“What’s Trust Got to Do with It?” Overcoming Barriers to Mental Health Access for African American Communities

Whats Trust Got To Do With It Header
Tina Robertson, LCSW, Director of Clinical Training
By Tina Robertson, LCSW, Director of Clinical Training Jan 22, 2018

In African American communities, you might hear phrases like, “Therapy is for White people” or “We don’t do therapy.” Of course, this is a generalization, but culturally speaking, predominately African American communities don’t seek out or participate in mental health services to the same degree as other populations. Some of the barriers include lack of availability, accessibility, and ability to cover costs associated with mental health services.  Additionally, the lack of awareness related to signs and symptoms of mental health issues coupled with the stigma of receiving therapy is a hurdle that should be addressed through intervention.  Yet, one pivotal barrier to consider before partnering with African American communities is the issue of trust. While building trust is an essential part of mental health service provision for everyone, it is even more necessary when serving this community.

African American communities have experienced historical and perpetual oppression and mistreatment at the hands of people with power, primarily by White people.  Many documented incidences of mistreatment have occurred in and through our nation’s health care systems.  These unfortunate experiences are an important part of our history and should not be ignored.  As a result, you can likely imagine why generation after generation, this community of color has become distrustful of White people in general, but especially as it relates to receiving physical and mental health services by predominately White service providers. The stigma associated with receiving these services also has historical implications. African American families have demonstrated tremendous resilience in the face of systemic racism and discrimination. Strength was and is highly valued and respected within the culture. Receiving mental health services is often interpreted as an admittance of weakness; and displays of weakness have had costly consequences.    

Perceptions, beliefs and values are shaped largely by your culture. How you view the role of marriage, parenting, the importance of education, religious practices, and celebrate family traditions are rooted in your culture.  Beliefs about mental health services are cultivated the same way. If your culture views mental health service provision favorably and encourages you to seek support, you are more likely to think that therapy is a reasonable and positive option. However, if your culture continually communicates that certain people and/or systems are not to be trusted, you are likely to internalize those messages and reinforce those perceptions and beliefs. Fortunately, belief systems can be reshaped. 

Predominantly White service providers who attempt to engage African American communities will need to consider all of these factors if successful connections will occur. Acknowledging their history of mistreatment along with current systemic barriers that create toxic levels of stress, and understanding the impact this has on their cultural beliefs and psychology of mistrust, is critical. In addition, preparing for reticence in the service and therapeutic process is essential. African American clients need time to ensure that White service providers have their best interests in mind.

Some White service providers believe that only people of color can effectively serve the African American community. While all service providers should employ a diversity of professionals from different racial, ethnic and cultural backgrounds and utilize more therapists of color to serve their communities, it is a misnomer to believe that only people of color can provide support to this community. Recently, an African American male client of mine told me, “I was skeptical of you at first. Now, I know you’re real and now I’m ‘all in’”. 

 We need all providers who partner with the African American community to serve thoughtfully and with humility.  We need providers who can convey with their presence, that they respect the client’s collective cultural experience even when they don’t understand it or may feel guilty because of it. We need providers that will allow themselves to be assessed and tested, so that trust can emerge on the other side. We need providers that will continually and honestly address their own beliefs that might reveal privilege, fear, judgment, stereotypes or any misgivings that will perpetuate the cycle of mistrust.  African Americans want what everyone else wants in service provision—equity, empathy and authenticity. Most of all, they want to be valued for who they are and respected for their resilience.  They want to be seen, heard and felt. This is the pathway to building trust…and trust has everything to do with it! 

©2018 Momentous Institute
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