Black children in the United States are more likely than White children to experience serious trauma.
As adults, they are more likely to have general feelings of sadness and hopelessness, but less likely to receive treatment, counseling or medication for mental health issues.
In Multnomah County, African American residents are far less likely to receive mental health services from someone who looks like them, even though research shows the quality of a clinician's diagnosis is influenced by their race.
And yet Black Americans experience some of the lowest rates of serious mental illness or attempts at suicide.
“We forget as Black people that we are resilient,” Ebony Clarke, interim director of Multnomah County’s Mental Health and Addiction Services Division, said to a crowded hall at Cascadia Behavioral Healthcare’s Garlington Center. “There is something we have, something we hold, that’s working, and I want to tap into that.”
Leaders at Multnomah County’s Mental Health and Addiction Services Division joined residents, consumers, nonprofit partners and providers Thursday at the Garlington Center in Northeast Portland for a town hall to talk about culturally specific services for African American residents.
African American enrollment in behavioral health services in Multnomah County has nearly doubled in three years, from 7.5 percent in 2015, to 14 percent in 2018. But that’s still four points lower than for White residents.
“More people are using our services, but we’re not satisfied with completion rates,” said Clarke. “How do we create a system of care that meets the needs of who we are, that integrates our values and our traditions?”
Murmurs of agreement answered her, as Clarke listed the ways systemic racism has exacerbated mental health issues for Black residents and how prejudice has weakened the services Black clients receive.
“We recognize — as a government entity and a mental health system — how those impact the quality of services we’re able to provide,” she said. “We see racism and trauma and oppression play out, and we recognize the challenges and barriers it puts up for people accessing our services.
“I’m here to keep it real,” she said as the room broke into applause.
Speakers included providers and clients who laid out challenges to requesting care.
Patricia Ford, who works for NAMI Multnomah, said she was told to go to school and start a family. But trauma, and then addiction, got in her way. No one talked about either the trauma or the addiction. But after landing in prison, Ford landed in a Black-run treatment center.
“That afforded me an opportunity where people looked like me. I didn’t have to talk proper. They were straight out honest with me,” she said.
Therapist LaShawnda Jones said African American communities need to start talking about mental health.
“We have many taboos, beliefs, stereotypes, stigmas when it comes to mental illness,” she said, to growing shouts of agreement from the audience. “People want to keep mental illness quiet,” she said. “It’s a conversation to avoid.”
During the four-hour event, participants divided into groups to discuss mental health and addiction programs. In a session on culturally specific services, African American providers and clients spoke of taboos and the frustration of having too few Black providers.
“Even saying, ‘I need help,’ my mom would say, ‘There’s nothing wrong with you,’” said Maya Noble, a wraparound services coordinator for the County. “So later I’d go through bouts of depression and I would tell myself, ‘There’s nothing wrong with you. I just need to deal with it.’”
Therapist Melvin Hawkins agreed. He said it seems there’s less stigma in being addicted to drugs than experiencing mental illness.
“It’s easier to be labeled a crack addict than to be labeled as crazy,” he said.
And if it’s more difficult in the Black community to confront mental illness, it’s doubly difficult to seek help from a system of White providers.
“We try to get help, and you get someone who doesn’t understand you at all,” said provider Rochelle Hart.
“And then you have to spend all your time explaining what it means to be a Black woman,” another participant added.
“My request for medication is seen as pill-seeking,” a young woman said. “Also, I sound White on the phone. And then providers see me, and say ‘Oh, you’re so articulate, so well-spoken.’”
“There’s a piece about our behavior, a pathology, our behavior is seen as abnormal,” said Tasha Wheatt-Delancy, operations director for Multnomah County health centers. “I can’t be angry. I must be all these other things.”
Hart, a counselor, said parents feel an inherent trust when they meet her. Most of her 23 families have told her they wouldn’t have agreed to counseling if she were White.
“If they get a White provider, they’re not going to be honest about needing mental health services,” she said.
Instead, parents initially list needing help only with things like with rent. And it’s not until they meet in person that parents open up about needing more services.
“I get there because they trust me,” she said.
Participants also got the chance to visit, eat a meal together and hear two artists who shared their stories.
Roy Moore, a Portland hip-hop artist in recovery, showed a video of his song “Honesty.” He wrote the song after his brother died from a drug overdose, prompting Moore t o become sober.
Today he’s rounding the corner on two years of sobriety and works with the Portland Opportunities Industrialization Center to reach young men involved in drugs and gangs.
“You can’t talk about gang violence without talking about drugs and mental health,” he said. “They’re using gangs and drugs to deal with that illness. I turned to music, and it saved my life.”
His lyrics laid bare that desperation: “I’m slipping. I’m falling and I can’t get up. It’s a long way to heaven when you’re halfway to hell.”
“Unless we find a way to get them out of that place,” Moore said when the video was over, “we’re stuck.”
Next, Saeeda Wright, a Portland singer and songwriter who has performed with Prince and others, stepped to the front of the room.
“People look at you and have no idea what you’ve been through. What your story is,” she said. Wright described being raped during college and the deep depression that followed. Because she had never learned about depression, she didn’t recognize what was happening when her grades slipped, her hair started falling out or she could no longer get out of bed.
“It is important to have people who can recognize what’s going on, and who can tell you, ‘You’re not lazy. You’re sleeping because something is wrong,’” Wright said. “I needed someone to see me and direct me to services so I could get help.”
She wrote her song “Press On” as an encouragement to herself, and to others who can’t see a way out of depression.
“I got to keep on moving on,” she sang then. “Keep on pressing on. Press on.”
Clarke, who spent months planning the event with a core group, greeted each of the 175 guests, including her husband and her mother.
Afterward, she reflected on the vulnerability she heard in community members’ honesty and on the willingness of her team to absorb the critical review of County services.
“It was full accountability. Not just looking at the system, but looking at us as a community, too,” Clarke said later. “We are a resilient people. We hold a lot of strength.”