According to the Columbia University Department of Psychiatry, the adult Black community is 20 percent more likely to experience serious mental health problems, yet only one in three African-Americans who need help actually receive it. To give a comparison: About 25% of Black people seek mental care compared to 40% of whites.

There are a number of barriers that account for this disparity and make it harder for Black people to receive access to professionals. Some of which include a lack of Black therapists, cultural stigma within the community, and high costs.

1: High Costs Of Mental Health

Despite the Affordable Care Act, around 12 percent of African-Americans are uninsured and, as Dr. LaToya Gaines notes, even those with health insurance often don’t have mental health services covered or have expensive co-pays or deductibles.

“Some therapists choose not to take insurance and many people do not understand how to use out of network benefits to cover the cost of sessions,” she tells us. Paying out of pocket often isn’t an option for a lot of Black people and that lack of financial means stops them from being able to consistently engage in mental health care.

2: Familial Shame Around Mental Health

When 25-year-old Hafeezah Nazim first started going to therapy more than five years ago, one of her biggest concerns was her family’s dismissiveness of mental health. “There was always a sense of paranoia about me venting about my feelings for fear that people would know my ‘family business,’ that my family would be seen as a dysfunctional,” she says. “Those ideas were passed down generationally to my parents and were taught to my siblings and I.”

3: Cultural Stigma Of Mental Illness

The familial shame often stems from a broader cultural stigma surrounding mental health in the Black community. Going to therapy is viewed as a sign of weakness and something to be ashamed of. “A lot of Black people don’t think of therapy as a realistic or viable option for help and mental health isn’t seen as something to focus on, improve, or get professional help for,” Dr. Racine Henry shares. Instead, as Jardin Dogan, therapist and founder of @blkfolkxtherapy notes, they turn to other “safer” avenues like church, friends, and healing circles.

4: Lack of Diversity In Healthcare

Often, Black people prefer to talk to someone who looks like them and will better understand their experience but, unfortunately, in 2014, only around 2 percent of the American Psychological Association members and associates identified as Black. This not only makes it harder to find a therapist, Dr. Gaines says, but also means “that our caseloads fill up pretty quickly.” The lack of representation can make it hard for those seeking a counselor to find the help they need when they need it. “Recruitment and retention of black therapists in training programs is key,” Dr. Gaines adds.

5: Poor Competency Among Non-Black Clinicians

As Dr. Henry explains “not all clinicians are trained to be aware or curious about how culture, race, and ethnicity impact a person’s mental and emotional wellbeing.” Nazim found that to be the case when she started going to therapy while attending undergrad. “So much of what ended up coming to light in my sessions were tied to my identity and I found myself needing to explain a lot of nuanced things tied to race and gender to my therapist, who was both white and male,” she says.

6: Whiteness As A Foundation to Mental Healthcare

Dogan explains that most of the psychological training that therapists receive is based on the experiences of “white people, norms, values, and beliefs” which can influence the competency of non-Black therapists. “The DSM-5 generally does not account for cultural factors that influence symptomatology, and diagnoses that speak to cultural issues such as racial discrimination or acculturation,” she explains. “Counseling, psychology, and social work training programs hardly ever include the voices of Black mental health theorists, researchers, and practitioners.”

7: Distrust of the Medical Industry

Many Black people have grown suspicious of the broader health care system due to a history of being mistreated and misdiagnosed that stems back to slavery. “From eugenics to the bell curve, historically the psychology community has bred mistrust in Black communities through unethical treatment, exploitative experimentation, and general deficit-based and culturally-incompetent treatment,” Dr. Janelle S. Peifer explains. “Generationally, Black families who experienced or lived with parents who directly suffered through these ills developed mistrust of mental health treatment that informs stigma about therapy and mental health treatment that persists even today.”

8: Difficulty Navigating The Process

Sydney Gore, 27, compares the process of looking for a therapist to that of job hunting, and though there are now a number of online resources available to help make the process easier, it can still be overwhelming. “A lot of people do not know where to begin looking for a therapist who will fit their needs,” Dr. Gaines says. “In addition, most do not know what questions to ask a potential therapist when meeting for the first time to ensure they are the right fit.”

9: Emotional Hesitation

Black people are often taught to keep our feelings to ourselves and so, even after finding a therapist, the process of opening up can be particularly difficult. Nazim says that she still finds herself experiencing “emotional hesitation” even six years after being in therapy. “Talking about emotions is something that many of us are not directly taught how to do,” says Dr. Gaines. “So, the idea of learning how to and sharing that process with a stranger can be daunting.”

10: Negative Past Experiences

“It is often common that black people have seen a counselor in the past—voluntary and/or involuntary—and the experience was not great,” Dr. Gaines explains. This could be due to the therapist’s lack of cultural awareness and competence or other factors. Those negative experiences can dissuade Black people from finding a new counselor and continuing the healing process.

The takeaway: All of these issues make it more difficult to find and get help. At the same time, systemic racism takes a big toll on Black mental health and is fueling the crisis of depression and suicide.

Last Updated: Jul 21, 2020