Breaking Through Mistrust to Better Mental Health in Black Communities
Reflecting upon Science 37’s “Mental Health & Clinical Trials in the Black Community” webinar (presented with George Floyd Memorial Center Foundation and BlackDoctor.org), there seemed a universal challenge to overcome: mistrust.
Within our discussions regarding the long history of medical abuses and continued traumas for the Black community, was the idea of researchers and health professionals intentionally engaging and partnering with traditional sources of information and aid. Such sources for Black Americans are places of worship, schools, and businesses - they help further patient self-advocacy and confidence in our healthcare system.
We need these partnerships to work alongside technology and treatment to correct misinformation for those suffering from both physical and mental health stressors, such as depression, which is a dire health concern in the Black community.
Black Americans represent more than 17% of the estimated 53 million adults diagnosed with mental, behavioral, or emotional disorders in the U.S. – and sadly, with half of Americans ages 13 to 18 reporting symptoms, suicide has become the second leading cause of death for Black adolescents.
Mental illness affects nearly 20% of Black adults and youths – but only 56% affected are receiving treatment, leaving nearly half suffering in silence. There is historical causation, but there’s also a stigma, with 63% of Black Americans believing mental health conditions are personal weaknesses.
This stigma affects how Black community members approach illnesses - they turn to prayer and home remedies. However, patients need advocates and credible recommendations from licensed professionals, who will not form any judgments and provide scientifically-sound treatment. Because of the mistrust, the Black community relies on church and family as allies to help them maneuver through the health system to advocate for their own health and wellbeing.
If operating alongside the pulpit encourages better health, why not utilize that resource to allow healthcare to become more inclusive and accessible to the Black community? Training local Black community leaders in non-licensed individual and group counseling provides active listeners, who can help alleviate the wariness that patients have for healthcare professionals. Hosting mental and physical health clinics at public schools or providing virtual on-demand access will help create safe spaces to alleviate that barrier of mistrust.
Numerous economic and environmental inequities, compounding social injustices, and degenerative social determinants of health limit access for Black Americans. Patients with the resources and determination to proactively address their ailments still find geographic, financial, and logistical barriers that keep BIPOC from participating in clinical trials. And when BIPOC do participate in clinical trials, many report that they have yet to see their data.
Willingness is not the issue: accessibility, awareness, and direct communication of the benefits to the affected populations are. We must partner with the Black community to effectively communicate about initiatives to better advocate for health. Let’s start with proper framing, what is commonly referred to as “The Tuskegee Trial” must be properly classified as the U.S. Public Health Service Study of Syphilis in Tuskegee.
The majority of trials are not conducted by representative researchers. This very fact fails to counteract the centuries of historical medical and research abuse that resulted in valid mistrust of the health care system, less preventive care, and lower rates of early detection for Black Americans.
- One in five Black adults say they’ve personally experienced race-based discrimination in health care in the past year;
- Black mothers are four times more likely to die from pregnancy-related causes or in childbirth than white, non-Hispanic mothers;
- Black men are misdiagnosed with schizophrenia more frequently than any group when presenting with symptoms of post-traumatic stress disorder;
- And, in 2016, it was confirmed that medical trainees and doctors perceive Black patients to be less susceptible to pain, leading Black Americans to only seek emergency room care in life-threatening situations.
This is why Black patients are most comfortable with those who look like them; but currently, only 5.4% of physicians and 4% of psychologists are Black. Certain websites, telehealth, and databases make it easier to connect with Black providers – but minority physicians still have limited time and space.
Black communities can have improved mental and physical health outcomes with increased access to physicians of any race who are willing to have ongoing, valid, trustworthy conversations with patients rather than providing substandard care with misguided instructions.
Primary physicians need to have cultural competence training so that they understand how various issues such as lifelong racism and structural and systemic inequities disproportionately affect the health and social outcomes of Black communities. This kind of training might address the “weathering” of BIPOC patients earlier in life. Physicians would learn that Black patients are more likely to describe physical issues related to mental health trauma than behavioral. This could help guide comprehensive examinations and discussions on how their current environment and experiences are contributing to their health.
We can leverage this new, more trusting patient/physician dynamic to better diversify our patient populations when commercializing breakthrough treatments. To enhance our connection to the Black community, we need to connect to the patients themselves. Medical mistrust has often protected the Black community from injustice and discrimination. We need to help patients understand that this can become a tool that we all can use to inspire and educate, rather than exclude.
Patients should be actively encouraged by providers to ask questions until they feel comfortable and safe, at any point throughout an exam, procedure, or study – questions not only related to financial concerns, treatments, or experience, but also cultural understanding, communication styles, and inclusion of one’s traditions, faith, and values. Patients can ask the following questions:
- How can you actively partner with me through my healthcare journey?
- Do you have the knowledge to know the differences in health outcomes and risks for BIPOC patients like me? Have you received cultural competence training?
- How does your background and belief system influence your communication and treatment plan?
Patients must be treated with respect, especially when seeking and expressing insights along their journey to better health. Educating on culturally-relevant health outcomes, engaging trusted community providers, working to expand accessible physician and mobile nursing networks, and increasing diversity in clinical trials will all create positive change. But first, we must foster a greater desire to understand.
Participating in clinical trials may actively improve health outcomes for diverse communities as a whole. If you are interested in participating, Science 37 is currently enrolling patients in a wide variety of clinical trials.
Global Head, Diversity in Clinical Trials Business Unit & Diversity in Clinical Trials Foundation, Science 37