Mental Health and Communities of Color

George Dicks, Chair, Mayor's Council on African American Elders

What is Mental Health?

What is considered normal or mentally healthy varies greatly over the lifespan by social and cultural identity, and by the times in which we live. Even a person with dementia can experience a healthy and happy outlook, compared to common perceptions of fear, anxiety and paranoia. Older adults benefit from preventive mental health interventions and, when necessary, aggressive psychiatric treatment.

According to the World Health Organization, health is defined as "a state of complete physical, mental and social well-being, and not merely the absence of disease." It is related to the promotion of well-being, the prevention of mental disorders, and the treatment and rehabilitation of people affected by mental disorders.

Mental health is reflected in how a person thinks, feels, and acts when faced with life's situations. It is how people look at themselves, their lives, and the other people in their lives, evaluate their challenges and problems, and explore choices. This includes handling stress, relating to other people, and making decisions.

Risk Factors

Of the 35 million Americans age 65 or older, 10-20% suffer from depression. Another 5 million suffer from less severe forms of the illness. The fastest growing segments of older adults are also the most likely to experience stressors related to mental health problems. The very old, women, people of color, and people living alone have the highest rates of poverty, the poorest perceptions of health status, and the highest levels of activity limitations.

Risk factors increase the vulnerability of an individual, a group, or a community to untreated mental health problems. Racism and discrimination are stressful events that can adversely affect health and mental health. They place people of color at risk for mental disorders such as depression and anxiety. Additional risk factors might include: biology and heredity, a history of violence and/or trauma, poverty, depression, and/or suicide attempts. Immigrants and refugees whose language and cultural values differ from the mainstream culture are also at risk, because they often do not get services they need. Immigrant and refugee elders face barriers to service due to language, culture, lack of information, financial resources, and transportation difficulties. Although no one risk factor is disorder-specific, multiple risk factors are often related to more negative effects such as mental disorders.

Mental Health Disparities

The United States population is composed of many diverse groups. Evidence indicates a persistent disparity in the health status within communities of color, as compared with the overall health status of the U.S. population. In addition, these communities are often overrepresented in our nation’s most vulnerable populations, the poor, the uninsured, and the homeless. The Surgeon General’s Report on Mental Health documents the existence of several disparities affecting mental health care of racial and ethnic communities compared to whites:

• Communities of color have less access to, and availability of, mental health services.
• Communities of color are less likely to receive needed mental health services.
• People of color who may be in treatment often receive a poorer quality of mental health care.
• People of color are underrepresented in mental health research.
• Communities of color collectively experience a greater disability burden from mental illness than do whites.

Because mental health is negatively affected by chronic social conditions such as poverty, violence, racism, and discrimination, the reduction of these harmful conditions is crucial to improving the mental health of communities of color. The recognition of these disparities brings hope that they can be seriously addressed and remedied.

Older persons of color are survivors who have overcome many challenges. They pride themselves on functioning to fulfill their roles as family members, community elders, and on commitments to lifelong friendships.

Mental health promotion and mental illness prevention can improve the health of a community and the nation. Efforts in this field should build on community strengths such as spirituality, positive ethnic identity, traditional values, educational achievement, and local leadership. Programs founded on individual, family, and community assets have the potential to both improve risk and foster resilience. (For an example of this type of program, see the article about the PEARLS Project in this month's Seniors Digest.)

For More Information

These organizations offer a wealth of online resources about mental health:

SAMHSA, Center for Mental Health Services

National Institute for Mental Health (NIMH), NIH 

American Psychological Association 

American Psychiatric Association

National Alliance for Mental Illness 

National Mental Health Association

References:

1. U.S. Department of Health and Human Services, Office of Minority Health, Mental Health 101 (www.omhrc.gov).
2. U.S. Surgeon General Report on Mental Health 1999, National Mental Health Information (www.samhsa.gov).
3. Mental Health: Culture, Race, Ethnicity Supplement to Mental Health: Report of the Surgeon General, 1999.
4. National Institute on Aging (http://nihseniorhealth.gov/depression/toc.html).
5. Sullivan, M. et al. "Stepping out on faith: Geriatric mental health in 2015," Project 2015: The Future of Aging in New York, http://aging.state.ny.us/explore/project2015/artEld.pdf, pg. 111.
6. The World Health Organization (www.who.int/en)

George Dicks currently supervises the Geriatric Psychiatry Service clinic at Harborview Mental Health Services. The clinic provides psychiatric services to the greater Seattle community, including the African American community. George is also a contracted instructor for the University of Washington, School of Continuing Education Program, and at the Edmonds Community College in the Social & Health Sciences Department. He teaches courses on Gerontology, Psychiatric Consultation, and Mental Health. George has been actively involved in the African American community for over twenty years through a variety of groups and organizations. George is Chair of the Mayor's Council on African American Elders (MCAAE). The MCAAE is a mayoral appointed City of Seattle Commission. George's motivation for being on the Council is to inform the community about mental health for successful aging.