Disparities on mental illness treatment among blacks in america

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Mental Illness
Submitted by
Student Name
Human Services Department
In partial fulfillment of the requirements for the degree of Master of Science
In Human Services
Boricua College
Bronx, New York
Fall 2019
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ABSTRACT
Despites the existence effective treatment of various conditions including mental healthcare,
inequalities still exist in the availability, quality of services and accessibility for AfricanAmericans populations. Black Community living with mental health problems do not get equal
treatment and diagnosis of mental health issues and this continue to increase the prevalence of
the condition in the society. Societal issues are some of the major causes of mental health
problems in the Black community and therefore, addressing an increase cases of mental health
problems requires finding a permanent solution to the societal issues such as poverty, violence,
unemployment rate, drug abuse and stereotypes against the Black community. The systematic
review was used to provide analysis of various published literature about the racial inequalities
of African-Americans in the mental health care system. The particular focused questions of
this systematic review was: What are some causes of mental illness? How does mental illness
differentiate in races? What are the particular services offered for blacks suffering mental
illness? The project was guided by Thoreau Cochrane database, EBSCO, PubMed, ProQuest,
SAMHSA and CINAHL with Medline. The process included systematic review of articles,
surveys, and mixed-method studies. In order to get appropriate information required for the
completion of the study, search terms were applied and some of the search terms used were
mental health, mental health illness and African-Americans, mental health care, mental
healthcare and African-Americans, mental health or disparities, African-Americans
populations, inequalities in mental health, disproportions and African-American populations.
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TABLE OF CONTENTS
ABSTRACT ……………………………………………………………………………………………………………… 2
1.0. CHAPTER 1.INTRODUCTION …………………………………………………………………………. 5
1.1. Background ……………………………………………………………………………………………………… 5
1.2. Problem Statement ……………………………………………………………………………………………. 6
1.3. Purpose ……………………………………………………………………………………………………………. 6
1.4. Research Questions …………………………………………………………………………………………… 7
2.0. CHAPTER TWO: LITERATURE REVIEW ………………………………………………………. 8
3.0. CHAPTER THREE: METHODOLOGY DESIGN ……………………………………………. 11
3.1.
Research Design ………………………………………………………………………………………….. 11
3.2.
Data Collection Techniques ………………………………………………………………………….. 12
3.3.
Data Analysis ……………………………………………………………………………………………… 12
3.4.
Summary ……………………………………………………………………………………………………. 12
4.0. CHAPTER FOUR: DATA ANALYSIS AND FINDINGS ………………………………….. 14
4.1. Introduction ……………………………………………………………………………………………………. 14
4.2. Background ……………………………………………………………………………………………………. 14
4.3. Demographic ………………………………………………………………………………………………….. 16
4.4. Data Collection ……………………………………………………………………………………………….. 16
4.5. Data Analysis …………………………………………………………………………………………………. 17
4.6. Findings …………………………………………………………………………………………………………. 17
4.7. Theme: Causes of Mental Health among Black Community in American ………………. 19
4.7.1. Societal Issues…………………………………………………………………………………………… 19
4.7.2. Drug abuse ……………………………………………………………………………………………….. 23
4.8. Theme 2: Mental illness differentiate in race ………………………………………………………. 24
4.8.1. Social change implication ……………………………………………………………………………… 27
4.9. Summary ……………………………………………………………………………………………………….. 28
5.0. CHAPTER FIVE: RECOMMENDATION AND CONCLUSION………………………. 30
5.1. Recommendations …………………………………………………………………………………………… 30
5.2. Interpretation of the findings …………………………………………………………………………….. 30
5.3. Parents and community Involvement …………………………………………………………………. 32
5.4. Legislations and policies ………………………………………………………………………………….. 33
5.5. Racism …………………………………………………………………………………………………………… 33
5.6. Equal job Opportunity to African-Americans ……………………………………………………… 34
5.7. Environmental ………………………………………………………………………………………………… 35
5.8. Police Brutality……………………………………………………………………………………………….. 35
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5.9. Recommendation …………………………………………………………………………………………….. 39
5.10. Conclusion……………………………………………………………………………………………………. 40
6.0. REFERENCES………………………………………………………. Error! Bookmark not defined.
7.0. APPENDICES …………………………………………………………………….…….47
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1.0. CHAPTER 1.INTRODUCTION
1.1. Background
The diagnosis of mental illness is a misnomer among the African American population,
which forces many blacks to go untreated, undiagnosed, or non-compliant with treatment.
Many African Americans who suffer mental illness are not aware of what mental illness is and
have even less idea of the history and symptoms of mental illness. This population group may
wonder if it is a sickness they were born with that could possibly spread to their children or if
it was bought on by an unfortunate circumstance. And if in fact, mental illness is a real thing
then what can this mean for one’s self and the impact having an illness can have on society?
According to General Social Study (GSS) conducted in 1996 blacks may be more
skeptical than whites of genetic and family-based explanations because of their resemblance to
arguments that have been used to criticize blacks and justify their disadvantage structural
position (Sawyer & Gampa, 2018). If being a black minority isn’t hard enough having a
psychological condition can make one feel even lesser than other races of higher social status.
These disparities that black people suffer in our communities also forces many blacks to suffer
mental illness in silence.
As leaders in Mental Health and Human Services we must incorporate the role race
play in health and treatment compliance. This can be done by dissecting both the internal and
external criteria used to determine the causes of mental illness. Medical approach should be
unique to the individual. If a recurring but largely unexamined explanation for this difference
(in black and white people accepting mental health services) has been cultural differences in
beliefs about mental illness, then we must endeavor to diversify the scientific methods we use
to diagnose African Americans with mental illness (Coleman, et al., 2016).
The researcher is conducting this research because as a black woman working in a
mental health facility servicing a population of predominately African Americans, the
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difference in compliance in White patients as opposed to Black patients is duly noted. White
patients are usually very knowledgeable of their diagnosis and necessary treatments and willing
to comply and black patients usually are not, yet they are all diagnosed using the same
diagnostic tool called the Diagnostic and Statistical Manual of Mental Disorders, 5th edition or
commonly known as the DSM-5. This diagnostic tool offers no distinction in race. Only
focuses on signs and symptoms of mental illness.
The researches stance is to break racial disparities in mental health and to activate
positive understanding of what having a mental disorder mean in the black community. Draw
more attention to the overall issue that is the importance wellness through treatment compliance
so that blacks may share equally in the hope for recovery from mental illness.
1.2. Problem Statement
Black Americans are more non-compliant with diagnosis and mental health services
because they are unwilling to accept mental illness as a treatable illness but more as rather as
disadvantage in society. There are limited services geared toward the sensitive nature of being
black with mental illness and those in dire need of intervention. And the tools used to diagnose
mental illness are not unique to any individual.
The goal would be for all institutions who service a large population of African
Americans to offer their black individuals some history on blacks with mental illness starting
with Black American Slavery. This may activate a connection between an individual and their
ancestors who struggled as well through unfortunate circumstances yet still manage to leave
behind their great legacy to be manifested.
1.3. Purpose
The purpose of my study is to understand the various causes of mental illness in African
Americans and how it differs from White Americans. To discuss the reasons and effects of
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non- compliance in mental health among African Americans. To discuss the social disparity of
mental illness in the black community. To discuss the lack of culturally competent institutions.
