Allan Thomas remembers June 8, 1967 —the day Israeli air and sea forces mistakenly attacked the USS Liberty, a U.S. Naval intelligence ship, just outside Egypt. Thomas was a Navy seaman who worked on a rescue ship in the area. He drew the assignment of retrieving and identifying the bodies.
“I remember the captain told us over the P.A. system, ‘We don’t know how we [are] going to come out [of] this situation so you’d better be right with your Lord,’” says the 61-year-old St. Joseph, Mo., resident. “It was terrible; they were tore to pieces,” he says, shaking his salt-and-pepper gray head. “And the smell….” Thomas survived what would come to be known as the Six Day War — an attack that left 34 U.S. servicemen dead and more than 170 wounded — a traumatic experience for anyone. But perhaps the horrors of a six-day war compare little to a lifetime of dealing with racism.
After Thomas, an African-American, left the service, he faced racism on most jobs he had. He says he was denied promotions, endured racist jokes and remarks, and constantly had to prove himself. And lingering memories from the war left little room for the added stress.
“I was carrying that all the while this was upon me,” says Thomas. “It wears on your mind.” Thomas eventually ended up losing not only jobs, but his family. He was also hospitalized for a mental condition which doctors described as schizoaffective disorder, a condition where a person suffers from symptoms of schizophrenia and mood disorder.
But Thomas refuses to believe his problems were all in his mind. And as a black person he doesn’t believe he’s ever received proper mental health treatment. All he ever got was a handful of pills and some dubious advice, he says. “All they wanted to do was medicate me and I was trying to tell them my problem, but they kept telling me to read books about Martin Luther King and other blacks who had made it,” Thomas says.
Thomas’ belief that proper mental health for minorities stands lacking is shared by many African-Americans and other ethnic groups across the county. The mental health needs of African-Americans, Asian-Americans, Native Americans and Hispanics are more often than not the same as their Caucasian counterparts. Fears, phobias and delusions are colorblind. But as much as we’re the same, we’re all different as well.
One ethnic group may have more needs in one area than another. And diagnoses are often not the same. Ken Hines, a St. Joseph, Mo. psychologist believes that African-Americans are usually given the more “heavy duty” diagnosis of schizophrenia rather than the milder schizoaffective disorders. And that diagnosis more than likely comes from a Caucasian therapist. Many African-Americans may not seek mental health services simply because there are less African-American practitioners. According to Hines, it’s more about supply rather than demand.
“People of color are more likely to be referred by Division of Family Services or public health and less likely to seek the help directly … from a ‘white’ guy,” says Hines, who is Caucasian.
“More white women go to see men therapists and more white men go to see women,” he adds. “A gay therapist is more likely to get gay clients. So I am projecting that if there were more black therapists, there might be more black clients who come in on their own.”
But Hines says there is a lot of therapy going on that doesn’t get reported — the free kind that comes from bartenders, ministers and old women talking over the back fence. If this is correct, the number of African-Americans seeking mental health advice may be greater than believed.
“I suspect there is a lot of therapy that doesn’t get reported and that poor people, blacks and otherwise, never get to be statistics,” Hines says. “Therefore, a lot of the statistics are going to be skewed.”
According to the 1999 U.S. Surgeon General’s Report on Mental Health, historical adversity is a major cause of disparity in mental health treatment afforded African-Americans. Slavery and race-based exclusion from health, educational, and economic resources throughout history have created disparity in socioeconomic status experienced by African-Americans. And socioeconomic status is often linked to mental health. Limited access to health insurance can play a part as well.
An over-representation of African-Americans in high-need populations such as prisons, shelters and other institutional facilities, are also likely to under-represent the number of African-Americans in need of mental health services. And mistrust is another factor, according to the Surgeon General’s report.
But Daniel Buccino, a professor at Johns Hopkins University School of Medicine in Baltimore, Md., says it’s a relative issue. In his experience, African-Americans in general, specifically men, seek mental health services more often than Caucasians, Hispanics, Asian-Americans or Native Americans. It’s relative to the size of their respective populations, he says. However, the premature dropout rate of African-American patients receiving mental health care is higher.
“A greater number of African-American men who seek therapy do not return after the first session,” Buccino says.
Buccino agrees with Hines that African-American men are diagnosed with more severe psychotic disorders and therefore are prescribed anti-psychotic medication at much higher rates. “African-Americans, often for very good reasons, express less trust than others that the resources that are available to them are adequate enough to meet their mental health needs,” Buccino says.
