Access to quality mental healthcare is important for all people, but that doesn’t mean that everyone in the United States has the same level of access. Black, indigenous, and people of color (BIPOC) communities often experience more barriers to effective mental health care than their white counterparts. This is caused by a variety of factors that range from social biases against BIPOC individuals, incorrect diagnoses, and a lack of mental health resources available to these groups.

The topic of mental health care for BIPOC Americans is complex but needs to be talked about. Community leaders and medical professionals can’t take steps to improve access to BIPOC individuals without fully understanding the state of mental health in the country. This guide will address some of the barriers to care and concerns that BIPOC patients and their support systems have when they need mental health support.

The Impact of Historical Trauma on BIPOC Mental Health

According to the Administration for Children and Families, historical trauma is defined as, “multigenerational trauma experienced by a specific cultural, racial or ethnic group.” Examples of historical trauma can be found throughout American BIPOC communities. The impacts of slavery still linger in black communities and many Americans still have living memories of life in the segregated South. Indigenous groups have historical trauma from colonization and forced migration, which impacts communities to this day.

Mental Health Effects of Historical Trauma

Historical trauma has deep impacts on the mental health of BIPOC communities. Within Native American communities, mental health experts have noticed a variety of side effects including depression, anxiety, higher rates of substance abuse, post-traumatic stress disorder (PTSD), self-hatred, internalized oppression, and a general loss of hope. There are guides for psychiatrists who are treating these communities so they have a better understanding of the role historical trauma plays in mental health.

Historical trauma erodes a person’s sense of safety, security, and trust in their environment. It also negatively impacts relationships, leading to isolation, mistrust, and disconnection. You can see this in the symptoms of internalized oppression and self-hatred, which can lead to substance abuse and depression. Symptoms can build on each other and worsen the mental health of BIPOC individuals.

This loss of hope and self-devaluation can also create a sense of powerlessness that makes it difficult to seek help. A person has to feel like they are worthy and deserving of help in order to seek it out.

Addressing Historical Trauma in BIPOC Communities

The first step to addressing the mental health needs of BIPOC Americans is to better understand the impact of historical trauma on these communities. One psychiatrist cannot overcome centuries of oppression, but they can be more aware of how historical trauma can impact their patients. This is particularly important as racist acts, discrimination, and harmful stereotypes continue to be prevalent in American society — turning historical trauma into present trauma.

Cultural Considerations in Diagnosis and Treatment

Historical trauma is just one aspect of BIPOC mental health. There are additional cultural and social factors that prevent people within these communities from getting the care they need. Here are just a few considerations when accessing mental health care and how they can impact communities:

• Language barriers: learning a second or third language is difficult for most Americans, but this becomes even harder when you add complicated medical terminology to the conversation. Many BIPOC individuals speak English as a second language and have varying levels of fluency. Mental health practitioners can help these patients by working with interpreters and providing translated materials to ensure clarity about care.
• Stigma and mistrust: doctors have abused BIPOC patients for centuries, from the non-consensual experiments on slaves by James Marion Sims — known as the Father of Gynecology — to the treatment of Henrietta Lacks, whose stolen cervical cells have led to countless scientific discoveries and profits for medical companies. This historical trauma runs deep and many BIPOC communities are wary of medical professionals as a result.
• Systemic barriers to access: even patients who want to seek out care might not be able to. Along with finding affordable care from a trusted professional, patients need to secure time off from work, transportation to the office, and childcare for kids at home. Getting treatment is significantly harder for poorer communities and neighborhoods of color.
• Social and familial support: stigmas around mental healthcare aren’t just related to historical trauma. Many communities also approach mental health treatment with skepticism, which means BIPOC patients are less likely to seek treatment. This means mental health conditions can go undiagnosed.

If mental health concerns aren’t diagnosed, then they are more likely to be misdiagnosed. For example, students of color are less likely to receive an ADHD diagnosis or subsequent treatment. They are more likely to be labeled disruptive and punished for acting out than their properly-diagnosed white counterparts.

Overcoming these barriers

There is no single solution for overcoming centuries of trauma, mistrust, and denial of access. However, both medical providers and BIPOC individuals can take steps to address barriers to care and find ways to lower them. Here are a few steps to take:

• Find and access care: resources like ZocDoc can help patients find therapists and counselors in their area. Patients can also schedule appointments with psychologists. 
• Search for affordable providers: some healthcare providers offer sliding scale fees or reduced fees for BIPOC patients. Their focus is on providing care to patients based on what they can afford. 
• Seek services from community organizations: patients can reach out to their places of worship and neighborhood groups to learn about mental health resources.  
• Look into telehealth services: teletherapy or online therapy could be a good option for patients who cannot take off work or attend therapy during standard office hours. This also eliminates the need to secure transportation and childcare.
• Involve family members: the destigmatization of mental health treatment starts at home. BIPOC patients don’t need to broadcast their experiences if they don’t feel comfortable, but advocates who are willing to have open conversations about mental health can make a big difference in representation.   
• Advocate for better care: patients and community leaders need to demand culturally-responsive mental health care and provide concrete examples of what that means.

Mental health practitioners can also lower barriers to communication by learning cultural differences in expressions. Different cultures express mental distress in varying ways. For example, somatization occurs when patients experience physical symptoms because of emotional distress — like a person hyperventilating or feeling chest pain when they have high levels of anxiety. There are also nonverbal expressions of emotional distress,  like avoiding eye contact or fidgety movements. Medical professionals can learn how to read people and understand the information they are given.