1.4. Research Questions
The researcher has gathered these questions based on my experience working in a
predominately black in-patient and out-patient mental health facility and my observation of
destitute blacks in my community. In conjunction with the information I have gathered above
on mental illness I believe that I can further educate myself and others on mental health
conditions and circumstances causing these conditions in African Americans.
1) What are some causes of mental illness?
2) How does mental illness differentiate in races?
3) What are the particular services offered for blacks suffering mental illness?
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2.0. CHAPTER TWO: LITERATURE REVIEW
Mental Health awareness within the black community is not taken seriously due to
social injustice and racism in black society. There are a multitude of factors to consider
regarding African Americans and mental illness. The treatment of black people over decades
past has caused distrust of professional help due to racism, racial profiling and misdiagnosis.
The stigmas of these issues have led black people to avoid their emotions, turn to distasteful
actions to cope such as drug use or drug dealing, alcoholism and suicide.
There are a number of articles that confirm the different elements associated with the
mental health of black people being overlooked. According to article, Mental Health
Disparities: African Americans by American Psychiatric Association (APA) 2020 rates of
mental illness in Africa Americans are similar to those of the general population but disparities
do exist in regard to mental health services for blacks. Africa Americans receive poorer quality
of care and lack access to culturally competent care. (Primm A, et al. “African Americans “,
chapters in Disparities in psychiatric Care. Ruiz and Primm editors.)
Also, only one in three African Americans who require mental health care receive it.
(Delancour M, et al. “The Role of Faith-Based Organizations in the Depression Care of African
Americans and Hispanics in Los Angeles Psychiatric Services. 2017.) compared with nonHispanic whites, African Americans with any mental illness have lower rates of any mental
health service use including prescriptions medications and out-patient services. (Substance
Abuse and Mental Health Services “Racial/Ethnic Differences among Adults” 2015.
The rate of illicit drug use among African Americans is slightly higher than the national
average (12.4% vs 10.2%). Rate of alcohol use is just slightly lower than the national average
(44.2 %vs 52.7%). (Centers for Disease Control and Prevention. “Health, United States,
2015”). Rate of opioid overdose among African Americans (6.6%) is less than half of that for
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non-Hispanic whites (13.9%). (Kaiser Family Foundation. “Opioid Overdose Deaths by
Race/Ethnicity [2012-2015]”).
Compared with whites’ blacks are less likely to receive guideline consistent care and
less likely included in research but more likely to use emergency room care or primary care
rather than mental health services. (U. S Surgeon General, HHS. Mental Health: Culture,
Races, and Ethnicity- A Supplement to Mental Health: A Report of the Surgeon General. 2001.)
Compared with the general population, African Americans are less likely to be offered
either evidence-based medication therapy or psychotherapy. Borja, Logan-Greene, Tennyson,
& Nurius (2017) RC “Recent care of common mental disorders in the United States: Prevalence
and conformance with evidence-based recommendations”.)
Compared with whites with same symptoms, Africa Americans are more frequently
diagnosed with schizophrenia and less frequently diagnosed with mood disorders. Differences
in how African Americans express symptoms of emotional distress may contribute to
misdiagnosis. (Bell C, et al “Misdiagnosis of African Americans with Psychiatric Issues part
II” J Natl Med Assoc. 2015.107 [3]: 35-41.)
Physician-patient communication differs for African Americans then white patients.
A study found that physicians were 23% more verbally dominant and engaged in 33% less
patient- centered communication with African American patients then white patients. (Johnson
R, et al. “Patient race/ethnicity and quality of patient-physician communication during medical
visits.” (Am J Public Health 2004.)
Black people with mental health disorders, and other psychoses are more likely to be
incarcerated than people of other races (Ranapurwala, Shanahan,Alexandridis, Proeschold,
Naumann,Edwards and Marshall (2018) “Incarceration among Adults who are in public mental
health system: rates, risk factors, and shirt-term outcomes”. Despite many efforts to improve
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mental health services for black people, barriers remain regarding access to and quality of care.
(Flaum, 2017)
The reluctance and inability to access mental health services is caused by distrust and
incorrect diagnosis of illness. African Americans have been and continue to be negatively
affected by prejudice and discrimination in the health system. Inadequate treatment and cultural
incompetence by health care professionals have deemed mental health awareness as a
misconception of reality for blacks.
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3.0. Chapter Three: Methodology Design
The purpose of this study is to examine the federal framework for African Americans
in Mental Health. Through this study the researcher analyzed the existing policies in place for
mentally ill. This a qualitative research method by conducting a secondary analysis. The
qualitative method is appropriate when seeking to understand a phenomenon and expand
information. Conducting a secondary analysis will allow the researcher to analyze the
relationship between meanings. This method is relevant when determining the how and why?
The secondary analysis method will allow the research to be more of an exploration rather than
shaped by theory.
The following research questions were used to evaluate the areas of difficulties black
people with mental illness experience in the mental health care system.
1. How does the DSM5 diagnose Black patient’s vs White patients?
2. Do black patients in the mental health care system achieve their safety, wellness
and treatment goals?
3. What services are in place to avoid discrimination against blacks in the mental
health care system?
3.1.Research Design
The researcher gained data through reviewing articles on the disparity of African
Americans in the mental health care system, policies, and laws from key databases on mental
health. The researcher printed articles related to social factors that impacted blacks in the
mental health care system. The researcher will identify the key themes, concepts and then
highlight and code through the material by identifying which of the material relates to identified
themes. The researcher will compare and contrast the findings from the studies. The
researcher’s highlighted key information will be charted into an excel sheet to identify patterns.
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3.2.Data Collection Techniques
A secondary analysis method was used to collect the data for the study. The researcher
gathered information from several websites and scholarly databases on mental health, blacks
in the mental health care system and blacks incarcerated with mental illness. These websites
and databases contained information use by the American Psychiatric Association to track
African Americans throughout the mental health care system. The researcher collected thirty
articles and used eight studies to collect the analysis. The researcher used articles that
connected and matched with the key words identified in the literature review.
3.3.Data Analysis
The researcher gathered 30 articles and from that number eight studies were used to
code conceptual themes. The following process was used to code and analyze the data. First
the researcher read each article carefully. Second, the researcher divided the articled into five
categories and listed them by the recurring themes from the literature review. The themes are
entered vertically into an excel spreadsheet. Next, the researcher entered the studies
horizontally into the excel spreadsheet. See Appendix Chart 1.
After carefully mapping out the survey, the researcher underlined key statements about
education, health, homelessness, non-compliance and services. The researcher color-coded the
themes by highlighting and comparing and contrasting out the data for similarities and
differences. The researcher is able to better code and analyze the data through this process.
3.4.Summary
This study consists of a qualitative study approach to determine how African Americans
achieve their permanency goals through agency discrimination with education, housing,
health/wellness and services to sustain their success as they embark on a life-long journey of
mental health treatment. The researcher, for the sake of conducting this study in a timely
manner and in conjunction with agency policy on patient confidentiality, chose not to interview
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mentally ill persons in the mental health care system; however, to review the literature of past
studies and conduct a secondary analysis.
