In America, systemic racism and white supremacy has fueled the fire for centuries, and continues to be a major problem in today's society. Racism has been proven to be a leading cause in psychological disparities among people of color, resulting in what we now define as "racial trauma." Black, Asian, Latinx and other communities of people of color continue to experience discrimination and oppression stemmed from prejudice beliefs, linking racism to negative psychological health, such as depression, anxiety, PTSD, psychological distress, lower self-esteem, negative affect, poor sleep outcomes, and suicidal ideation (11) (13). Numerous studies have concluded that POC are "at greater risk for depression and suicide compared to white individuals," while Black and Latino individuals have higher rates of attempted suicide during their lifetime (19). Suicide serves as the tenth leading cause of death within the United States, holding a statistic of over 40,000 annual deaths (CDC, 2014) (19).
Generational transitions of racism persists in today's predominately white society, where people of color have reported experiencing reoccurring subjective bouts of racism. A cross-sectional study of 202 service users who reported having a severe mental illness was conducted, where the participants were interviewed in order to assess their experiences of discrimination. It was found that 88% of participants reported experiencing discrimination at least once in their life, whereas 94% reported experiencing daily discrimination (12). The areas of where they experienced this discrimination are as follows: mental health care (44%), neighbors (42%), police (33%), employment (31%), and general medical care (31%). Race-ethnicity was a common attribution for major discrimination 24% of the time (12).
Racial trauma has stemmed from individual-level racism, which includes "implicit and explicit personal beliefs about perceived inferior qualities of people from certain racial/ethnic backgrounds and the actions that stem from those beliefs" (Neblett Jr., 2019) (20). Individual-level racism is most common during bouts of tragedy – one example being Middle Eastern Americans stereotyped as terrorists post 9/11.
During the last year, the Asian community has suffered a great deal of discrimination as a result of the COVID-19 outbreak. Individuals within this community "have become a scapegoat as the source of COVID-19 in the U.S." (20). Almost 1,500 incidents have been reported within a one-month timespan towards the Asian community, resulting in physical attacks, being yelled at, and even spit on (20).
The Black community has also had their fair share of grievances, ranging from police brutality, racial profiling, and a substantial mortality rate due to the pandemic that surpasses any other race within the country. Black people accounted for 33% of all deaths resulting from COVID-19, while only representing 13% of the population (20). COVID-19 has also encompassed an increase in racial profiling, as in one instance, after the CDC recommended face marks to be worn in public, law-enforcement raised concerns towards racial profiling and CDC guideline compliance. In March of 2020, two black men shopping at Walmart were followed and catechized by a police officer, who then prompted the two men to leave because they were wearing surgical masks (20).
In a court case held in 1970, Alcorn v. Anbro Engineering, Inc., a black union steward by the name of Manuel Alcorn, filed a case against Anbro Engineering, Inc. after an incident between him and another employee resulted in racial slurs and termination of employment. Alcorn argued that "as a result of this incident he suffered humiliation, mental anguish, and emotional and physical distress. He claimed that for several weeks after the experience he suffered from shock, nausea, and insomnia and was unable to work" (18).
Meanwhile, psychiatrist Sandra Walker, M.D., an associate clinical professor at the University of Washington, recounted her experience of what it was like to grow up black during the 1960's in Alabama. Walker was a childhood friend among 1 out of the 4 Black school girls that was murdered in the 16th Street Baptist Church bombing in Birmingham in 1963; a bombing conducted out of racial hatred.
Racial trauma has come to a crossroads, conflicting with structural racism, which "includes laws, policies, and practices of societies and institutions that overtly or covertly discriminate, disadvantage, neglect, or oppress across race or ethnicity" (Williams et al., 2019) (20).
Napoleon Higgins, M.D., a Houston psychiatrist, CEO of Global Health Psychiatry LLC., and owner of the Bay Pointe Behavioral Health Services as well as the Southeast Houston Research Group, gave commentary in an August webiner on racism and the American healthcare system. According to Higgins, generations of mistreatment toward Black people has led to "a destroyed trust" in the American healthcare system (17).
Today, the criminal justice system has clashed with mental health in terms of systemic racism. An innumerable amount of people from the Black community are finding themselves incarcerated in situations where, in actuality, should be receiving treatment for mental or behavioral disorders.
Misdiagnosis is not the only issue at hand. Many POC are finding themselves uninsured and misunderstood. As defined by the Aspen Institute, structural racism is "a system in which public policies, institutional practices, cultural representations, and other norms work in various, often reinforcing ways to perpetuate racial group inequity" (13). The Medicaid Institutions for Mental Disease (IMD) holds a payment exclusion, which "prohibits reimbursement for many accredited inpatient psychiatric facilities" (13), while few psychiatrists accept insurance. In turn, POC find themselves unable to afford mental health care. POC are at a disadvantage for yet again for health opportunities.
Crisis in minorities and their mental health stands at a dead end, as the majority of the mental health industry is predominantly white, furthering the withdrawal of ethnic-based communities reaching out for help. According to Daniel H. Gillison Jr., CEO of the National Alliance on Mental Illness (NAMI), there is a shortage of Black mental health professionals. "The population of available Black psychiatrists is 3% and it is 16% for Black psychologists, so there are [few] that look like the patient" (15). POC are finding it difficult to identify with a mental health provider and feel heard.
While POC avoid seeking help for mental illness, it leads to, as Primm describes it, as "the double whammy." With avoidance or inability to seek help for untreated mental illness or substance abuse, people are finding themselves falling "down a path of destruction—violence, homicide, suicide, incarceration, [and] exposure to disease like HIV/AIDS" (15).
As stated by Orlando Lightfoot, M.D., Boston University's vice chair of community psychiatry, regarding racism, that "there is no perfect solution for such a complex issue," Just because there isn't a definite solution doesn't mean there's not a possibility for improvement and change. In agreement to Lightfoot, we must all collectively be open-minded and attempt to understand and learn historical wrongs, while creating and implementing future rights. Lightfood also suggested that we "continue to modify legislative systems and policies that overtly or covertly oppress a particular group of people" (16).
Vabren Watts wrote in an article Institutional Racism Still Has Major Impact on African-American Mental Health, that "to better serve minority patients, psychiatrists need to understand how institutional racism can lead to negative mental health consequences" (16). Daniel H. Gillison Jr. suggested that changing systemic racism — whether it's in healthcare, the criminal justice system or even the education system — we must change how people think. Three steps were offered to mental health professionals in the journal article, Racism and Mental Health Equity: History Repeating Itself, regarding racial equity:
- Step 1: "increase awareness and acknowledge that racism exists everywhere."
- Step 2: "take an honest individual and institutional inventory."
- Step 3: "apply a racial equity lens to mental health advocacy." (13)
"Acknowledging individual and structural racism by examining racist policies and implementing anti-racist policies is the first step toward achieving mental health equity [...] To paraphrase writer and activist Audre Lorde, our silence will not protect us" (13).
References:
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Sutter, M., & Perrin, P. B. (2016). Discrimination, Mental Health, and Suicidal Ideation
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https://doi-org.proxy.lib.uiowa.edu/10.1037/cou0000126
(20) Liu, S. R., & Modir, S. (2020). The outbreak that was always here: Racial trauma in the
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Thank you for this well researched piece!