Emmanuel Peprah openly acknowledges it: When it comes to his mental health, “I don’t always have sunny days.”
Even in normal times, being Black like Peprah can be challenging, having to cope with major insults and microaggressions based on his race. That burden has become heavier lately, due to a trio of crises disproportionately affecting the Black community: the coronavirus pandemic, the worst economic downturn since the Great Depression, and the George Floyd killing in Minneapolis, which sparked weeks of protests for racial justice.
So when his skies turn dark – and after months of social distancing, the gray clouds creep in more often than before – Peprah understands that talking about his feelings can help him avoid damage from an emotional thunderstorm.
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“It took me a long time to deal with my emotions,” says Peprah, a global health professor at New York University whose work involves analyzing behavior patterns and psychology to study intervention strategies in underserved populations. “It’s a hard struggle. Being vulnerable is very, very important and being honest in terms of the pain that you’re going through. As a man, I’m supposed to be the person that has all the answers that can fix the problem. But sometimes I have to admit – many times – I don’t.”
Peprah’s awareness of and ability to care for his mental health sets him apart from many of his peers in the Black community, even amid concerns that Black Americans may be in the midst of a mental health crisis, with a combination of factors – some cultural, others systemic – creating barriers to care.
In Cook County, Illinois, home to Chicago, officials say suicides in the Black community this year have been happening at an extreme pace, with men accounting for nearly 80% of victims. Meanwhile, snapshot government data collected last month indicates 4 in 10 Black Americans were struggling with anxiety or depression, while a Centers for Disease Control and Prevention report released Thursday showed that 15% of Black survey respondents in late June had seriously considered suicide in the past 30 days, compared with about 8% of whites.
Age-old disparities in mental health treatment, coupled with implicit bias among providers and die-hard myths among African Americans, had experts worried long before the shockwaves sent by the pandemic, job loss and images of Floyd begging for his life on a Minneapolis street. But the ongoing need for social distancing to prevent spreading the coronavirus – along with restrictions on important community spaces like barber shops, beauty parlors and churches – are making the crisis even worse.
“There’s a public health term, ‘syndemic,’ that means the convergence of, essentially, multiple big-time stressors,” says Nadine Kaslow, a professor of psychiatry in the Emory University School of Medicine. The term, she says, describes what the Black community is undergoing: a triple-whammy of disproportionate deaths from COVID-19, a Black unemployment rate of 14.6% in July and renewed but long-simmering anger and anxiety over police brutality after Floyd’s death.
“I think that the mental health crisis is increasing for everybody,” she says. “But I think that it’s really reverberating for people who are Black.”
It’s clear that long before the discontent and anxiety of 2020, mental health among African Americans was a significant but often overlooked public health issue. According to a 2018 survey by the federal Substance Abuse and Mental Health Services Administration, or SAMHSA, 16% of African American adults reported having a mental illness in the past year, and 22.4% of that group reported a serious mental illness. Of the nearly 5 million African Americans with a mental illness, close to 70% hadn’t received treatment, according to SAMHSA.
Peprah, the NYU professor, agrees that “the mental health issue in terms of African Americans has always been problematic. We experience just as much or greater mental health problems, but we do not seek as much care.”
That’s partly because conversations about mental health are often still taboo in the Black community, particularly among men. The reluctance is supported by an entrenched belief that, as free descendants of formerly enslaved people who survived racist brutality and abuse, feeling sad and asking for help is a sign of weakness.
“In the Black community, there is a negative stigma surrounding mental health,” podcast host Hafeez Baoku wrote in a blog post on the National Alliance on Mental Illness website. “Instead of seeking professional help for conditions such as depression and anxiety, many in the community resort to self-medication” through drugs and alcohol “or isolation in an attempt to solve their problems on their own.”
“Speaking from experience, I know how black men grow up in (a) culture that tells us ‘men are not supposed to cry,’ that we ‘should deal with problems on our own,’ Baoku writes. “This only enforces the idea that it’s not okay for us to say we are hurting inside.”
Data shows a steep price paid for that belief: Suicide was the third-leading cause of death among Black males ages 1 to 19 in 2017, and the fourth-leading cause of death among Black males ages 20 to 44, according to the CDC. Now, Peprah worries efforts to control the spread of the coronavirus are undercutting the informal networks that sometimes stand in for mental health treatment.
Black people “tend to use friends and family … as more of our coping mechanisms, but that can be problematic during a pandemic,” he says. “When you’re separated from friends and family for long periods of time, that stress does wear on you. On top of that, we have to still remain socially distant for a long period of time. People talk about the barber shop being a place where men can talk. You know, we don’t have that anymore.”
“There is a lot of bias in the system – that bias has been historical and it has led to reluctance (for Black people) to engage in the system,” Peprah says. “Somebody is complaining of a particular symptom and they might be misdiagnosed. They might be prescribed a medication that’s probably not best for them.”
Indeed, a study published in 2016 indicated that callers seeking therapy were far more likely to have an appointment offered if they were white and middle-class instead of Black and middle-class. Another recent study found that African Americans are disproportionately misdiagnosed with schizophrenia, a disorder treated with antipsychotic drugs and potentially hospitalization, while a separate paper published in the journal Psychiatric Services suggests implicit bias in the mental health field has a lot to do with it.
“Consider, for example, a black man who has grown up in a society where men and boys of color are disproportionately targeted by law enforcement,” the paper states. “His vigilance in everyday life might be perceived as a natural consequence of racial profiling by one provider, whereas that same behavior might be interpreted as paranoia related to schizophrenia by another.”
Peprah says the mental health profession urgently needs “cultural competence” in order to “really address some of these issues.” And though barriers to care have existed for decades, Kaslow, the Emory University professor, says they’re imperiling the Black community at a critical time, when racism and inequity – and stubborn resistance to change – have been firmly established on the national agenda.
“It’s not that it’s more, it’s just that it’s so front and center,” Kaslow says. “And I think people can’t compartmentalize it maybe the way they had, or push it to the side. The pain of it is just extreme.”
“There’s just not enough mental health providers,” Kaslow says. “Then, for people who don’t have money, there’s even less mental health providers. And unfortunately, a lot of (low-income African Americans) often don’t have the technology to do virtual sessions, or telehealth.”
Though the news is grim and seemingly relentless, Peprah says this too shall pass, even as the work of raising awareness of and bringing equity to the African American community must continue. In fact, he says, that work will be critical in the coming years, in order to heal what are likely to be deep and lingering psychological wounds from the coronavirus era.
The pandemic “is going to be eventually over,” he says. When that happens, Peprah says, community leaders and mental health providers should team up, advocate for more services and push to reduce the stigma around the issue.
Looking after one’s health “contains a lot of components. One is mental, one is nutritional, one is, of course, physical health,” Peprah says. “We tend to focus on physical health, and sort of (ignore) mental and nutritional health. And I think we need to include all those three elements.
“As they say,” he says, “Body, mind and soul.”