The secondary analysis supported the researcher to review past studies of blacks in the
mental health care system and to determine the common themes and challenges faced with this
population. The researcher was able to identify five themes from the literature review that will
be analyzed and compared with the data from the secondary analysis.
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4.0. CHAPTER FOUR: DATA ANALYSIS AND FINDINGS
4.1. Introduction
Many findings of the study were obtained when literature review and discovery of
scholarly articles were conducted. All findings were useful when getting to understand the
racial disparities of Blacks in the American mental healthcare system. The data collected were
important for understanding the concept of racial disparities in mental illness diagnosis,
treatment and other services provision. It provided clear overview of the racial disparities in
the provision of healthcare services to mental disorder patients especially to Blacks in the
society. It further helps in understanding the causes of mental illness among Blacks in America,
differentiation in mental diagnosis and treatment of mental illness among races in America.
Although many of the studies provided vivid causes and differentiation in diagnosis and
treatment of mental health issues among races in America, it came out clear that Blacks in
America are disadvantaged when it comes to getting services related to diagnosis, treatment,
and other healthcare services. Many of these studies measures that ca be used to bridge the gap
in mental care services offered to Blacks and Caucasians, results shows that there are still
inequalities in healthcare service provision to Blacks with mental illness and social issues that
cause mental illness have not been fully addressed.
4.2. Background
In the United States, issues affecting racial and ethnic minority population is well
documented and clearly show the existence of health care inequalities. Even though the general
incidence rates of mental illness are the same across racial and ethnic population (Vance, 2019),
there is high burden of mental complaints among African-American group or Black
Community. The African-American populations experience worse health status and higher risk
compared to other groups such as Caucasians. These inequalities are the same across a number
of different diseases and provision of services, as well as mental and physical health concerns.
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Refining the process of health access to provide African-Americans access to mental health
treatment the same as Caucasians and other groups is likely to reduce the gap in severity and
persistence because there would be evidence based care works for Africa-Americans as it does
for Caucasians.
In the discipline of mental health, the entire treatment process is purely based on the
way a patient and clinician relates. This significant association is based on shared trust, respect,
and open communication between clinician and the patient. The good understanding among
the key persons in healthcare provision determine the health outcomes of mental health patients
(Yohannan, John, Millie, & Batsche-McKenzie, 2017). Furthermore, the social determinants
make a good contribution to these highlighted inequalities but fail to make a clear clarification
of them. The examination of racial and ethnic differences in leaving mental health services has
not assess several forms of services that are provided and the reason behind racial and ethnic
population cease to seek for better treatment. As stated by Miranda & McGuire (2018)
healthcare provider biases can be a major contributor to inequalities in health care provision
among Blacks in America and therefore, without addressing these issues, the disparities in
mental healthcare services might continue to exist for a longer period.
Research has further established that cultural barriers and healthcare provider
predispositions can be a major contributor to a lesser quality of service that could contribute to
these disparities among the African-American population (Himmelstein, Woolhandler, Saadi,
& Mejia, 2017). There is still evidence that connect cultural competency and health outcome
is not available among Black population and therefore, it drives the increase cases of mental
problems. The primary goal of the systematic review of some of the latest literature was to
provide a detailed investigation of the published literatures about racial disparities among
African-American population. It focuses on the barriers and effective techniques or strategies
that can be used to identify and provide treatment to patients with mental health disorders. The
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practice focused of the conducted systematic review: What are some of the causes of mental
illness among the African-Americans population? How does metal illness differential in races
across the country? What are the particular services offered for blacks suffering mental illness?
4.3. Demographic
As a result of challenges of getting a Blacks in America with mental health problem for
the study, the researcher did not carry out interviews or used questionnaires to collect data.
The population was defined by carrying out secondary analysis of similar studies that have
been conducted were done by the researchers. However, the data collection from other research
was obtained from the information, which define the population required. After completion of
defining the study group as Blacks in American or Africa-Americans with mental health
problem and have been seeking mental health care and treatment.
4.4. Data Collection
A secondary analysis technique was used to gather data for the study. I collected
information from several databases, hospitals and other websites with information related to
racial disparities of Blacks in the American mental health care system. However, the evidence
were collected from various databases and some of the databases used are: Thoreau Cochrane
database, EBSCO, PubMed, ProQuest, SAMHSA and CINAHL with Medline. The process
included systematic review of articles, surveys, and mixed-method studies. In order to get
appropriate information required for the completion of the study, search terms were applied
and some of the search terms used were mental health, mental health illness and AfricanAmericans, mental health care, mental healthcare and African-Americans, mental health or
disparities, African-Americans populations, inequalities in mental health, disproportions and
African-American populations. It is also important to point out that after, I completed
conducting selection of the articles, appraisal, and grading of the articles, I proceeded to the
incorporations of the articles into a literature review medium. The evidence obtained were
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graded using the Melynk and Fineout-Overholt system of hierarchy of evidence to ensure
appropriate and the best information are used to complete the study.
4.5. Data Analysis
The Black Americans are documented as vulnerable to mental health disparities and
they usually face unique challenges associated with mental healthcare. The search conducted
to get related literature between 2015 and 2021 produced more than 500 articles when full text
was used. Removal of duplication was done one by one where approximately 300 articles were
left with for further review and analysis. The researcher conducted color-coding of the themes
by highlighting and comparing and contrasting out the data for similarities and differences. The
researcher is able to better code and analyze the data through this process. After series of review
and analysis of the articles, 50 articles were left to be used for the completion of the study. The
articles remained for the study were 10 surveys, 15 were mixed method studies and 25 were
articles as indicated on the figure 1 below:
4.6. Findings
In this section, each research questions is addressed in detail based on the results and
findings from the data analysis. The listed below is the annotated literary review based on the
themes and they are provided from one to four. The themes are derived based on the result and
findings on the some of the issues related to racial inequalities of Blacks in the American mental
healthcare system. Therefore, themes are DSM5 diagnose, social issues, drug abuse and
discrimination. There are several annotated articles provided to provide detailed illustration of
the findings of system review conducted on several articles obtained for the completion of the
research. The review of literature generated five systematic reviews two mixed method studies
and four reviews. The findings of these studies are therefore, summarized and categorized by
the key results comprising of various variables identify, which can be used to reduce the
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disparities gap of DSM5 of African-Americans and Whites. It further identified prevention of
mental healthcare engagement and interventions required to reduce disparities.
Five of the chosen (n-25) articles reviewed indicated that the DSM5 diagnose Black
patient’s vs White patients shows that there is difference in the method of diagnose of AfricanAmericans and Caucasian patients. The study shows that schizophrenia usually is diagnosed
among African-Americans, while mood disorders are more diagnosed among whites and
therefore, it raises serious questions of perceived clinical judgment across race (Gara, Minsky,
Silverstein, Miskimen, & Strakowski, 2018). There is no evidence indicating the practice of
racial disparity in diagnosing and treatment of African-American. From this literature review,
I discovered that there is racial diagnosis existing among African-Americans and Caucasians.
