The Origins of Black Mental Health

We have been good friends and colleagues for decades, and we have had careers rooted in university and public settings. We’ve been students of black-white interactions, sensitive to policy developments in the public sector and to the racialized ambience of the inner city. We always followed the happenings in American psychiatry because of our active membership in key psychiatric organizations.

In late 2016, there was a buzz in the air. Donald Trump had won the election. The post-Obama era was on its way, and as public mental health figures, we were beginning to worry about the effects and possible damage of policy changes. Public intellectuals were decrying the overt manifestations of racism that were becoming more blatant than usual, even at the highest levels in society. The deadly reactions of law enforcement officers to the misunderstood behavior of black men made us pause. Then there was the sad passing of some of our black leaders in psychiatry, like Phyllis Harrison Ross and Chester Pierce. We worried about what to do and say, and where and when to say it. Talk about the mental health concerns of the black community came to the fore, but in a sputtering sort of way.

However, it became clear that members of APA, the Black Psychiatrists of America (BPA), and the National Medical Association were engaging in discussions about what appeared at first to be a bleak period in these professional health societies. These organizations had found ways of conversing about certain topics of significance to the maintenance of the health and mental health of blacks in this country. For example, there was ongoing discussion about the significance of social determinants of mental illness, intersectionality (as seen with black women and black LGBTQ persons), and the presence of multiple medical problems in black elderly patients. Plus, there was talk about how blacks were incarcerated at more than five times the rate of whites.

With these exchanges in the background, we attended a symposium at APA’s Annual Meeting in May 2017. The occasion was an academic event in honor of Chester Pierce, M.D., marking his death and celebrating his contributions to American psychiatry. The APA meeting was brimming with promise and hope for the future. The election of one of the authors of this article—Altha Stewart, M.D.—as the first black president had shattered the ceiling above us. The organization’s election news was a validation, not only of Dr. Stewart’s outstanding abilities and accomplishments, but also a statement that black members could belong fully to the organization.

We also recognized that the BPA would be 50 years old in 2019. The BPA was born out of the protest of senior black psychiatrists at APA’s 1969 Annual Meeting in Miami. The primary focus of the protest was for greater and more open involvement in APA of black members. Not only had that been achieved, it had opened the door for other minority and underrepresented groups.

These events, when linked to our memories of the 1999 text by Jeanne Spurlock, M.D. (Black Psychiatrists and American Psychiatry), helped us understand that we had to respond to this confluence of forces that were so insistently calling on us. We decided quickly that we would produce a new book, which we decided to title Black Mental Health: Patients, Providers and Systems. It is now available from American Psychiatric Association Publishing. We wanted to combat the nihilistic feelings and the morbid preoccupations by talking about how far we had come over the last 50 years in the domain of mental health care for blacks in the United States.

Our book consists of about 400 pages broken into 28 chapters written by 48 authors; it is organized into four main sections: “Reflections,” “Patient Care,” “Training of Black Mental Health Care Providers,” and “Psychiatric Research and Blacks.” We think of this text as an exemplar of communication: between us and our authors, and especially between the authors and the broader audience of readers.

We know there is a need for special knowledge when treating black patients. For example, our authors argue that practitioners should have some understanding of black children and their families and of their values and lifestyles, as well as the general health and behavioral impediments they face when seeking mental health treatment. Our authors point out that research findings indicate that black youth as young as 10 to 12 years old are significantly more likely to receive harsher judgments and punishments when compared with their white peers exhibiting similar behaviors. The authors recommend the use of evidence-based assessment tools that are useful in providing information about a black child’s or adolescent’s functioning. They caution, however, that clinicians should be aware that the reliability and validity of these measures with black youth vary from poor to superior. There is caution, too, about avoiding the unconscious bias that may intrude when we interact with minority groups.

In the conversation we intend in this text, we emphasize that racial discrimination is a public health pollutant with malignant effects on U.S. society, both whites and blacks. Its impact extends to all the spaces that we inhabit, and the resultant trauma include psychological and somatic health disorders. We hope this new text will push the conversation further about this important subject and will catalyze a new look at black mental health. ■