bebe Moore Campbell National Minority Mental Health Awareness Month and a great time to learn about mental illness, prevention, treatment, and research in diverse communities.
5. Support advocacy. Initiatives aiming to increase minority-specific research; diversify the mental health workforce; and train providers in the delivery of culturally competent mental health care is essential. The National Alliance on Mental Illness website provides updates on ways to take action.
5. Romero, R. E. (2000). The icon of the strong black woman: the paradox of strength. In L.C. Jackson and B. Greene (Eds), Psychotherapy with African-American Women:Innovations in psychodynamic perspectives and practice (pp. 225-238). New York, NY: Guilford press.