The literature shows that African-Americans are diagnosis in high numbers for substance abuse
and other factors that could lead to mental problems. I further discovered that there are many
sociocultural factors that influence African-Americans seeking for mental healthcare, and
when they can be provided with help and there are challenges they encounter to get diagnose
and treatment (Hetey & Eberhardt, 2018). The African-Americans populations lack proper
infrastructure in most of their neighborhoods that could help in immediate diagnose of mental
health problem. This clear indicates the different in diagnosis of mental health problem
between African-Americans and Caucasians group in our society.
Due to these factors, African-Americans are unlikely to get proper diagnosis and stay
or take part in treatment. Gara, Minsky, Silverstein, Miskimen, and Strakowski (2018) pointed
out that many cases of mental health disorder among African-Americans are due to poor
diagnosis and therefore, African-Americans do not get the same diagnosis the Whites are
accorded when they show any signs of mental disorder. The use of psychosocial as a method
of intervention such as collaborative care, increase diversity at workforce and providers
working in the African-American’s neighboorhoods, improved cultural understanding and
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competency skills and reducing of stigman can help in addressing mental health inequalities.
For example, Fadus, et al. (2020) stated that the environment of primary healthcare could be a
promising setting for conducting assessment, screeming and treatment of mental diseases for
African-Americans populaions. Therefore, creating an inclusive, and culturally centered
integrated care model could be one of the best strategies to address the diagnosis disparities
among African Americans and provide better mental health diagnosis, and treatment.
4.7. Theme: Causes of Mental Health among Black Community in American
Research Question 2 asked: What are some causes of mental illness among AfricanAmericans? A review of an article published by Stein, Gennuso, Ugboaja, & Remington (2017)
indicates that 13.6% of the U.S. populations identifies as African-Americans and 16.5% of
them are reported to have mental illness in the past years. Review of articles established that
there are several issues that cause mental illness among African-Americans and some of those
issues are: demographic or societal issues, prevalence, attitudes, access to insurance and
treatment issues.
4.7.1. Societal Issues
Assari (2018) pointed out that 55 percent of African-Americans people live in the
South, 17 percent in the Northeast, 18% in the South and 10 percent in the West. Since 1980,
the population of Blacks in the United States has increased from 816,000 to 4.2 million by
2016. Overall, 24 percent of Black and African Americans are graduated of bachelor degree
and majority are not bachelor graduates. Assari (2018) stated that more than 1 in 5 Black and
African Americans in the United States are living in poverty. Assari (2018) further indicated
that more than 30 percent of women heads of households are African-Americans, compared to
white homes of 9 percent. There is a big gap in education, poverty and populations that leads
to stress and depression hence mental disorder among the population.
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Al-Rousan, Rubenstein, Sieleni, Harbans, & Wallace (2017) further noted that the
existence of racial stereotypes and rejection have adverse consequences on African Americans,
which lead to mental health problem in the society. Al-Rousan, Rubenstein, Sieleni, Harbans,
& Wallace (2017) conducted a qualitative study that determined that historical issues such as
sharecropping, race-based exclusion from health, social and economic resources create a
socioeconomic inequalities among the Black and African-American population today and these
are some of the major contributors of high rate of mental health problem among the AfricanAmericans and other Blacks in the United States. Fadus, et al., (2020) articulated in the article
that people who have been impoverished, incarcerated, homeless or using substance have
higher risk for poor mental health and therefore, majority of people facing similar problems
are African-Americans. In brief, the mental health problem among Black people are majorly
caused by societal issues and can be addressed when these societal issues are solved. Fadus, et
al., (2020) stated that Black people do not have several amenities such as good infrastructure
in their neighborhood, housing, education and other essentials for life. Majority of Blacks live
in poverty and they do not access better healthcare service.
The review of article published by Caldwel and Assari (2017) indicated that exposure
to violence, involvement in the foster care system and incarceration could lead to mental
disorder. The Black community is at risk of increased development of mental health issues
due to violence in their neighborhoods and incarceration. Caldwel and Assari (2017) stated that
in the violence, incarceration and political issues systematically destroy the physical and
psychological health. The pressure on Black community to meet the needs of family is too
much and lead to stress, depression and trauma, which are some of the major issues causing
mental health problem. Dealing with layers of trauma and other societal problems could be a
major issues and most Black people have high rate of poverty due low employment rate, which
deny them access to many social services and better healthcare.
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Flores and Lin (2018) codnucted a review to assess some people from the
neighboorhood and policy predictors fo the inequalities. Flores and Lin (2018) further made
an attempt to establish an understanding of mental health care access, which necessitates not
only comprehesive behavior change but also coming to understanding the interrelationship
among social context, the disease history, individual episode factors, social support, and the
healthcare delivery structure, which is used to provide formal treatment to mental health
patients. Flores and Lin (2018) further reviewed several surveys and responses from the Panel
of 9 to 13 respondents corresponding to year 2004 – 2009 of the Medical Expenditure Panel
Review with sample generated from non-Latino, African-Americans, Whites, and Hispanic
adults aged 19 years and older with psychiatric disorder (N=13211) episodes of mental disorder
related problems, which representing 10,399 of the individual respondents.
The result shows that disparities among African-Americans have arise because many
African-Americans are more likely to live in the same neighborhoods, where the provision of
treatment is low because of the influence of different neighborhood disadvantage on the
provison of treatment, which is being provided to the African-Americans compared with
Caucasians. The low rates of initiation within the neighborhood with a high population
specialists means that interventions is meant to increase mental care specialists, without putting
much focus on providing treatment to African-Americans might not be able to reduce access
inequalities (Eyongherok, 2019). The availability of specialists who are practicing in the
environment with many African-Americans populaitons requires suggest that a greater access
to the available resoruces can help in reducing the inequalities in mental health treament and
care.
Olbert, Arundati , and Benjamin (2018) utilized logistic regression models to conduct
a test for variation access of mental health care and treatment of African-Americans in the
relationship between preceived need for treatment and soverity of mental illness. Akinhanmi,
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et al., (2018) primary aim wa to resolve the contradictory evidnce about African Americans
differences that exist in the perceived need from mental treatment by using a large and diverse
epidemiologic sample from 7 years, which was done repeated cross-sectional survey of the
U.S. civilian of non-institutionalized populations (N-233,723). The finding of the study
indicates that African-Americans are less to see the need for mental health treatment, even after
coming to know their mental status. It suggests that differences in perceived need could be
aborted because African-Americans disparities in mental health care use.
Akinhanmi, et al., (2018) carreid out a systematic review of clinical trial to investigate
the participation and inclusion of African-Americans in a randomized trials. The study further
examined progress creating a working mental health force more diverse and better representing
African-Americans in a randomized intervention trials of some of the common mental health
issues from the time the publication of the U.S. surgeons general, which is covered in 2001
report on mental health, race, culture and ethnicity. The results obtained from the review show
that from 1999 to 2006, the professionals in healthcare sector from the minority groups have
increased from 17.6% to 21.4% in psychiatry and other related professions. The finding also
indicates that there are also an increase of social workers from 8.2 to 12.9% and 6.6% to 7.8%
in the field of psychology. Therefore, there is practical actions that have been taken to bridge
the gap and ensure there are enough ethnic composition of healthcare workers. DePetris (2015)
stated that the ethnic matching between service providers and encourages clients to stay for
treatment. This could be the best strategy to reducing mental health care inequalities and
therefore, increasing diverist of the workforce evidence based treatment address AfricanAmericans concerns.
