It's no secret that exposure to racism and discrimination is linked to various adverse mental health outcomes. The effects of systemic racism on Black Americans have been persistent and profound, as the National Alliance on Mental Illness (NAMI) points out, and the increase in media reports and images of police brutality and violence inflicted upon members of the Black community has added insult to injury.
The impact can be chronic, says Angela Neal-Barnett, PhD, a professor of psychology and the director of the Program for Research on Anxiety Disorders Among African Americans at Kent State University in Ohio. “Traumatic events related to racism have been unrelenting for Blacks. In good times, racism is a stressor; in bad times, racism is trauma,” she says.
As mental health challenges continue to rise in this community, some Black Americans still aren’t receiving the mental health care and treatment they may need. This is especially true for Black men, who are not only affected by the general barriers to medical treatment that many in the Black community face, but who also have internalized certain behaviors that fit within the social constructs of Black masculinity — ultimately impacting their help-seeking behaviors. Despite known or suspected mental health issues, Black men are for numerous reasons often reluctant to seek treatment.
Mental Health and the Black Community
Mental health issues are relatively common in the Black community at large. According to the National Institute on Minority Health and Health Disparities, African Americans are 20 percent more likely to experience serious psychological distress, such as major depressive disorder, than white Americans. Rates of major depressive disorder in young Black adults ages 18 to 25 increased by more than 3 percent between 2015 and 2018, according to the Substance Abuse and Mental Health Services Administration (SAMHSA), yet Black Americans of all age groups are less likely to seek treatment than white Americans. Additionally, the U.S. Department of Health and Human Services Office of Minority Health reports that Black adults are more likely than white adults to experience persistent symptoms of emotional distress, such as sadness, hopelessness, and feeling that they have to dedicate extra effort to everything they do.
While numerous factors have historically contributed to the Black community’s greater incidence of mental health challenges, more recently the ongoing exposure to discrimination and institutional racism alongside the pandemic has created what Brian Smedley, PhD, the chief of psychology in the public interest at the American Psychological Association, referred to in an interview with NBC News as a “mental health tsunami” that could be worsened by a dearth of resources to help.
“The combination of physical distancing, economic anxiety, and — for people of color — the very real stress from racism since the pandemic means that we will have a lot of unmet mental health needs unless we can dramatically shore up the mental health infrastructure and address workforce shortages,” he said.
Scarcity of Resources and Mistrust Are Barriers to Care
Lack of access to culturally responsive and appropriate mental health care, along with documented racism and bias within the healthcare system, have made some people in the Black community less likely to seek treatment. According to research and Dr. Neal-Barnett, there is a collective mistrust of healthcare and medical providers because of abuse Black patients have historically experienced under the guise of medical testing and advancement, such as in the U.S. Public Health Service Syphilis Study at Tuskegee.
Lack of access to services is another factor that prevents adequate mental health care, according to the NAMI: Resources can be difficult to obtain when people don’t have health insurance, have demanding shift jobs, live in locations with few services, or don't have reliable transportation. Stigma and misinformation about mental illness can also deter people from seeking treatment.
How Black Masculinity Norms Affect the Mental Health of Black Men
Adding to these factors for Black men specifically are traditional masculinity roles and ideas across racial and ethnic backgrounds that have caused men to struggle with being vulnerable and sharing their emotions — making them even more reluctant to seek help. A growing body of research and commentary looks specifically at how Black masculinity norms and presumptions affect mental health among Black men.
In her book We Real Cool: Black Men and Masculinity, the social and cultural critic bell hooks examined the impact on Black men of social expectations that they'll behave in ways associated with Black masculinity, and described how the expectation to follow a specific set of behaviors creates a toxic environment: Viewed inside a stereotype, Black men can become dehumanized and invisible, and their psychological and emotional health suffers. In addition, the lack of love and acceptance that many of them face can create a separate emotional crisis.
Researchers who examine how Black masculinity and norms affect help-seeking behavior among Black men have found negative outcomes. In a study of Black men who were experiencing mental health challenges published in the July–September 2016 issue of Behavioral Medicine, notions about Black masculinity both exacerbated psychological and emotional challenges such as depression, anxiety, and PTSD and prevented the men from seeking help to address those challenges.
Traditional media portrayals of Black men haven’t helped. As a study published in 2019 in the journal Psychology of Men & Masculinities explains, we have been inundated with images in film, television, and social media that depict Black men as overly masculine and, in some cases, aggressive and hypersexual. Open displays of emotion, on the other hand, are often frowned upon and not socially acceptable, sending a clear message to some Black men that to be accepted, they must fit a particular gender role in which strength and stoicism are mandatory.
Neal-Barnett explains that Black men experience unique challenges that other men don’t face because of the attention placed on their looks and bodies — and rarely on their mental or emotional intelligence. “In many spaces, Black men are expected to be strong and resilient physically. They are encouraged to do well in athletics and to engage and thrive in physical activities, but not in activities that promote learning or emotional or mental growth,” she says.
The foundation of this Black masculinity construct is laid early, with many Black men growing up believing their psychological and emotional health and wellness do not have an inherent or productive value to other members of the Black community or to society as a whole. Many Black men internalize the idea that their value lies in what they can contribute physically, such as through sports or performing physical labor, and that discussing or exploring psychological or emotional concerns is in direct contradiction to societal expectations.
Self-examination may be seen as not only pointless, but a sign of weakness. According to Neal-Barnett, in order for Black men to seek and receive help, they must be willing to be vulnerable enough to admit that they need help and ask for it. And asking for help requires some Black men to deviate from expectations that require them to be tough — which itself can create significant inner tension and conflict. Given the numerous negative impacts of Black masculinity, experts like Neal-Barnett wish the construct could be done away with entirely.
