Q&A: Prioritizing cultural competence key to improving mental health for Black individuals
Key takeaways:
- Black individuals in the United States face substantial obstacles to receiving the best mental health care.
- Advocacy and community partnerships can help remove stigma and bias.
According to a study published in International Journal of Bipolar Disorders, substantial gaps exist in the diagnosis and treatment of bipolar disorder, as well as in symptom burden, between Black and white individuals.
Healio spoke with Leesha M. Ellis-Cox, MD, MPH, board-certified psychiatrist and Kevin N. Williams, MS, MPAS, PA-C, CEO and lead clinician at OnPoint Behavioral Health in Tampa, Florida, for their insight into the challenges and promise for addressing these gaps and ways to advocate for mental and physical health in the Black community.
Healio: What main factors are responsible for the underdiagnosis or misdiagnosis of bipolar disorder among Black patients compared with others?
Ellis-Cox: Structural racism and bias in medicine, stigma, distrust of the medical community, a shortage of Black psychiatrists and different cultural expressions of illness all contribute to the misdiagnosis of bipolar disorder in the community.
Health care providers may fail to screen for mood disorders once a Black patient endorses auditory hallucinations or disorganized behaviors. Black individuals may fear being labeled “crazy,” being seen as weak or lacking faith in God if they seek psychiatric services.
Williams: The underdiagnosis and misdiagnosis of bipolar disorder in Black patients is a multifaceted issue, deeply rooted in various societal and clinical factors.
I have observed that many individuals from the Black community tend to wait until their symptoms become significantly more severe before reaching out for help. This delay is often in stark contrast to other demographics, highlighting a profound distrust of the medical establishment.
Healio: How can you, as a clinician, help address these gaps?
Ellis-Cox: I speak at schools, sororities and fraternity meetings, churches and at other community events, as well as write about my experiences as a seasoned psychiatrist to increase awareness.
Partnering with community organizations, churches, colleges and universities, and agencies like the National Alliance on Mental Illness (NAMI) provides opportunities to increase awareness about signs and symptoms of mental illness.
Williams: I have established a psychiatry practice dedicated to closing the gaps in care for diverse populations. A cornerstone of our approach is the comprehensive training of our clinical team to recognize and assess cultural differences during each patient visit.
By prioritizing cultural competence, we can create a more inclusive environment that not only acknowledges but also respects the diverse narratives of our patients.
Healio: How can these factors be addressed beyond the clinical setting?
Ellis-Cox: Advocacy efforts such as talking to lawmakers to enact policy changes, increase funding, address workforce shortages and improve access to care for underserved communities can have tremendous impact on mental health outcomes.
Additionally, encouraging health providers to acknowledge and confront their own bias along with incorporating didactics around health care disparities into graduate medical education programs will lead to a new generation of providers who know better and can do better.
Williams: It is imperative that we continue to drive initiatives within our local and state organizations to advocate for the accessibility of new and innovative mental health treatments for everyone in need.
By engaging in a grassroots approach, we can empower professionals in the field of psychiatry to maintain a close connection with the pulse of our communities. This proactive engagement is essential to ensuring that our local, state and federal lawmakers remain informed about the evolving landscape of mental health care and the necessity of making these advancements accessible.
Healio: How can Black individuals empower and advocate for themselves to receive the best care?
Ellis-Cox:
- Do your research: Check out reputable online sources like NAMI, the National Institute of Mental Health or the American Psychiatric Association.
- Find a mental health provider you can trust: Ask your primary care physician, check with friends, use sites like Therapy for Black Girls, Melanin and Mental Health, and BEAM to find providers of color.
- Ask questions: If you do not understand or simply want to know more, then ask.
- Speak up: Do not let others silence your voice no matter the circumstances.
- Draft a mental health wellness plan: Outline your goals, list the individuals on your mental health support team, identify emotional triggers and create a self-care algorithm.
Williams:
- Be prepared and informed.
- Ask questions and seek clarity.
- Include your support system in visits.
- Speak up about bias.
- Seek culturally competent providers.
- Build confidence in self-advocacy.
By adopting these strategies, Black individuals can take meaningful steps toward empowering themselves in their mental health journeys, fostering a more equitable and understanding health care experience.
Healio: How can community partnerships help reduce stigma and increase access to medical services?
Ellis-Cox: In the United States, the Black church is as much a psychosocial entity as it is a religious entity; in addition to religious gatherings it has been the site of voter registration drives, civil rights meetings and health fairs, and has also clothed the needy and fed the poor.
Community partnerships with the Black church can help dispel myths and stereotypes and reduce stigma around mental illness in the Black community. Pastors can use the pulpit to educate the congregation and the community at large through public forums, panel discussions and even sermons that demonstrate the intersection of faith and mental health.
Williams: Community partnerships play a crucial role in reducing the stigma surrounding mental health and increasing access to medical services within the Black community. However, the challenge often lies in finding synergistic partnerships that foster collaboration rather than fragmentation. This lack of coordination results in fragmented services that fail to comprehensively meet the needs of the community.
By fostering collaboration between hospital systems, outpatient offices and ancillary services, we can create a unified network of care that works in harmony to serve Black communities. Partnerships rooted in collaboration and mutual understanding have the power to transform mental health care, making it more inclusive, equitable and effective for everyone.
Reference:
For more information:
Leesha Ellis-Cox, MD, PhD, can be reached at hello@drleesha.com.
Kevin Williams, MS, MPAS, PA-C, can be reached at info@onpointcare.net.