How Can We Improve Mental Health Treatment for Black Youth?
To help Black youth overcome mental health challenges, therapists need to
better understand their unique challenges and cultural strengths.
Black youth are more likely to experience stressors that put them
at greater risk for mental health challenges. However, their needs are not
being adequately addressed by current mental health treatments. Research shows
that dropout rates for Black youth in treatment are high, and many
standardized treatments are less effective for Black youth than for other
groups.
By
Jill Suttie
This concerns Joya Hampton-Anderson, assistant professor in the Department of Psychiatry and Behavioral Sciences at Emory School of Medicine. Hampton-Anderson has devoted her career to understanding what can be done to improve mental health services for Black families, and she understands that COVID has made her work even more urgent. By combing through treatment literature and exploring the unique challenges that Black families and youth face, though, she hopes to create culturally responsive treatment protocols that will serve Black communities and better meet their mental health needs.
I spoke to her recently about her work and what she’s learning about Black youth mental health. Here is an edited version of our conversation.
Jill Suttie: You’ve written several papers outlining the research on mental health among Black youth and what effective treatment looks like. What are some of the overarching themes you’ve discovered?
Joya Hampton-Anderson: The term “culturally responsive care” comes up a lot. As clinical psychologists, we are discovering what that means and what it looks like in the therapy room—and how we work that into treatment for youth. Part of what constitutes culturally responsive treatment is incorporating culture-specific protective factors, like race socialization, for example. That means, for Black youth, how do they make sense of their race as it pertains to the broader society? As you can imagine, that’s been a huge part of the conversation over the last couple of years, as we’ve navigated those questions as a country.
Another key is positive racial identity building—pride around one’s race and how that pertains to the way someone sees themselves. In the developmental psychology literature, those two things—race socialization and positive racial identity—have been associated with psychological well-being in Black youth. Yet it’s not incorporated in any of the standard treatments that we use for anxiety, depression, etc. Part of my project is figuring out how we can incorporate those two factors into treatment.
JS: One of your papers focused on eating issues among Black youth—in particular, overeating and obesity. What are some of the unique psychosocial issues Black youth face that might contribute to these?
JHA: That paper, written during my graduate school career, was meant to bring an understanding of what psychosocial and cultural factors maintain disparities in childhood obesity rates in Black youth but aren’t often factored into treatment for childhood obesity—things like the role of food as a symbol of togetherness, health, and wealth and food as a positive celebratory symbol.
These factors are common across many cultures. But, for youth and families seeking treatment for obesity, they may make it difficult to adhere to a standard treatment regimen. Knowledge of those cultural factors could help providers tailor treatment and make it more amenable to youth and parents. There also may be differences in perception of acceptable child weight. If that is the case, providers may have trouble engaging that parent and family in treatment.
Another really important issue is mistrust of the formal medical system—again, something true for many groups. When providers come in and want to change the family context as it pertains to food, mistrust creates hesitancy to make some of the behavioral changes. That mistrust is rooted in key systemic issues; so, awareness of them by the provider could go a long way toward increasing patients’ collaboration around treatment.
JS: How do you think providers could be more collaborative with patients?
JHA: That paper was geared toward providers that work within a fast-paced health care model. What I talk about is checking in a lot with patients—asking, “How does that recommendation sound to you?” and then addressing the barrier they might bring up. Another question that’s helpful is, “What might get in the way of your trying that before our next session?” That could bring up issues like, “I hate this kind of food” or “My friends and family are gonna make fun of me for changing my diet,” that can then be explored together.
JS: One interesting finding is that disparities in weight concerns cross socioeconomic boundaries in the Black community, so wealthier Black families also suffer disproportionately. What drives that?
JHA: That finding actually cuts across many health disparities, which is striking. As it pertains to obesity, I think there are two things at play. One is the cultural piece mentioned above, and the second is stress. Racial minority stress, in particular, is related to a host of health concerns. Not only can stress directly impact weight regulation; regarding eating behavior, stress related to racial discrimination (as is the case for other types of stressors) may increase “stress eating.” We know that stress plays on reward systems in the brain to make you crave highly palatable foods, so it’s plausible that a stress overeating profile can develop.
JS: You also wrote about adverse childhood events (ACEs)—things like growing up with experiences of abuse, neglect, or household dysfunction that can lead to psychological problems later on. Are these more or less prevalent in Black families?
JHA: ACEs are a major public health concern, and the literature suggests that up to two-thirds of adults experience at least one ACE. The literature is mixed—however, the general theme is that youth of color experience more ACEs than White youth. A key direction in which the literature is moving is recognizing that we’re not considering all of the adverse childhood experiences that Black youth experience. In particular, there have been papers published in the last year or so looking at the role of discriminatory adverse childhood experiences, and when that’s considered, you most certainly expect to see more adverse childhood experiences in Black youth and youth of color more broadly.
JS: How can this be addressed more effectively?
JHA: We know that increased stress leads to a host of psychological symptoms and disorders, as well as cognitive and affective deficits, like problems with regulating emotions, sustaining attention, and memory. We also have social correlates of ACE exposure—in particular, childhood abuse is associated with lower levels of social support. And social support is very protective against stress; so, that’s a key consideration.
“The Black community is known for coping collectively—their family, friends, and social support systems really banding together during difficult times to help support one another. ”
There are also important cultural processes that impact the influence of ACE exposure. In fact, culture-specific coping strategies can be helpful in addressing ACEs. Drawing on individual strengths in treatment and incorporating the cultural responsivity that we talked about earlier can actually build up what individuals are already doing and make treatment more effective.
JS: What are some of the strengths of Black families and communities that therapists need to take into account?
JHA: The Black community is known for coping collectively—their family, friends, and social support systems really banding together during difficult times to help support one another. Black Americans in the United States have had to overcome quite a lot. So, the coping strategies they use are helpful, and we can build on that as psychologists.
Spirituality is also a huge hallmark of Black culture and is cited continually in the research literature as a strength that can be protective against mental health concerns. That’s something psychologists should be aware of that might come up in the therapy room with Black youth and families.
There’s a lot of resilience displayed among Black people, of pushing through really difficult times no matter what to get things done. That’s helpful in many respects, but also unhelpful in many respects. In the news, you hear about Simone Biles taking the pretty radical step of stepping back from her role in the Olympic games to protect both her mental and physical health. The research supports that not being the norm for Black women. So, these high-profile examples signal a potential culture shift.
JS: Are there any programs you think do a good job of being culturally sensitive when helping Black youth?
JHA: The EMBrace program that’s run by Dr. Riana Anderson at the University of Michigan. Her program focuses on using positive racial socialization and positive racial identity building to increase psychological well-being among community samples of Black youth. So, I hope to incorporate those key cultural factors in my work with youth who are seeking outpatient mental health care.
As psychologists, we have our standard cognitive behavioral treatments to treat youth with mood concerns, anxiety, and stress-related disorders. I am hoping to pair our standard treatments with culture-specific interventions to see how they work together for outpatient use. Hopefully the combination helps with retention in care.
JS: What research will you be focusing on next?
JHA: I am focused on speaking to Black youth and relevant community stakeholders about how they feel about mental health in the Black community and what makes the most sense to them as far as treatment for anxiety and stress-related disorders in Black youth. After that qualitative piece is completed, we aim to take that feedback and incorporate it into intervention development offered through our clinic.