July is Bebe Moore Campbell Minority Mental Health Awareness Month. This author and activist co-founded NAMI-Urban Los Angeles and wrote the book 72 Hour Hold about a family's experiences with their adult daughter in the mental health system. She won the NAMI Outstanding Media Award for her children's book Sometimes My Mommy Gets Angry about a mother with bipolar.
Though Bebe exited this life in 2006 her legacy lives on and there is much to be hopeful about although it seems the news isn't good. To research this tradition created in 2008 by an act of congress, I Googled various terms, including "schizophrenia blacks" and "schizophrenia African Americans" and added the search term "solutions" at the end of both to come up with hope.
At the end of this SharePost I will give these solutions and two links to where you can get hooked up with a Black Psychiatrist of America on that group's web site. Before I focus on the solutions I'm going to reveal the statistics I found.
My first stop was the NAMI Multicultural Action Center Fact Sheet for African American Community Mental Health. Some of the findings:
African Americans in the United States are less likely to receive diagnoses and treatments for their mental illnesses than Caucasian Americans.
• Culture biases against mental health professionals and health care professionals in general prevent many African Americans from accessing care due to prior experiences with historical misdiagnoses, inadequate treatment, and a lack of cultural understanding: only 2 percent of psychiatrists, 2 percent of psychologists and 4 percent of social workers in the U.S. are African American.
• African Americans tend to rely on family, religious and social communities for emotional support, rather than turning to health care professionals, even though this may at times be necessary.
Experiences of mental illness vary across cultures and some mental illnesses are more prevalent in the African American community compared to other cultures in the U.S.
• Some studies suggest that African Americans metabolize medications more slowly than Caucasian Americans, yet they often receive higher doses of psychiatric medications, which may result in increased side effects and decreased medication compliance.
Social circumstances often serve as an indicator for the likelihood of developing a mental illness. African Americans are disproportionately more likely to experience social circumstances that increase their chances of developing a mental illness.
• African Americans comprise 40 percent of the homeless population and only 12 percent of the U.S. population. People experiencing homelessness are at a greater risk of developing a mental illness.
With the implementation of various programs and innovations, African Americans' patronization rates for mental health services may be improved.
• Programs in African American communities sponsored by respected institutions, such as churches and local community groups can increase awareness of mental health issues and resources and decrease the related stigma.
• Overall sensitivity to African American cultural differences, such as differences in medication metabolization rates, unique views of mental illness and propensity towards experiencing certain mental illnesses, can improve African Americans' treatment experiences and increase patronization of mental health care services.
NAMI education and advocacy efforts during Bebe Moore Campbell Month include peers giving In Our Own Voice lectures at churches and community centers and outreach efforts where brochures are given in multiple languages.
As I researched this topic, I kept coming up with the consensus that schizophrenia is overdiagnosed in African Americans.
Sarah Tourville of the University of Denver notes in her research paper that rates of a diagnosis of schizophrenia among African Americans exceed that of non-African Americans by 10 to almost 40 percent (Trierweiler et al., 2000). Has this reduced circa 2010?
One reason cited was that certain patients' communication styles could mirror the negative symptoms of schizophrenia such as a flat affect, monotone speech and poor communication, leading to a diagnosis of schizophrenia.
Also hallucinations experienced among African Americans with depression mislead clinicians into a diagnosis of schizophrenia.
Sarah Tourville suggests these remedies:
• Mental health clinics could go to the clients rather than have clients reach out for services. This could be done by community members making referrals for service and staff members contacting the client to offer services.
• Funneling resources into poor communities could also increase the quality of care.
• Clinicians should be taught important beliefs and values of the cultures they may serve. In addition, clinicians should also be taught the importance of thorough interviews so that the information they obtain can help exclude other factors that may contribute to symptoms. An example of this is hallucinations often associated with alcohol withdrawal. If the clinician is not careful to screen for alcohol use or abuse the client may receive an inaccurate diagnosis of schizophrenia when the actual cause of the hallucinations could be to alcohol withdrawal.
• In addition, social workers need to be diligent in their selection of screening instruments when conducting assessments. Social workers and clinicians need to be selective in the instruments they use and keep the characteristics of the population being evaluated in mind.
Her paper revealed "some vague diagnostic criteria for individuals with schizophrenia . . . such as flat affect, monotone speech and poor communication. Exhibition of these symptoms could be attributed to many environmental factors therefore they are not necessarily indicative of schizophrenia . . . social workers should advocate for change among the diagnostic criteria for schizophrenia. They should push for the implementation of new negative symptoms that cannot be attributed to cultural or environmental factors."
Does that sound like throwing the baby out with the bathwater? It's an interesting point she makes about the criteria for diagnosis.
I will close out with the idea that poverty is the root cause of a lot of the problems in society. In these dire economic times our elected leaders are quick to reduce spending on mental health services as a cost-cutting measure. The Federal Matching Grant for Medicaid was recently shot down.
Events like the BP oil spill in the Gulf that affected fishermen who depend on clean water and others living in the area contribute to a strain on the mental health services in those counties as well as psychological distress and poverty for the people involved.
Living in a violent neighborhood also increases the risk of a person having mental health issues like schizophrenia and other mental illnesses such as PTSD.
Over and over in my research the idea of the "protective wariness" of people who were historically abused by the mental health system kept popping up. This more than anything could contribute to a heightened refusal to seek help from the established medical community.
Access to care and quality of care are the twin engines driving a person's successful treatment and ultimate recovery.
Now like I said I want to end on a positive note.
I welcome hearing your perspective on this topic and sharing ideas for how to improve recovery rates for people who are often misunderstood and misdiagnosed.
Published On: July 09, 2010