Intersectionality and Mental Health

Kimberlé Crenshaw, legal scholar and critical race theory expert, is credited with coining the term intersectionality in 1989. It refers to how different aspects of each person’s life interact. For example, a white woman experiences privilege from her race but limitations due to her gender. A black woman in the LGBTQ+ community might experience hardship and oppression because of her race, gender, and sexuality.

Understanding intersectionality is a key part of mental health treatment because no one person is defined by a single aspect of their life. A patient might identify as black and feel proud to represent their community, but they are also defined by countless other aspects of their lives, all of which can impact them mentally. Mental health professionals need to understand the various aspects of intersectionality and how they affect both mental health and care.

For example, white male children were more likely to receive autism diagnoses than their non-white or female peers. This is starting to change as greater awareness of bias in autism diagnoses grows. More students of color are receiving diagnoses and treatment while more women are also being diagnosed. Women have been able to mask their symptoms better — essentially hiding them to better blend in with society. This means a black woman has to fight against both gender and racial bias to get diagnosed.

Intersectionality is a complicated concept but important for mental health providers to understand if they want to effectively work with BIPOC communities near them.

Community-Based Approaches to Mental Health Care

One in five adults (22.8% of Americans) will experience mental illness each year. As society becomes more aware of the need for comprehensive mental health care in all communities, there is a growing realization that BIPOC patients are being left behind.

Some health practitioners are working to take community-based approaches to mental health care in order to reach these groups where they are — rather than demanding that BIPOC patients come to them. There are both benefits and challenges to this community-based approach.

Benefits of Community-Based Care

• Accessibility: bringing mental health care to BIPOC groups makes treatment more accessible. This eliminates problems related to transportation, cost, and language barriers.
• Cultural competence: community-based care is developed by specific groups and meant to address specific needs. There is a greater cultural understanding associated with this process than if mental health professionals developed care plans based on stereotypes and well-meaning-but-incorrect assumptions.
• Trust and engagement: these programs are led by trusted members of communities who have proven track records of helping the people they work with. This approach is a great way to overcome distrust of the medical system and stigmas against mental health care.
• Holistic approach: mental health providers can care for patients in a manner that works for the community. They can speak their cultural language.

Challenges of Community-Based Care

• Funding: community mental health programs are rarely cheap. Organizers need to secure funding for venues, practitioner pay, prescriptions, and marketing materials to attract patients. Funding can be insufficient or temporary through grants, which limits the reach of these efforts.
• Staffing: community groups also need to find qualified mental health providers who are willing to work with them. These providers often earn less than they could at a private practice or need to donate their hours. Mental health providers need to be certified and experienced while also having cultural competency related to the patients they are treating — like speaking the same language or understanding how gender roles affect communication.
• Resources: poor funding can lead to difficulty with staffing and other reduced resources. Community-driven mental health experts might need to refer patients to other doctors with better resources or try to stretch the resources they have been given.

Successful Programs in BIPOC Communities

The idea of developing community-based care programs can strike a mixture of hope and worry in organizers. While these programs have so much potential, they can also quickly become expensive and fail without adequate funding. However, some groups continue to persist, and their mental health care efforts are paying off. Here are two inspiring examples of community-based programs for BIPOC groups.

• Behavioral Health Aide (BHA) Program: developed by the Alaska Native Tribal Health Consortium, this program provides “culturally relevant training and education for village-based counselors.” The counselors can improve their education and skills and then apply them to their towns and communities. This program covers a variety of topics including grief, depression, suicide, and substance abuse. 
• NAMI Peer-to-Peer: this program provides eight free sessions to individuals who want to learn more about their mental health conditions. It is led by people with lived experiences with various conditions and includes a mixture of videos, activities, and discussions. Participants say the Peer-to-Peer program has helped them better understand their triggers and talk to their families about their mental health. This is not a treatment program but a way to empower newly-diagnosed patients with the terminology to discuss their conditions and advocate for themselves.  
• Chicago’s #All77 Campaign: the Chicago Department of Public Health (CDPH) has set a goal to provide mental health services to all 77 community districts in the city. One way the city is doing this is by offering free individual counseling at libraries once a week. This provides a safe, nearby location where people can talk to a mental health professional and take the first steps to get the treatment they need. In 2019, there are only 13 city-funded mental health services locations. There will be at least 77 by the end of 2023. There is also mental health care available in 80 homeless shelters in the city.

Additional Resources for BIPOC Mental Health Care

While community resources continue to grow, along with greater awareness about the mental health needs of BIPOC groups, there are still plenty of individuals who struggle to access mental health care. Here are a few resources that anyone who is struggling mentally can turn to for support.

• National Alliance on Mental Illness: (NAMI) Helpline: 1-800-950-NAMI (6264). You can call this line for peer support and resource referrals. This helpline is staffed by volunteers. 
• Substance Abuse and Mental Health Services Administration: (SAMHSA) National Helpline: 1-800-662-HELP (4357). This is another resource referral helpline that is staffed 365 days a year. 
• The Steve Fund: this group provides mental health support to young people of color. 
• Therapy for Black Girls: this is an online directory of therapists who specialize in working with Black women and girls. The goal is to destigmatize young black women who need therapy. 
• The Asian Mental Health Collective: which provides resources and support to Asian communities. 
• The National Queer and Trans Therapists of Color Network: which provides a directory of therapists for queer and trans people of color.
• The Indigenous Wellness Training Society: which provides training and resources to support Indigenous wellness.

Mental illness does not discriminate by race, gender, age, or background. Any person can live with anxiety, depression, or other symptoms. It is essential that the treatment offered to American residents also doesn’t discriminate either. When communities actively break down barriers to mental health care access, they can help BIPOC groups get the treatment they need.

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