E.Hamilton, et al., (2018) conducted a qualitative study to find out facilitators and some
of the barriers to the successful implementation of primary care behavior health intergration in
a setting of multilingual behavior. The research was carried out involving seven focus group
23
and five semi structured interviews. The number of respodents were 41 patients and five
healthcare providers who are included in integrated care at the community mental health clinic,
which is situated in California and it serves African-Americans and Asian immigrants. The
result from the study indicated that limited system-level preconditions and some of the cross
organizational dynamics create a lot of challenge to integrated care. Thereforem change the
culture of an organization and practice that involved patient – provider and provider- provider
communication, could be the best way to increase patient participation in improved clinical
outcomes and help in the facilitation of effective implementation. It is therefore, clear that lack
of enough trained mental health care providers from Black community increases chance of
mental illness.
4.7.2. Drug abuse
Yang, Wong,, Margaux , and Deborah (2017) illustrated that drug abuse is a major
cause of mental health in the Black communities. Yang, Wong,, Margaux , and Deborah (2017)
further stated that many people who are drugs addicts are also diagnosed with mental disorders.
Compared to the general population, individuals who are drug addicts are roughly twice as
people who are likely to suffer from anxiety and mood disorders. According to DeFreitas,
Crone, DeLeon , and Anna (2021) stated that a study conducted in 2015, approximated that
about 43.2 million which is 17 percent of adults aged 18 years and above usually experience
some form of mental disease. The same study established that approximately 8.1 million people
who had substance abuse usually experience mental illness. Even the use of substance disorder
is associated with mental illness, it is usually not clear whether one assistance cause the other
or if the common underlying factors result to both disorders. The systematic review indicates
that substance abuse can mental illness and therefore, abuse of substance is one of the high risk
of mental health problem.
24
The systematic review of an article published by Parsons, English, & Rendina (2018)
indicates that the use of substance abuse is common among Black community. The AfricanAmericans experience lower rates of binge drinking compared to other ethnic groups in the
United States. A study conducted by Parsons, English, & Rendina (2018) established that
African-Americans are more likely to experience alcohol abuse and recurrent persistent based
on the prevalent when a comparison is done with other ethnic groups. A study of the drug usage
among different ethnic groups revealed a unique statistical trend between American-Americans
with other ethnic groups, when it comes to substance abuse. Parsons, English, and Rendina
(2018) pointed out that African-Americans rate of drug abuse is high when compared to other
groups. Parsons, English, and Rendina (2018) further pointed out that due to high rate of drug
abuse, the rate of mental disorder is also common among the Black community. The study
conducted among different ethnic groups include Asian-American, Hispanic, Caucasians and
African-Americans focusing on drug abuse and mental health problems established more than
15 percent of African-Americans admitted with cases of mental health had drug abuse cases.
4.8. Theme 2: Mental illness differentiate in race
Research question 3 Asked: How does mental illness differentiate in races? The
review of article focusing on the mental illness and race establish a clear distinction across
the country. It shows vividly that ethnic, race and mental health is practice in the United
States due to stigmatization of mental health and Black Americans, the focus of the review of
the article was to determine whether impact of mental illness to community is driven by race
and the way each race treated and provided with mental healthcare in the United States.
Wong, Collins, Cerully, Seelam, and Roth (2017) noted in the article “Racial and Ethnic
Differences in Mental Illness Stigma and Discrimination among Californians Experiencing
Mental Health Challenges” that there are different in view how people with mental health are
treated and these views are racial oriented. Wong, Collins, Cerully, Seelam, and Roth (2017)
25
conducted a study to examine whether there are ethnic/ racial differences among California
adults having mental health challenges with regard to stigma, which include the view of
people in the provision of treatment of people suffering from mental disorder, discrimination,
self stigma, health treatment attitudes, exposure and utilization of CaLMSA’s SDR activities.
Since California is one of the states, which are ethnicially and racially diverse in the
nation the study focussed on the stigma and disproportionation of mental health and the
affect to ethnic and racial minorities. The article reported that mental illness is racially treated
and the perception, attitude and stereotype are some of the major issues affecting people with
mental problem. Coleman, et al. (2016) stated that there have been significant racial-ethnic
differences in the way giagnosis and treatment of psychiatric condition across 11 difference
U.S. health care system. A study indicates that treatment for psychiatric conditions differ bu
race-ethnicity across the country. Persons with any psychiartric condition and from Black
community in Americanare less likely to get a better treatment compared to whites. Whites or
Caucasians are morely to be provided with treatment and receive medication for their
conditions, which is something different with African-Americans (Coleman, et al., 2016).
Like the results for diagnosis, results of most of the treatment provision studies were done
based on survey reports from providers and patients. The evidence available for accurancy of
patients reported medical treatment being provided to patient is mixed and it depends on the
treatment being delivered (Coleman, et al., 2016).
Maura and Mamani (2017) stated that key treatment modalities, such as surgery
discovered to be more accurate that the recceipts of participation for a consition. The
physicians providing services to Black community are less studies with the limited evidence
that indicates that physicians self-reported treatment is different with the treatment methods
recorded in the medical records. Maura and Mamani (2017) further pointed out that
physicians, nurses and other healthcare providers directly providing mental healthcare
26
services to Blacks in America are not properly trained. It states that there are few trained
African-Americans or Blacks who are trained to provide mental healthcare service to the
Blacks in America. Maura and Mamani(2017) discussed that there are mounting evidence
shows that there are mental health inequalities in the United States, which disadvantage
African-Americans in the mental health settings. It clearly states that Black community are
not given better mental health care and in most cases there are few healthcare providers ready
to listen and provise healthecare service to Blacks in America.
The study conducted by Lui (2020) regarding mental illness diagnosis, and treatment
shows that whites and other races are more likley to seek mental illness treatment compared
to African-Americans. A quatitative study conducted by (Lui, 2020 ), shows that 75% of
African-Americans do not seek treatment because of stereotypes and descrimination against
Black community seeking for mental health care. A review of another syudy conducted by
Borja, Logan-Greene, Tennyson, & Nurius, (2017) indicates that the failure to seek mental
healthcare is due lack of enough Black community in the profession of mental health and
therefore, most Africa-Americans usually feeel being descriminated and neglected when by
healthcare provider. Therefor, there is a clear racial disparities in the provision of healthcare
to Black community in the United States and this is one of the causes of increased cases of
mental health problems among the African-American community.
Matejkowski, Aaron , and Michael (2017) also noted that diagnosis and treatment of mental
health illness is racial bias. Whites have access mental health care services easily and
efficient care due to their financial strength. Acccording Matejkowski, Aaron , and Michael
(2017), the stereotype and and descrimination against African-Americans contribute to poor
healthcare services because Blacks take long before getting access to mental health services
compared to whites. The variation in service delivery is due to fewer number of AfricanAmericans trained to provide mental healthcare services and the few available professionals
27
are whites. This is a big gap, which encouranges the existence of racial disparities in the
provision of mental health care services to the Black community in America.
