Where Mental Health and Social Justice Meet
Mar 11, 2019, 1:00 PM, Posted by Dwayne Proctor
A few years ago, I read a painfully insightful account in the New York Times of what it means to be a black American struggling with mental health. The author vividly describes how socio-historical “trauma lives in our blood,” materializing in our daily lives, and ultimately affecting our mental health.
A groundbreaking 2017 poll that the Robert Wood Johnson Foundation (RWJF) supported offers more insight into how discrimination fuels persistent stress. This stress leads to physiological responses that raise the risk of heart disease, stroke, and diabetes. Trauma and violence are also more likely to affect the lives of boys and young men of color, often leaving them with unresolved psychological wounds.
Compounding these problems are the many barriers that prevent African-Americans from receiving adequate mental health services. These include stigma, and a lack of representation among and trust of providers.
An inspiring leader I recently met—Mr. Yolo Akili Robinson—is dedicated to addressing this very problem. Robinson received a 2018 RWJF Award for Health Equity, which honors leaders who are changing systems and showing how solutions at the community level can lead to health equity. He is the executive director of BEAM, which stands for Black Emotional and Mental Health Collective. BEAM trains health care providers and community activists to be sensitive to the issues that plague black communities. BEAM has many programs that focus on men, boys, and nongender-conforming people.
I was pleased to delve deeper into Robinson’s work in the following Q&A:
What led you to your work in mental health advocacy?
I’ve been working in public health for the past 15 years, focusing on wellness, mental health, violence prevention, and HIV/AIDS. I saw huge pieces that were missing almost everywhere. I saw people who were visiting community-based organizations and hearing stigmatizing messages. For example, when I was working at an institution in Atlanta, a young man confided in an HIV testing counselor, “Sometimes I hear voices.”
The counselor’s response was unsettling. “Oh, my God, that sounds really bad. That’s crazy. You need to talk to somebody,” he said.
As a result, the young man grew fearful, shut down, and altogether avoided discussing what troubled him. Clearly, these kinds of messages and negative terminology are re-traumatizing and made him afraid to move forward with talking to a mental health worker and getting care.
What are the top mistakes that people within organizations might make in serving black clients—from receptionists to doctors—even though they’re trying to help?
It’s important to think critically about how we subconsciously respond to black people. For example, research suggests that medical students and residents may hold and use false beliefs about biological differences between blacks and whites to inform medical judgment. This may contribute to disparities in how they assess and treat pain, leading them to make different decisions about treatment than they would for white patients.
We all grow up internalizing things we hear, whether we like them or not. BEAM's approach to unconscious bias is that all of us grow up learning racism, sexism and other “isms.” So for me as someone raised and perceived as male, it would be impossible to not, in my 37 years of life, have learned biases toward women or have been taught behaviors that encouraged me to dominate, silence, or diminish them. That's an unfortunate aspect of American culture. Instead of denying or pretending to be "color or gender blind," we need honest exploration about the toxic things we learned and this can help us unlearn them, along with ongoing assessment. For example, as a man, am I taking up too much space? How am I using my power to support women? How could I be engaging other men to stop a culture of violence against women? That work is ongoing—and that means I need to always be cognizant when I am engaging someone different that I may embody privilege in relation to them.
Can you mention a few of the unique barriers African-Americans experiencing mental health problems encounter when seeking care?
The biggest systemic-level barriers that many black people face are access and community. When I say access, I mean having health insurance and money for a co-pay; having transportation to get to and from services (especially in rural communities); and finding culturally competent, sensitive enrollment processes that take into consideration the burden and fear that engaging therapy will bring up for many in our community.
Another barrier is the community. When our churches teach us that we can pray it all away, or our families believe that a "whoopin" or discipline is the issue instead of legitimate psychological distress, they keep us from getting the care we need and the intergenerational trauma continues. These issues, compounded with the structural barriers of ableism, transphobia, racism, homophobia, and black mental health myths are considerable challenges.
If I’m not paying attention to my own wellness and biases, that may become a barrier that shows up in interactions with those in my care.
BEAM responds to these barriers in many ways. Our Black Mental Health & Healing Justice Training trains educators, activists, religious leaders, and many more who work in black communities on accurate mental health information, peer support skills, and strategies to dismantle mental health myths. Our training also holds space for the unique way racism, transphobia, sexism, and homophobia impact mental health, something few other mental health literacy interventions in the country do. This intervention helps really address community-level barriers.
For systemic-level barriers, we provide training and technical assistance to organizations to help them integrate healing justice/mental health into their direct service and operations. Our Transforming Our Systems, Transforming Ourselves initiative also specifically supports organizations with assessing the wellness of their staff, as well as how they are impacting communities. I also have to mention our Southern Healing Support Fund, which offers micro-grants to black therapists, yoga teachers, and herbalists doing care support work in the rural deep South.
You also work with African-American college-age men, helping them address rigid masculine norms that may contribute to poor mental health. What are these issues?
The unique intersection of race and culture has led to what we now call black masculinity. This is, among other things, the idea that black men should embrace hardness, which is emotionally harmful and counterintuitive to our well-being. This notion of masculinity is perpetuated across racial and ethnic categories. However, because of the economic disadvantages for black men, there is pressure to perform in ways that are debatably more rigid than for white men.
Through our efforts around Masculinity & Mental Health Training, we work with people who identify as men, asking them, “How did you learn about masculinity, and how did that influence your relationship to your emotional or mental health? How are the women in your life impacted because of being in a relationship with a person who doesn’t want to commit to their well-being? How does that create loneliness, violence, isolation, misogyny, and transphobia?”
Our program also involves a community project, so people can bring lessons into churches, fraternities, and schools. It’s not just the 20 or 30 folks in the room [hearing these conversations]—that dialogue is going to your dad and your uncle. We’re hoping this leads to further learning and empowers young people who come to believe, “I can interrupt violence when I see my friend or my boy being disruptive, and that doesn’t make me less of a man.” We have a lot of unlearning to do, but we can be different kinds of men and people. We can create a world that centers on healing and doesn’t create harm.
You also focus on helping caretakers to look after themselves. Why?
Many of us—who are doing healing justice, mental health, or other support work in our communities—are drawn to it because of our own trauma. We may be survivors of the very issues we are trying to address, such as assault or chronic illness. We develop an altruism that leads us to become self-sacrificial in our approach toward how we nurture others. We push ourselves aside, minimizing our own needs. Healing others actually becomes an avoidance mechanism.
Also, people can say things that trigger and awaken our own anxiety, like when I talked to a man about how he beat his daughter. These aren’t always amicable clinical interactions either. When you’re facing and listening to so much distress, it lands in your heart.
If I’m not paying attention to my own wellness and biases, that may become a barrier that shows up in interactions with those in my care. I can be more aggressive or short with someone, or I can burn out and become indifferent, or so exhausted that I don’t come to work. We need to recognize this and attend to wellness and make space for it. Some of my own self-care involves getting the basic essentials like sleeping, eating healthy foods (with the occasional sweet treat), getting downtime and going to therapy, which is honestly amazing. Having an hour to focus on my feelings and processing has meant everything. This is not something extra that you do after work. This is the work.
Learn more about the RWJF Award for Health Equity.
About the Author
Dwayne Proctor, senior adviser to the president, believes that the Foundation’s vision for building a Culture of Health presents a unique opportunity to achieve health equity by advancing and promoting innovative systems changes related to the social determinants of health.