The Rev. Willie Elliott, a social work professor at Northern Kentucky University, also agrees that mistrust is a big barrier for African-Americans and other ethnic groups seeking treatment. “The reason why is because treatment tends to be geared to white, middleclass women,” he says. “[And] there are differences in mental health needs for Hispanics, blacks, whites, Asians and Native Americans because of the cultural differences in each group.”
Regional differences in access to care are often influenced by language barriers, Rev. Elliott adds.
Suicide is another mental health area where African-Americans differ from other races. Suicide rates vary greatly, not only between African-Americans and Caucasians but between other minority groups as well.
Dr. Richard Shadick, director of Pace University Counseling Center in New “Within certain Asian families there is more of a taboo around accessing mental health services and therefore they are less likely to get help and [are more likely to] take desperate measures.”
In the suicide study, Shadick focused particularly on the college population. Shadick found that the ethnic demographic exhibiting the most suicidal thoughts was Asian women, followed by Latinos who had more suicide attempts.
The reasons are cultural. “Within certain Asian families there is more of a taboo around accessing mental health services and therefore they are less likely to get help and [are more likely to] take desperate measures,” Shadick explains. For Latinos, the suicidal stress is also cultural. And it oftentimes stems from parental expectations. “They end up disappointing their parents and feeling like they can’t access help, and as a result end up trying to kill themselves,” Shadick says.
African-Americans have the lowest rate of suicide among any group. “The reason may be they have a greater support network with family and they also turn to the church more,” he adds.
Dr. Hines says that in his profession as a prison psychologist, he also sees fewer suicide attempts in the African-American population.
“[When asked about suicide] most of them smirk or give me the ‘What?’ look,” Hines says. “Now I’m sure there is a bias when a white guy is asking the questions, but I still have to believe that it is just not a happening thing in the black culture.”
However, suicide is the second leading cause of death among American Indians and Alaska Natives between the ages of 15 and 34 years old. According to the CDC, suicide rates are 1.9 times higher than the national average for that particular age group.
Suicide rates also vary according to geographic location. According to the CDC, suicide rates are lower in the Mid-Atlantic and upper Mid-Western parts of the country. Rates are highest in the Mountain and Western states.
“East Coast and West Coast people are generally more interested in seeking mental health help,” Hines says. “The landlocked people are more likely to see it as a sign of weakness or vulnerability. On the coasts it is more chic, more hip, more intellectual.”
A 1999 Surgeon General’s report on ethnic mental health shows that mental health disorders on the whole have risen in the American Indian and Alaskan Native populations. The study also found that American Indian children have similar rates of mental disorders as compared with white children, but have higher rates of substance abuse. That’s right — child substance abuse. According to the study, the high rate of substance abuse among 13-year-old children was attributed to alcohol use.
Dr. Daniel Dickerson, chair of the American Psychiatric Association (APA) Committee of American Indian, Alaskan Native and Native Hawiian Psychiatrists, has discussed the issues of mental health within this population on the APA Expert Opinion Web page. According to Dickerson, behavioral health and substance abuse are pressing issues in the American Indian and Native Alaskan populations, and this particular demographic has a high rate of suicide and methamphetamine use.
“Native Americans continue to experience significant mental health disparities,” Dr. Dickerson says in his discussion. “Many barriers impede Native Americans from obtaining mental health care. These barriers include issues related to access to care, stigma and mistrust of treatment and funding.”
Native Americans often utilize traditional healing methods as well as modern ones. “It is important to realize that both urban and rural American Indian and Native Alaskan populations highly value the use of traditional medicine,” Dickerson says.
“The integration of these two types of services in American Indian and Native Alaskan mental health clinics can help Native Americans feel more comfortable seeking mental health services.”
Native American healing is a holistic approach to treatment. It combines the healing practices of hundreds of American tribes, and combines religion, spirituality, herbal medicine and rituals.
Arlene Long is a family nurse practitioner and facility director at the White Cloud Indian Health Station in White Cloud, Kan., a rural community of about 230 residents and a sizable Native American population.
Serving the needs of the Iowa and Sac Fox tribes in the area, the clinic treats about 300 clients suffering from a number of physical and mental ailments each week.
“We can see any Native American or any Alaskan Native,” Long says. “And we see the whole gamut from womb to tomb just like you do in the public sector. We have depression, drug, and alcohol problems just like everybody does.”
Most White Cloud mental health services are contracted through Kanza Mental Health Services in nearby Hiawatha, Kan. “We have these care services available; we just don’t actually do them in-house,” Long says.