4.8.1. Social change implication
The primary goal of this systematic review was to provide evidence that can result to
effective interventions that can help in reducing the gaps in mental healthcare for Black
community in the United States. It was conducted to establish best strategy that can be used to
improve health standing, better quality care and patient satisfaction. stated that if healthcare
settings implement evidence based interventions the chances of reducing mental health
problem would be higher. It means that evidence-based practice could help in reducing the
number of mental health cases among African-Americans. It is also projected that the
modification of social life and adoption of inclusive healthcare training can help in solving
mental health problems in the society (Lindsay, Duxbury, & Frizzell, 2018). The social
implications of the conducted systematic review are mostly the major changes in the provisoon
of primary care.
It is difficult for anyone to receive mental health treatment and care in the United States.
But is more difficult for Black community to access mental care and treatment compared to
Caucasians and other ethnic groups. However, there are fewer trained African-Americans to
help in solving mental health problems in the Black community. By utilizing the findings
obtained form this project on bridging the gap in the provision of healthcare to AfricanAmericans with mental health problem, organizations can effectively implement interventions
to ensure the outcomes and patient satisfaction is improved (Iglay, et al., 2017). Therefore,
addressing social issues can be used to address the different in mental healthcare provision
among the Black community and Whites. Without proper mechanisms to solve the societal
isues the problem of mental illness among the African-Americans will continue to rise.
(Caldwel & Assari , 2017).
28
4.9. Summary
Mental disorder are persistent, with incidence of mental diseases diagnoses among
African-Americans or Black community when compared to Caucasian Americans. While
Black people have equitable existences of mental health illness, inequalities usually exist in the
use of mental health services, especially seeking for mental distress. These increase the
problem of mental health of the Black community in America. The review of articles and
analysis of other studies indicates that major causes of mental health problem among AfricanAmericans in America are social issues that have existed for decades. The findings indicates
that African-Americans have has problems related to racial discrimination, violence, lack of
health care problems including insurance cover, and poverty. Besides, the review of other
articles established that use of drug or drug abuse is a major cause of mental health problem
among the African-Americans. A study indicated that majority of African-Americans diagnose
with drug abuse are also suffering from various mental health problem. Societal issues, drug
abuse, violence and other issues such as discrimination and poverty are major causes of mental
illness problem common among Black community in America.
Furthermore, serious mechanism have been put in place to address the problem of
mental illness disparity but the problem still remain unchanged due to race differentiation in
the provision of mental health care services. A review of articles and other studies show that
the treatment provided to African-Americans seeking diagnosis and treatment of mental health
disorders are not given same care compared to whites and other races in America. The findings
of this review indicate that cultural practices in the society and views or perceptions of
individuals contributes to ethnic variances in seeking for help on mental health issues.
Likewise, perceived stigma of healthcare and lack of cultural competence in health care
providers including clinicians can influence African-Americans to disengage in treatment.
Therefore, taking initiatives to modify health care organizational culture and practice improve
29
communication between key stakeholders in the provision of mental healthcare services. It
means enhancing patient participation and communication between the patient and healthcare
providers could boost clinical outcomes and facilitate effective healthcare service utilization.
30
5.0. CHAPTER FIVE: RECOMMENDATION AND CONCLUSION
5.1. Recommendations
Racial inequalities in the provision of mental healthcare services still exist in America.
While mental health care services are available across the country and there are several trained
experts, African-Americans still do not have equal access to these services due to societal
issues. Whites and African-Americans do not get equal treatment by healthcare providers and
therefore, this has discourages African-Americans from seeking for diagnosis and treatment.
In the case, many African-Americans with mental health issues remain suffering silently for a
long period increasing cases of mental health in the society. This is why this kind of study is
needed to help in solving the problem by looking into the gaps and finding the appropriate
solutions. It helps to examine societal issues, drug abuse, violence, and other racial issues that
create barrier to the provision of better healthcare service. Although there are mental healthcare
to everyone, the racial differentiation exist in the society still make it difficult to minorities
such as Black community to receive services being provided by various healthcare facilities.
5.2. Interpretation of the findings
According to Yearby (2018) mental health is a problem among African-Americans
because of racial inequalities in the mental healthcare system. Despite the progress that has
been made in the healthcare sectors, racial bias still a major issue prevent Blacks in America
from receiving similar treatment provided to other races such as whites. The review of the
articles in depth revealed universal trend on the causes of mental health illness among the
African-Americans. From the article published by Bell, Sack, Tobin, and Thorp (2020), it
came out clearly that mental illness is a serious issue in the Black community and it is due to
societal issues. The study revealed that mental illness is common in Black community because
of systematic poor service delivery, unemployment rate among the population, incarceration,
31
poverty, violence, the use of drugs and discrimination (Williams, Mouzon, Oshin, , Chatters,
& Himle, 2017).
However, solving these societal issues could help in reducing mental health problem
rate among African-Americans in the society. It is important to relook at these causes to provide
amicable solutions to help in reducing the number of mental health cases among the AfricanAmerican populations. Addressing the causes is the best strategy that can be used to solve the
problem of racial disparities in the mental healthcare. Without proper solution, the racial
disparities in the healthcare sectors especially on mental health care system will continue in the
society for a longer period. However, these societal issues could be addressed at family level,
legislations and through addressing the financial gaps or poverty gaps in the country, which
affect Black community negatively in their neighborhood.
Several studies reviewed indicates that there is existence of racial disparities even in
diagnosis and treatment of mental health problems among the African-Americans. An article
by Wilkins, Schindler, and Morris (2020) revealed that Blacks in America do not seek for
diagnosis because of stereotype and discrimination. Most clinicians and other healthcare
providers are from other races and majority are white making it difficult of African-Americans
to seek for treatment. First, improvement the number of African-Americans in professions such
as psychology, nursing and other areas dealing directly with mental issues would be a good
step to address racial disparities. The whites get diagnosis and treatment of healthcare problems
quick and efficient and this is due to financial status and the high number of whites in the
healthcare sectors (Hudson, Sacks, Irani , & Asher , 2020). The review of the article clearly
revealed that the cost of diagnose and treatment of mental related problems are high and
therefore, most African-Americans cannot afford because majority do not have health
insurance cover.
32
5.3. Parents and community Involvement
Prevention and intervention methods will cut back the impact of drug use and mental
disorders in America’s youth. Enlightened by protecting factors that implicate family values in
reducing substance use risks, responsive hindrance programs may help parents. Family-based
hindrance programs have verified efficacious in lowering drug risks among minority- and majorityculture youth. For family approaches to drug hindrance to impact giant numbers of parents and
youth, they have to be affordable, affordable, and versatile, meet tight planning demands and
demonstrate fidelity (Hong et al., 2019). Intervention programs can ideally be offered on-demand,
accessible at homes, and delivered in an exceeding means that pulls in and retains the eye of
parents and the youth. Computer-mediated hindrance programming fits these necessities.
Parents also must play a big role in knowing their teens, activities they get involved in
when they are away from home. They must pay close attention to their children’s whereabouts,
what they do, who are their friends, and what are the behaviors of their friends. They must provide
support to the youth at all levels in their physical and mental growth to inculcate good morals and
behaviors. The parents themselves must set good examples in their homes by not getting involved
in excessive drug and substances abuse under the watch of their children (Hong et al., 2019). They
should know their teen’s activities and pay attention to their teen’s whereabouts. The government
and non-state actors should devise strategies for eliminating drug abuse among the youth and
adults. Some of these strategies like increasing community collaboration efforts can help a great
deal to reduce substance abuse among young people. Additionally, there should be mechanisms
for increasing and aligning community substance abuse prevention messaging; increasing access
to skill-building opportunities for youth and adults working with youth to make the young people
productively engaged in meaningful activities, which improve their livelihoods.
