Mental health care among blacks in America: Confronting racism and constructing solutions

OBJECTIVES: To describe reasons for unmet need for mental health care among blacks, identify factors associated with causes of unmet need, examine racism as a context of unmet need, and construct ways to improve service use. DATA SOURCES: Data from the 2011-2015 National Survey on Drug Use and Health were pooled to create an analytic sample of black adults with unmet mental health need (N = 1237). Qualitative data came from focus groups (N = 30) recruited through purposive sampling. STUDY DESIGN: Using sequential mixed methods, reasons for unmet need were regressed on sociodemographic, economic, and health characteristics of respondents. Findings were further explored in focus groups. PRINCIPAL FINDINGS: Higher education was associated with greater odds of reporting stigma and minimization of symptoms as reasons for unmet need. The fear of discrimination based on race and on mental illness was exacerbated among college-educated blacks. Racism causes mistrust in mental health service systems. Participants expressed the importance of anti-racism education and community-driven practice in reducing unmet need. CONCLUSION: Mental health systems should confront racism and engage the historical and contemporary racial contexts within which black people experience mental health problems. Critical self-reflection at the individual level and racial equity analysis at the organizational level are critical.