More Black Men Are Exposing Vulnerabilities, Creating Space for Dialogue and Change
Despite these norms and the frequent inner struggle over vulnerability, more and more Black men are sharing their challenges with mental health. In 2016, the rapper Kid Cudi openly talked about his depression on social media, as reported by The Good Men Project, after which the hashtag #YouGoodMan quickly began to trend on Twitter to encourage Black men to share more about mental health issues.
In 2018, the music mogul Jay-Z added to the conversation in an interview with Van Jones on CNN in which he discussed his own experience with therapy and “the ridiculousness of the stigma” attached to mental health issues; he openly advocated for therapy in schools.
More recently, in an interview with Forbes about his involvement with Okayplayer’s PASSAGE: The Practice of Healing, a new wellness initiative for people of color, the hip-hop artist Big K.R.I.T. talked about mental health and encouraged the Black community to seek counseling services when needed.
Members of the music industry are not alone in their efforts to increase awareness among Black men about mental health; TV portrayals are also shifting. In a 2020 episode of FX's Dave, GaTa — who plays a version of his real self on the show as hype man to Lil Dicky (Dave Burd) — reveals that he has been diagnosed with bipolar disorder. The episode was well received by fans, and GaTa later openly shared his real-life experiences with the diagnosis. And in season four of HBO’s Insecure, Issa’s on-again, off-again boyfriend Nathan confides in her that he, too, has been diagnosed with bipolar disorder — an issue that’s also part of the plot in season five.
5 Helpful Tips for Black Men Seeking Mental Health Care
Although some progress has been made toward destigmatizing mental health issues among Black men, more must be done. For Black men who find themselves conflicted about whether to seek a professional counselor and are wondering if it’s right for them, here are five things that Neal-Barnett and Barbara Shabazz, PsyD, a psychologist in Virginia Beach, Virginia, suggest for Black men consider.
- You have nothing to prove. Dr. Shabazz stresses that Black men who are experiencing psychological and emotional health challenges have nothing to prove to anyone but themselves. Of course, there are obligations to loved ones that must be fulfilled, but prioritizing mental and physical wellness so that you can be more present for those who love and depend on you is essential.
- Treatment, in all its forms, is entirely confidential. All counselors are ethically bound to maintain the confidentiality of their clients and are subject to losing licensure if they fail to do so. Neal-Barnett encourages Black men to not worry about those skeletons; they are safe with your therapist and psychiatrist.
- You can pick your mental health professional. Sitting down and sharing your deepest and darkest secrets can be difficult for anyone, regardless of biological sex or racial or ethnic background. But one of the great things about seeking services is that, in most cases, you can select the professional with whom you feel most comfortable.
- There is no shame in seeking treatment. You have probably heard this a million times, but it’s true. Neal-Barnett says sometimes the most courageous gesture we can make is to ask for help.
- Counseling, therapy, and psychiatric treatment are not for “crazy” people. This is a stereotype that needs to be retired once and for all. Shabazz emphasizes that counseling is for anyone who wants to speak with a nonbiased and objective professional in a confidential environment.
Choosing the Specialist Who’s Right for You
If you’ve made the decision to speak to someone, excellent! But keep in mind that not all mental health professionals are the same, and some offer and focus on different specializations. Do your own research on the best fit for you, but consider starting with your primary care doctor: They can offer further guidance on how to move forward in selecting a mental health professional.
The National Alliance on Mental Illness is a great resource for guidance on the different types of mental health care providers and how to select an expert. Here are some options that may be available to you.
Psychiatrist A psychiatrist has completed a medical residency specializing in psychiatry and earned a medical degree (MD). Psychiatrists specialize in the diagnosis and treatment of mental illness, prescribe medication, and facilitate therapy sessions.
Psychologist A psychologist has earned a doctoral-level degree (PhD or PsyD) specializing in diagnosis, treatment, and therapy. Unlike a psychiatrist, a psychologist cannot prescribe medication.
Licensed professional counselor (LPC) An LPC has earned a graduate-level master’s or doctoral degree in counseling (PhD, MS, or MA). A licensed professional counselor specializes in diagnosis and treatment and provides therapy. They often work with clients to develop healthy coping skills and offer a safe space to process experiences. Individuals can also receive specific clinical training and earn licensing to become a marriage, family, and couples therapist (MFT). MFTs are similar to LPCs, but their specialization is not in individual counseling but in working with couples and families. Neither MFTs nor LPCs can prescribe medication.
Licensed clinical social worker (LCSW) An LCSW has completed graduate-level training and has a master’s degree in social work (MSW). Like an LPC, they specialize in the diagnosis and treatment of mental illness and provide therapy. But they also have specific training in national social welfare policy and support services. Social workers cannot prescribe medication.
Psychiatric mental health nurse practitioner (PMHNP) A psychiatric mental health nurse practitioner, also known as a psychiatric nurse practitioner, is a registered nurse who has earned an additional postgraduate degree and specializes in diagnosing and treating mental illness. Like a psychiatrist, psychiatric nurse practitioners are licensed to prescribe medication. In some locations, nurse practitioners can prescribe medication independently, and in other places, they are required to collaborate with a physician.
According to Shabazz, once you begin working with a mental health provider, they will create a treatment plan based on your specific needs. A treatment plan may or may not include prescription medication, and in fact, most providers aim to help their clients make lifestyle changes rather than take prescription medication in order to work toward their goals. In the event that you and your provider agree that medication is necessary, your psychologist, licensed professional counselor, or social worker will help you find a psychiatrist.