Treatment is a mix of both traditional and conventional methods. It includes the use of sweat lodges, counseling and medicines when needed.
Long, also a Native American, has never been in a sweat lodge. “It’s mostly a male form of treatment,” she says. “I’ve never been in one because it’s too warm for me,” she laughs. “And, it’s primarily a male bonding thing. They may have a chant, a friend with them … it’s a form of meditation of sorts where they go and sweat out what’s bothering them, the problems or whatever the concern is. It’s a form of going within themselves and resolving the issue within themselves.”
Long has worked at the clinic for three years. Before that she worked several years in the public health care sector. She feels the treatment her clientele receive at the White Cloud clinic is as good or better than in any other facility. And she claims she hasn’t seen a disparity in cases of alcoholism and addiction between Native American and other ethnic groups either.
“We saw basically the same amount of alcoholism, drug abuse [and] tobacco abuse that we saw in the public sector,” she says. “Everybody has the same basic needs. And it’s very hard in this area with the price of gas going up and the lack of good paying jobs. Our population is a lot smaller but the problems are the same.”
As a Native American, Long says she hasn’t experienced much racism in the area. But sometimes her curly black hair and fair features have caused problems. “Oh, I got called a white Indian one time because I’m not as dark-skinned as some Native Americans and I don’t have straight black hair,” she says. “People are people; you can’t please everybody.”
With the growing presence of Hispanics in this country, it probably comes as no surprise that many feel their mental health and other needs aren’t met. The reasons vary from racism to language barriers and cultural differences.
“There is an amazing number of Latinos ending up in the prison system and most of them have a pathetic use of English as a second language,” Hines says. “How they could have defended themselves in court is beyond my imagination. And what interpretation sources are available is pretty much limited to volunteers and other inmates who are bi-lingual. There is no money for it and none much for mental health either, let alone the retarded or intellectually challenged.”
Margarita Alegria is director of the Center for Multicultural Mental Health Research and a psychology professor at Harvard Medical School. Alegria has done extensive research in mental health and other disparities in the Hispanic community. “Mental health issues often go undetected in the Hispanic community,” she says. “One issue is the fear of admitting mental health needs. There is still a stigma attached to mental illness.”
“One of the big issues has to do with confronting what people are going to think if they know about a mental health condition,” she says. “They feel it more with employers than anything else.” The issue of eligibility is another factor. “How you come to the United States makes a difference on being able to access services. For example, if you come as a refugee you have access to different services you don’t have if you come under student visa,” she says.
Insurance rates are also higher in some areas of the country, making treatment difficult for Hispanics who work at low paying jobs and can’t afford coverage. The worst region for Hispanics is in the northeast where 57 percent are uninsured and in the south where 57 have no insurance coverage.
“Part of it has to do with undocumented status,” Alegria says. From 2000 to 2004, Latino population growth represented half the total growth in the U.S. Access to public mental health services is overseen by state and federal policies which limit access to Medicaid and other forms of care for U.S. citizens.
Communities with high proportions of both Hispanic and African-American residents also are more likely to have a shortage of physicians. Add to that a low number of providers that are available but don’t provide multi-lingual services.
Creating an awareness of available services is a must. “I think one area that is very important is creating an awareness in our community on what people can do for themselves,” Alegria says. “It is important for people to get information; information is power and it is important for people to get the best information possible.”
Dr. Maria Kantha Munoz, a motivational speaker and diversity educator from New Rochelle, N.Y., agrees that mental health professionals need to recognize the needs of each ethnic group. Treatment requires a multi-cultural awareness.
“There are tremendous differences among these diverse groups of people. Mental health means different things to every culture,” she says. “We cannot assume that all groups perceive mental health as normal within a multi-cultural process. We must work harder to understand the differences among these groups and their perception of mental health versus mental illness.”
In the meantime, Allan Thomas will continue to rely on himself for his needs. Receiving disability now, he writes songs and has a small videotaping business which, he says, help give him some emotional comfort, he says.
“I reprogrammed myself and re-channeled myself to keep going on,” he says.|
About the author: Alonzo Weston is an award winning columnist and reporter for the St. Joseph News-Press in St. Joseph, Mo. His work has also appeared in the New York Daily News and the Nashville Tennessean. A graduate of the 2002 inaugural class of the Freedom Forum Diversity Institute at Vanderbilt University, he also won the Missouri Department of Mental Health Media Award in 2002.