The Following Statement Can be Attributed to Joel E. Miller, Executive Director and CEO, American Mental Health Counselors Association (AMHCA)
All across our nation, thousands of Americans have taken to the streets in over 50 cities to protest the killing of George Floyd by a police officer who pressed his knee into Mr. Floyd’s neck for over eight minutes as he was pinned down on the ground in handcuffs. It was a collective cry of anguish and a demand for change to what has become commonplace – the killing of unarmed black people at the hands of law enforcement. It is easy to understand the response of multiracial protesters in Minneapolis. If you look closely, hundreds of white people are participating as injustices are apparent to them.
There is significant pain in the heart of our country. And there is significant inequality. While our laws have changed, the reality is that their protections are still not universally applied. Too many people have had enough. They are taking to the streets because this is the only way for them to be heard.
The killing of George Floyd is not an isolated case of the excessive use of lethal force by police. Georgia resident Ahmaud Arbery, 23, was gunned down in February during a so-called citizen’s arrest led by a former police officer.
Americans of color, and all of those whose lives have been marginalized by those in power, experience life differently from those whose lives have not been devalued. They experience overt racism and bigotry far too often. They experience fear. A recent study by American University found that more than half of all African Americans surveyed fear interactions with police.
They shoulder a mental health burden that is deeper than what others face. When you must live in fear for your life just for jogging across a street or being accused of passing a bogus $20 bill, you cannot be mentally healthy at the same time.
Let’s use this moment to not only address structural racism in the United States, but address disparities in mental health.
The 2001 landmark Surgeon General’s report, Mental Health: Culture, Race, and Ethnicity, underscored significant disparities in initiation of and engagement in mental health care among persons from racial-ethnic groups. Now, almost 20 years later, these disparities persist, with higher rates of morbidity from decreased engagement in high-quality care, including use of evidence-based medications and mental health therapies.
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), only one-third of African Americans who need mental health care services receive it.
Reasons for lower treatment engagement are multifactorial and range from a lack of culturally informed treatment options to absence of a diverse mental health workforce, racism, mistrust of health care systems, variance in the quality of mental health treatment offered, and lack of attention to the social determinants of health.
Discrimination in its multiple forms (e.g., discrimination based on color or race), is an important social determinant of mental health and may be linked to other determinants including socio-economic status and gender.
We need to address the severity of the problem among adults and children from racial and ethnic groups, with consideration of cultural issues related to higher attrition rates and structural challenges associated with access to care.
For African Americans, racism affects mental health through factors such as poverty and segregation, which have operated since slavery.
The legacy of slavery and racism, as well as the current realities of racial oppression and violence, has uniquely impacted the mental health of African Americans.
African Americans have higher rates of severe depression yet lower rates of treatment compared to white populations. African Americans are less likely to receive office-based counseling for psychological stressors and are more likely to be seen in emergency rooms.
African Americans endure more intense and frequent mental and behavioral health issues than their counterparts, in a large part related to poverty and exposure to racism and discrimination, both of which disproportionally affect people of color.
Among African Americans, having at least one everyday discrimination experience attributed to race is associated with a greater likelihood of meeting criteria for at least one lifetime anxiety disorder or a lifetime depressive or mood disorder.
Racism and discrimination are stressful events that adversely affect health and mental health, placing people of color at risk for mental health disorders such as depression and anxiety.
We need to explore strategies for dismantling structural racism, including health reform (through public health interventions focused on African American health crises, such as neighborhood violence) and criminal justice reform.
Integrated behavioral health care holds promise for reducing mental health disparities for racial and ethnic groups. Critical components of effective integrated models for people of color include cultural and linguistic competence and a diverse workforce, and emerging best practices. To successfully implement integrated models into practice with people of color will require guidance from communities, consumers and family members, and national experts.
Many African-Americans have difficulty in finding care for mental health services.
Mental health counselors and the profession have a unique role to play in eliminating racial and ethnic mental health disparities. Health care reforms provide an opportunity for mental health counselors to expand on previous efforts and advance a multilevel response to addressing the social determinants of mental health and addictions and reducing disparities.
AMHCA is calling for a multi-faceted counseling response to eliminate disparities in mental health and addiction.
To be effective, such a response must encompass varied elements, including informed counselor education; the growth of a research agenda to better understand social determinants and inform interventions; the provision of culturally responsive, evidence-based clinical services; and policy action on relevant issues such as the impact of incarceration and the criminal justice system on people struggling with mental health and substance use problems.
In AMHCA’s, "Essentials of the Clinical Mental Health Counseling Profession" we emphasize that clinical mental health counselors have historically received graduate education in multi-cultural counseling. We recognize that many community problems – including discrimination and racism – have a significant mental health component. We recognize that many societal problems not only affect individual’s live and relationships, but result in economic and mental health burdens on individuals, families, and communities.
Clinical mental health counselors can address discrimination and related risk factors by asking questions, listening carefully and empathically, and showing understanding and support regarding discriminatory-related sources of stress. African Americans with a mental health condition often have to contend with double discrimination – in which individuals experience discrimination both due to race and as a person with a mental illness.
Special policy proposals to addressing discrimination as a social determinant of mental health should include several local, state and national policies and programs.
At the local and state levels, opportunities exist for the clinical mental health counseling profession to develop policies and procedures for training and education in mental health counseling to extend culturally sensitive knowledge about the nature of social determinants of mental health. Local and state organizations can also play an important role by providing guidelines and strong recommendations for addressing discrimination and bias in general and pertaining to treatments.
The most notable legislation and policies that address race and color discrimination have been at the federal level such as the Civil Rights Act, These laws must be vigorously enforced to protect against a wide range of discriminatory behaviors across our society and sectors. We need to insist that governments need to move swiftly and decisively to address complaints and move legal cases faster. The historical unequal and tardy enforcement of existing policies at the federal and state levels undermines community and citizen confidence in legal civil rights matters.
AMHCA and other associations should assume a greater responsibility in educating and developing effective anti-racism and anti-discrimination movements through collaborations and partnerships with private and government institutions and racial and ethnic communities.
Finally, we need new ideas and approaches to assure that all Americans have access to affordable health insurance coverage and quality health care, and innovative redesign of health systems that promote better access to health care and mental health care services for all communities to break down barriers to needed care and eliminate discriminatory practices.
The time is now to make a difference.
We need major systemic change so that we stop traumatizing people of color. We need new approaches to address systemic racism; address the impact of racial segregation on health outcomes; develop new federal and state policy to reduce health inequities; and identify racism’s impact on health outcomes.
As Martin Luther King said:
“Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”
We stand together with all people because as individuals we are inextricably connected to one another. Anything less, is to disavow are own humanity.