33
5.4. Legislations and policies
Several studies have shown a relationship between mental illness and violence. In most
cases, people with mental health problems are more likely to be targeted and become victims of
violence and those who experience violence oftentimes suffer mental health problems. To cover
young black Americans from mental illnesses arising from violence, the public sector of the United
States must ensure that Black African Americans have sufficient and culturally competent chances
for healthcare and adequate health insurance schemes to cover them. The federal government also
must increase its investment in education for young Blacks, as this is another sure way of protecting
them against crime because education removes other risk factors for violence while low education
is seen to be a catalyst or risk factor for violence against them (Ervin, 2020). Addressing
unemployment among Black youth using sustainable, and concrete job opportunities is also a key
measure towards lowering risks for violence, and victimization including homicide which affect
their mental health. Lack of housing creates instability among many Black African Americans, and
this increases their chances of exposure to crimes and violent experiences. Homelessness is
normally associated with higher risks of violence, particularly for young Black Americans. The
United States should invest in supportive housing to holistically reduce violence and crime in Black
neighborhoods.
5.5. Racism
Reducing inequities in health needs dismantlement the systems that initiate and sustain
inequities in a very broad variety of social group establishments that are the drivers of inequities
in health. All of those social group inequities are driven by racism. Racism is associated organized
social group system, within which the dominant racial cluster, supported a hierarchy of human
worth, categorizes and ranks folks into social teams referred to as “races”, and uses its power to
devalue, disempower, and differentially portion social group resources and opportunities to teams
outlined as inferior (Williams & Cooper, 2019). As a structured system, racism interacts with
34
alternative social establishments, like the political, legal, and economic establishments, shaping
the values, policies, and practices among these establishments and being re-shaped by them.
Improving the health of underprivileged black American youth and reducing gaps in health needs
dynamic systems like policies, laws on human rights, and governance approaches, to boost
conditions that confirm equity in health provision to all races in their homes, schools,
neighborhoods, workplaces, homes of worship, and alternative social contexts.
5.6. Equal job Opportunity to African-Americans
Living in a very poor house has been joined to mental ill-health and increased risk for
psychological state issues in the youth which will persist for a protracted time in their lives. Despite
their high need for mental health services, young and families living in impoverishment are least
probably to be connected with high-quality mental care. Though the U. S. is among the wealthiest
countries, the speed of impoverishment in America particularly exceeds that of the many
alternative industrialized nations. Poverty has been associated with mental illnesses and
accumulated risk for psychological disorders among youth in America, with several studies
showing lower mental health service utilization among African Americans and Hispanic youth,
compared with their white counterparts (Hodgkinson et al, 2017). Consequently, there’s a
requirement for additional upstream, innovative, comprehensive approaches to addressing mental
health issues among black youth experiencing impoverishment. Specifically, programs
that are youth-driven, target African youths in their natural contexts, incorporate evidence-based
interventions, and take a comprehensive approach to treatment that addresses relevant social
determinants (e.g., housing or food insecurity) could also be related to bigger therapeutic changes,
decreased treatment attrition, and accumulated engagement.
Education and training of medics ought to concentrate on each cultural shifts and
cultural diversity information acquisition, given the importance of the first care medics in
distinguishing and managing mental health issues and in helping the families to have interaction
35
on mental health care. Some specific areas for education and technical help include increasing the
capability of suppliers and employees to deal with sensible, logistical, and psychological barriers
to patient engagement in mental health care like racism, housing, lack of cash, and neighborhood
conditions.
5.7. Environmental
Environmental factors which affect someone’s mental health are well tied up with or in
other factors. For instance, depression or drug abuse may lead to unemployment, which then
necessitates poverty, lack of good nutrition, and all other factors related to environmental
problems. Additionally, mental illness conditions such as hoarding can mutate into environmental
problems. Oftentimes, environmental and other related factors end up complementing one another
in a vicious cycle. The positive side of it is that the young Black Americans, their parents, and the
community in which they live, need to get or help the youth find solutions to one aspect, which in
turn often helps solve the other related or confounding factors along. Finding a counselor who can
help the Black African American youth to tackle the mental health problems which arise due to the
environment and can enable them to make the positive changes required both to bolster their mental
health and to get out of a toxic environment.
5.8. Police Brutality
A direct pathway between police brutality and health is injury and death. For some
victims of police brutality, death is not immediately but the results of repeated physical injury and
mental torture while in police custody, are very dire and severe. Police killings increase Blackspecific mortality rates as well as their mental instabilities. Even though just about 2% of injuries
from police brutality that need treatment in the emergency wings of clinics or hospitals lead to
death, statistically, Blacks are almost five to six times more likely than are Whites to have police
brutality-related casualties. These cases of police brutality normally leave emotional and
physiological effects on young people, their families, and the communities around them, which go
36
a long way in necessitating mental illnesses among many young Black African Americans (Alang,
S., and et al. 2017). The federal government together must come up with policies to end police
brutality which is largely associated with racial prejudice against black people, especially white
police officers who are the worst perpetrators of this vice. Police forces need capacity building and
sensitization or refresher training that is culturally or racially sensitive to educate them on how
they should embrace racial minorities (Yohannan, John, Millie, & Batsche-McKenzie, 2017). To
minimize this vice further, the government should recruit more African American youths into
police forces, to neutralize the number of majority whites.
For example, hazardous working conditions may not refer not just too physical danger where
workplaces are concerned. It includes any working condition which can put significant strain on
the body and/or mind. When people work in an environment that is stressful, their mental health is
mostly likely to suffer. The federal and state governments of the United States must put in places
measures that eliminate discriminations ad other prejudice vices against the Black African
Americans at workplaces that lead to them suffering mental disorders (Alang, S., and et al. 2017).
There must be tuff policy and legal provisions to curb abuses both physical, sexual, or emotional
which normally encompass all forms of domestic violence, and bullying within the community,
especially in areas where these vices are normal occurrences and experiences that Black youth go
through without any form of help. Further, the policymakers and security agencies must ensure
the security of these Black youths, because the feeling of being unsafe in their environment is likely
to cause them mental instability which can lead to mental illnesses.
What does mental illness differentiate in races?
Although racial and ethnic minorities are not similar in many ways, there are common
discriminations experienced by African-Americans, Hispanics, Asians, and American
Indian/Alaska races. Disparities in care lead to excess morbidity and disease burden for
racial/ethnic minorities’ children, young adults, and the elderly. This must be addressed through
37
one; tailoring the health services to reduce the barriers faced by the minority groups. This can be
done by expanding health services beyond clinics and hospitals, with a focus on engaging
racial/ethnic minority groups to discuss with them the programs which could be customized to help
reduce the gap in behavioral healthcare provision. For example the use of mobile clinics that focus
on those people difficult to reach like, the homeless and those without insurance coverage
(Margarita et al, 2016). Widespread use of movable clinics for behavioral health screening and
interventions would enhance confidentially, and language-specific treatment that can help
eliminate the stigma linked with the conventional hospitals. Other options to boost access include
the use of smartphone technology that can help patients who are not adept in English to conduct
confidential self-assessment of disease signs and before they refer them to linguistically compatible
medics. The use of linguistically and culturally appropriate technology that uses culturally
normative concepts, imagery, and recommendations could increase awareness of symptoms and
available providers for diverse racial/ethnic groups.
