Authored by Chidera Onyeoziri, 2018-19 AmeriCorps member
November 16 & 17th, the Mental Health Legal Advisors Committee in collaboration with the Charles Hamilton Houston Institute for Race & Justice hosted Race, Racism and Mental Health, held at Harvard Law School. Aiming to engage and encourage discussion among presenters and attendees, the first day was spent laying out the theoretical and practical scope of the intersection between racism and mental health. Attendees broke out into small discussion groups during day 2 to consider individual and organizational efforts to address racial disparities in the treatment of mental illness in minority communities.
The idea for the conference emerged from intense conversation among MHLAC staff about a December 11, 2017 article, “A brand new Boston, even whiter than the old,” published by the Boston Globe as part of its Spotlight series on Boston, Racism, Image, Reality. They were particularly surprised by staggering wealth inequality in Boston, where $247,000 to $8 represents the personal wealth of white Bostonians in comparison to the personal wealth of black Bostonians. Bob Hernandez, one of the conference’s lead organizers, highlighted during the event’s introduction that although the economic figure did not necessarily represent a mental health issue, the vastly disproportionate figure provoked concern about the ways in which racism produces racial disparities in everyday life which in turn engender and exacerbate mental illness in black and brown communities. In fact, keynote Dr. David R. Williams used national data for the United States to illuminate that racial differences in health were not simply a function of racial difference in income and education – African Americans with a college degree or more education have lower life expectancy at age 25 than whites with a college degree or more education, than whites with some college, and than whites who have not finished high school!
More profoundly determinative of black health than income and education is racism. Institutional/structural discrimination rather than individual/interpersonal racism is the driving force behind racial disparities. Dr. Williams effectively illustrated how discriminatory housing policies (redlining, mortgage discrimination, restrictive housing covenants) segregated black and white families and contributed to the overcrowding and physical deterioration of minority neighborhoods. The concentration of poverty and poor housing conditions directly impact mental health; stressors linked to the physical environment include roach and rodent infestation, trash buildup, dampness in the walls, “a lot of dark places…where women could be raped”; stressors linked to the social environment include a pervasiveness of violence and criminal activity, seeing drug activity, high level of break-ins and theft, constant worry about safety of children.
But racism is so pervasive; it reaches far beyond just our neighborhoods. Black Americans face discrimination when hailing a taxi, purchasing a car, suspensions from preschool, getting a job, obtaining a bank loan, purchasing insurance. Yet still, experiences of everyday discrimination are the number one source of toxic stress: being treated with less courtesy, less respect, and regarded with fear and as unintelligent, and dishonest – these are associated with coronary artery calcification, increases in cortisol a stress hormone, high blood pressure, cognitive impairment, poor sleep, and among other health problems: mortality. By age 20, there is systematic biological dysregulation in young African Americans linked to exposure to discrimination as teens.
I devote a tremendous amount of time recounting Dr. Williams’ address because for me it so perfectly encapsulated the central organizing principle of the conference—that racism exerts devastating impact upon mental health—and therefore deserves closer attention. While this principle may seem obvious, Williams explains rather clearly the mechanisms by which racism is linked to declines in black mental and physical health. The following panel discussions on “Irrational White Fear” and “The Impact of Everyday Racism” served to put human faces and experiences to the system of racism unique to the United States. At the risk of minimizing the panelists’ presentation to mere titles, I recall Abrigal Forrester’s problematization of the racism embedded in the “intellectualization of racism” through a repetitive processes that continue to exploit a people by requesting they enumerate and expose themselves to their own trauma in the name of academic studies and conferences.
The panel on “Racial and Ethnic Disparities in Mental Health Treatment” focused on discrimination in the healthcare setting. Dr. Benjamin Le Cook shared studies indicating black Americans tend to avoid seeking medical care for fear of discrimination. In fact, little more than one-third of black Americans believe they are being treated unfairly by their medical provider. These findings are unsurprising given the lack of bias awareness training in medical community, Le Cook shared more troubling research showing that Black individuals are disproportionally more likely than white and Latinos to be involuntarily committed to psychiatric treatment and forced into psychiatric medication. Black patients spend 30 minutes of 45 minutes trying make their provider understand their context, try to make them feel more comfortable. Interactions between black patient and service provider is fraught with tension; at the risk of involuntary commitment, the black patient seeks rather to or has no choice but to make the provider feel comfortable than to work substantively to deal with mental health concerns.
While at times, many struggled with what they heard, what they were experiencing, what others have experienced and how to effect systemic change, we worked together; we became a community-especially during the half-day break out sessions. Together we learned that understanding racism’s devastating impact upon mental health is cannot wait. We must act now.