National Minority Mental Health Awareness Month Blog Series

Dr. Harold W. Neighbors

When I started graduate school in the mid-1970s, I had just one seemingly simple research question. I wanted to know: “Who had the higher rate of mental illness, Black or White Americans?” I remember the puzzled looks from fellow students, as most of them already knew the answer – “Blacks of course!” Their reasoning made good sense – life was harder for Blacks in the United States, and a life spent fighting against racial discrimination can lead to emotional damage.

So, I began my investigation, uncovering layer after layer of complexity surrounding what I thought was a simple question. My motivations were both professional and personal. Personally, like many families, Black and White, mine had revealed a few semi-private stories about “bad nerves” (the preferred language of emotional distress used to describe mental health problems) that were offered for consumption in the smallest of morsels. And even though my curiosity was never quite satisfied, I instinctively knew not to push for too many details. Professionally, there was my first “big” assignment as a graduate research assistant on a new, innovative study, the “National Survey of Black Americans”¹. I wrote my dissertation on one aspect of the subject: help-seeking behavior for mental health problems, using data from the National Survey of Black Americans. My dissertation research told me that Black Americans need to stop, look, listen, and most importantly, tell the truth about our feelings. The key to sound mental health is what people of color decide to do about profound sadness, feelings of helplessness resulting from attacks on our self-esteem, and hopelessness due to unjust institutional impediments that erode aspirations for achieving one’s best life². My investigation revealed that when feelings become unbearably painful, they are symptoms. Once you are symptomatic, you need to get help. It is just that simple; and difficult; and complicated.

Access to Mental Health Care
Gaining access to mental health therapy is too hard for too many, especially for people of color. I know this to be true from my own help-seeking experiences. One of the lessons I learned was that getting help meant overcoming the fear of what others will think should it ever become public knowledge that you were in therapy. I was fortunate. My work history eliminated the financial barriers and I was, eventually, able to overcome my fear of being thought less of, because I decided to exercise my right to professional therapy³. Mine is but one story. Sadly, national statistics show that we still have a long way to go to eliminate racial and ethnic inequities in mental health services⁴.

Speak Up: Say Something to Somebody
If you feel something, say something, to somebody. Cutting ourselves off from a potential confidant, or our natural support networks, increases social isolation precisely when we need other people the most. Even worse, social isolation can lead to feelings of loneliness, which is bad for our mental health⁵. When we step back to view the larger social context surrounding what often feels like an exclusively private choice, we see that we do not need to face these problems alone; to do so is a choice we make. The first step is to reach out to just one person. But please hear me on this – we must go public!

Be Your Own Mental Health First Responder
In short, we are our own mental health “first responders.” We must act upon our symptoms in a manner that starts to alleviate the distress we feel. People of color must push back against stigmatization by telling our stories, because that is one way to erase the idea that mental health is something qualitatively different and apart from health. To me, Minority Mental Health Awareness Month, now known as Black, Indigenous, and People of Color (BIPOC) Mental Health Month, is about quality of life. Sadly, compared to Whites, Black Americans remain less happy with our lives. Racial and ethnic population group comparisons have limitations and are not always subject to thoughtful explanations. But a commitment to health equity demands the accountability that comes from regularly monitoring comparative data for changes over time⁶.

My Recommendations
July 2020 is the best month for everyone, regardless of skin color, age, gender identity, sexual orientation, religious background, or disability status, to start a new year of working on mental health.

Here are five ways to work on your mental health:

• Listen to your heart and vow to take better care of yourself.
• Cross your heart and promise to tell the truth.
• Summon the courage to talk with just one person about your true feelings.
• Try to question, or at least process, all racial micro-aggressions regardless of when the aggression occurred. Micro-aggressions, no matter how unintentional or accidental, are never “innocent,” and they certainly are not small. And because they often appear quickly, seemingly “out of nowhere,” the opportunity to respond in “real-time” also disappears quickly. A note of caution here; it is not always possible to respond directly, and it can be especially challenging to do so in the workplace.
• Connect with people who are committed to advocating for policies that are beneficial to the mental health of all people of color. Collective action, based on a shared identity and a sense of common fate, is good for mental health.

Acting on these recommendations will not be easy. I struggle with all of them. It is not easy precisely because our situation is so complicated. I have been around long enough to remember the family stories my elders used to tell us about what life was like when they were “coming along.” Because of them, my life has been different, less difficult, and better in many ways. They put in the hard work and made the sacrifices; now it is our turn to build upon that foundation and make it better for others.

References

1. Jackson, J. S. (1979-80). Program for Research on Black Americans. National Survey of Black Americans Series.
2. Neighbors, W., Sellers, S. L., Zhang, R., & Jackson, J. S. (2011). Goal-Striving Stress and Racial Differences in Mental Health. Race and Social Problems, 3(1), 51-62. https://doi.org/10.1007/s12552-011-9042-6
3. Neighbors, H. W. (2019). AAMC. “Manning up” can often bring men down.
4. Substance Abuse and Mental Health Services Administration. (2015). Racial/Ethnic Differences in Mental Health Service Use Among Adults.
5. Taylor, H. O., Taylor, R. J., Nguyen, A. W., & Chatters, L. (2018). Social Isolation, Depression, and Psychological Distress Among Older Adults. Journal of Aging and Health, 30(2), 229-246. https://doi.org/10.1177/0898264316673511
6. Iceland, J., & Ludwig-Dehm, S. (2019). Black-White Differences in Happiness, 1972 – 2014. Social Science Research, 77, 16-29. https://doi.org/ 10.1016/j.ssresearch.2018.10.004