OP-ED: Treatment by us, for us: the critical need for Black psychiatrists – New York Amsterdam News

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There is no way around it: If you want to address the Black mental health crisis in America, we need more Black psychiatrists. America has been dealing with the devastating effects of declining mental health for decades, and Black Americans are affected disproportionately. Black adults are more likely than white adults to report chronic symptoms of emotional distress, such as persistent depression and generalized anxiety disorders. The suicide rates of Black Americans are continuing to rise to troubling numbers: In 2022, suicide was the third leading cause of death among Black people from ages of 10 to 24.
The news mainstream media just doesn’t cover. Racial justice journalism since 1909.

The U.S. has spent millions of dollars on improving mental health in underserved communities by improving access to treatment. Why are mental health issues among minorities continuing to rise? While racism, systemic oppression, and stigma are all valid answers to this question, the lack of Black psychiatrists and other mental health professionals is an even louder answer. Only 2% of psychiatrists are Black, according to the American Psychiatric Association. This unsettling lack of diversity is felt most by Black patients.
Stigma has long been the default answer for why Black Americans suffer from mental health issues in silence. For instance, only 25% of Black Americans seek mental health treatment, compared to the 40% of white Americans. While it is true that cynicism exists in the Black community in regard to seeking mental health treatment, this can be directly tied to the impact of racism in the healthcare system. The Black population also has a general distrust of the healthcare system — for justifiable reasons, from the inhumane Tuskegee experiments to the high infant mortality rates among Black women. The terrifying comments by the country’s current leading healthcare official, Robert F. Kennedy, Jr., only further highlights the racist medical beliefs of many.
From an historical lens, Black Americans have faced a long history of mental health challenges. From the history of slavery, intergenerational trauma and high-profile cases of police brutality, more attention has been placed on how this affects mental health. Recent research has shown that viewing acts of police brutality on social media, and experiencing physical and verbal racist attacks, may be attributed to the high rates of Post-Traumatic Stress Disorder in the Black community. Another study found African American older adults were more likely to experience internalization of stigma and a devalued self-identity, and were more likely to endorse negative attitudes toward mental illness and treatment compared to their white counterparts.
What’s even more heartbreaking than the foregoing statistics is the countless number of Black individuals who have sought mental health treatment but have been met with misdiagnosis, dismissal, and inadequate treatment. The Black community being misdiagnosed in mental health treatment is a common occurrence. Too often, non-Black psychiatrists misread emotional cues as anger, symptoms of trauma as “disruptive behavior,” and over-pathologizing behaviors of Blacks as more dangerous or disobedient. For instance, Black children are more than twice as likely to receive a diagnosis of a disruptive disorder, such as Conduct Disorder versus Attention-Deficit/Hyperactivity Disorder (ADHD), even when meeting the criteria of ADHD.
This is concerning because disruptive disorders is a stigmatized diagnosis that is characterized by aggression and a callous disregard for others. Decades of research also show that Black people are frequently given psychiatric diagnoses more severe, less treatable, or incorrect. Schizophrenia has been misdiagnosed and overdiagnosed in Black men. Black psychiatric patients are 85% more likely to be restrained and for longer periods of time than white individuals.
Psychiatrists play an essential role in the diagnosis, treatment, and possible reduction of mental health symptoms by combining medical expertise with psychological insights. The lack of representation of the Black experience can lead to a misunderstanding of how Black patients display mental health symptoms.
Many agencies and institutions now require mental health professionals to take cultural competency training. However, this is only surface-level change that cannot properly convey the oppression and hurdles the Black community faces. The mental health profession — psychiatry in particular — suffers from a lack of diversity. This means that it is highly unlikely that Black individuals will have a psychiatrist who understands their intersectionality and unique experience. The foundation of a strong therapeutic relationship between a psychiatrist and client is built on trust and being understood. A lack of representation and cultural understanding leads to ineffective care for Black individuals.
To mitigate this issue and see change requires a multifaceted approach. One critical step is developing and increasing fellowships and student pipeline programs for Black students. For instance, medical schools should partner with Historically Black Colleges and Universities (HBCUs) to create pathways for students seeking a career in psychiatry. Black students face significant barriers to medical school, including a high financial burden, limited resources, and systemic racism, particularly in standardized testing. By partnering with HBCUs, medical schools can aid in reducing these barriers by providing waivers, application support, and mentorship. The voices of Black students who aspire to seek careers in psychiatry must be cultivated and celebrated.
Current and emerging Black psychiatrists also should be prioritized in leadership roles. In medical school, Black psychiatrists should hold faculty positions to aid in fostering strong relationships amongst Black students and lead research studies to further improve treatment outcomes. In treatment, Black psychiatrists, by nature of their lived experiences, can ensure that treatment plans are culturally sensitive and relevant. Many treatment plans and outcome goals rely on Eurocentric approaches that can lead to inadequate treatment among Black patients. In psychiatric inpatient settings, Black psychiatrists should also be overseeing the department to ensure that Black patients are being treated fairly, especially in disadvantaged communities.
Despite years of healthcare professionals ringing the alarm on the growing mental health crisis in our country, numbers are continuing to rise. As with most societal challenges, Blacks are immensely affected but often receive the least care. Frankly, if we want to reduce the mental health crisis in America, the fight for Black mental health equity must be at the forefront of the social justice movement.
Dr. Eboni Wooley, DSW, LCSW is a psychotherapist in New York City and an adjunct professor at New York University. whose work centers around developing and improving mental health treatment in socially disadvantaged communities.
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