Language difficulties impede the use of behavioral health services. To provide direct
language-matched treatment even when geographic distance might hinder face-to-face sessions,
telephone- and video-based treatments including assessments, care management, referral services,
medication consultation and management, and therapy could be used instead. Access to healthcare
may also be facilitated by integrating behavioral health services into programs that provide
housing, employment, or other social services, such as Housing First and Recovery College poor
patients are more likely to stick to behavioral interventions when they are combined with
community resources that aid them with basic social services (Margarita et al, 2016). Widespread
interactions and culturally relevant awareness developed with input from minority races are
required to improve access to behavioral health care. Such methods can solve issues of stigma and
lack of trust. Lastly, Ensuring appropriate training medical practitioners from disadvantaged racial
38
groups, to help eliminate deliberate discrimination based on racial prejudice. This kind of training
will also help eliminate cultural barriers which hinder Medicare minority diverse cultures.
Services which should be offered for blacks suffering mental illnesses
The root cause of mental health stigma among Black people can be traced back to
slavery. At that time it was widely believed that slaves were not fragile enough to develop
depression, anxiety, or other mental disorders (Collins, Wong, & Cerully,, 2016). From then to
date, this misconception has been ignored and being called different names like stress, or just
fatigue. This for many years led to underestimating the effects of mental illnesses while at the same
time strengthening the beliefs that mental disorders are an individual weakness. To reverse this
misconception, there must be a deliberate effort to change attitudes about mental health, so that
African-Americans affected can see it as something treatable and not nothing they need to be
ashamed of (Borja, Logan-Greene, Tennyson, & Nurius, 2017). One way to make this happen is
through using volunteers in public campaigns where they bravely discuss and tell their stories, on
how they were treated and overcame mental illnesses to Black Americans.
Secondly, members of the Black communities should be encouraged to seek
specialist therapists or counseling sessions to eradicate the stigma about their mental illnesses.
They must be encouraged, educated, and sensitized to open up about their sufferings so that they
may receive help from experts (DeFreitas, Crone, DeLeon , & Anna , 2021). Concerted efforts
both by the federal government, state governments, and non-governmental organizations can help
coordinate proper community events, where motivational speakers are invited, to help deliver
expertise talks in mental health, offer peer and family supports, and provide general information
on mental health as well as treatment and mitigation measures available for mentally ill youth.
There should also be a clear leadership and oversight to youth development programs
that involve the youth in communities, in schools, organizations, in their peer groups, and at their
family levels to prevent them from undergoing frustrations which in turn lead them to suffer mental
39
illnesses (E.Hamilton, et al., 2018). The government must invest in strengthening families,
communities, and their economies through applied science and research-based solutions to help
them improve on their well-being as well as helping them get quality lives. At the school level,
students need sensitization to enable them to raise mental health awareness among themselves and
their peers in schools, colleges, and universities.
5.9. Recommendation
The findings indicate that there is existence of racial inequalities in the provision of
diagnosis and treatment of mental health issues among the African-Americans. It is further
revealed that inequalities are caused by various factors such as poverty, violence, drug abuse, and
other societal issues. It is important to have a proper and efficient system to help in solving the
problem in the society to help in reducing the number of African-Americans having mental health
related problems. It is recommended to have enough trained healthcare workers and other
professionals in the mental health field to increase access to diagnosis and treatment of AfricanAmericans. This can be done with family setup to improve performance, but community
engagement on educational issues can help in increasing the number of African-Americans
pursuing courses in healthcare and especially courses related to mental health such as psychology.
As noted when reviewing articles, there is government failures, which have allowed the
increase of cases of mental health problems among the African-Americans community. The
violence and discrimination in healthcare facilities need to be addressed. The issues violence
against the Black community should be solved through legislation to ensure that policy and other
people cannot misuse their guns and arrest the community in suspicion the way it has been for
years. A properly mechanism to stop violence against the Black community need to be put in place
as a strategic plan in reducing mental health problem among the community. The government from
local, state and federal must play a critical role to help in addressing the problem amicably.
Legislations are also needed to ensure that there is not racial differential in diagnosis and treatment
40
of mental healthcare cases. Though healthcare system has strict policies on treatment of patient,
there is a set a gap when it comes to mental health diagnosis and treatment and it is why most
African-Americans do not seek for healthcare services from healthcare facilities.
5.10. Conclusion
The studies showed that it is significant for the issue of mental health problem among
African-Americans to be looked properly. Because these issues the main cause of mental health
problems and increases racial inequalities in the mental health care system. Despite the
improvement and policies in the healthcare system, the studies revealed an increase of racial biases
when it comes to diagnosis and treatment of mental health issues. It is also revealed that there is
racial disparities service provision in America and therefore, it results to mental health problem
among the African-Americans. The review of articles related to racial disparities in the provision
of healthcare services to mental disorder patients especially to Blacks in the society indicate a
growing treat because of violence and lack of access to basic needs. The study therefore help in
understanding the causes of mental illness among Blacks in America, differentiation in mental
diagnosis and treatment of mental illness among races in America. Although many of the studies
provided vivid causes and differentiation in diagnosis and treatment of mental health issues among
races in America, it came out clear that Blacks in America are disadvantaged when it comes to
getting services related to diagnosis, treatment, and other healthcare services. A quick and efficient
actions are needed to solve the problem and as revealed through the review of several articles
through legislations and building capacity of African-Americans to become economically stable
hence ending poverty could be one of the best way to solve the problem of mental health among
the African-Americans in the United States.
41
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46
7.0. Appendices
Appendix 1: Prisma
47
Appendix 2: Assessment and Score for systematic review
Assessment and Score for Systematic review
Element of Assessment
1 Study Design
2 outcome Measure
3 Clarity of outcome
4 Information on dropout rate
5 Research Question
6 Participant Sample
7 Participant exclusion criteria
8 Type of data collection performance
Sample Justification and power
9 analyses
Total
Scoring Criteria
0-Non randomized, systematic review observational and
cohorts
1 – Randomized experiment or quazi experiment
0- Measure of outcome in self report
1- measure of outcome has been mentioned and validated
0 – no definition of the study
1 – clearly defined the study outcome
0 – not stated or discusses
1- clearly defined the outcome of the study
0 – not discussed or stated
1 – reasons for withdrawal clearly stated for each group
0 – not clear
1 – clearly stated
0 – not clear
1 – specified
0 – not stated
1- clearly stated
0 unclear or not provided
1- sufficient justification of the description of the study
Article Article Article Article
1
2
3
4
0
1
1
1
1
1
1
1
1
1
1
0
1
1
0
1
0
1
0
1
1
0
1
1
1
1
1
1
1
1
0
1
8
1
7
1
7
1
7
1
48
Name:
Description:
…