Lorraine Cole

INGLEWOOD, Calif. (WOMENSENEWS)–"There’s a fear of putting our business in the street . . . of somehow revealing too much," said Latonya Slack, executive director of the California Black Women’s Health Project, an Inglewood, Calif., community-health organization. "Black women can perceive going to a therapist as something we don’t do," she added.

Lorraine Cole, president of the Black Women’s Health Imperative, the Washington, D.C.-based parent organization of the California BlackWomen’s Health Project, agrees. "There’s a deep-seated feeling that going to seek professional help is a sign of weakness," she said.

In California, African American women have the shortest life expectancy among women of all racial and ethnic groups in the state. They also have the highest mortality rate for heart disease and stroke and the highest prevalence of high blood pressure and obesity. Recent research indicates that mental health plays a role in these health disparities in California–and across the nation. But while many black women know and discuss the threats to their physical health, when it comes to mental health, there’s silence and inaction.

Slack and Cole, both African American women, are leading efforts to address the physical, mental and spiritual health needs of black women. Both have commissioned studies that revealed many black women are struggling with mental health issues but are not seeking professional help. They and others see improving black women’s access to mental health treatment as a crucial element to addressing the serious, but often manageable, illnesses plaguing their physical health.

Women Who Need Care Go Without

Despite the emotional and physical consequences of mental-health problems, black women are less likely to seek treatment. The percentage of African Americans overall who receive needed mental-health care is only half that of whites, according to a 2001 Surgeon General report on mental health. By some estimates, only 7 percent of black women suffering from depression receive any treatment, compared with 20 percent of the general population.

Last year, Slack’s organization, the California Black Women’s Health Project, released the results of a study of more than 1,300 African American women across the state. The subjects in the study revealed that they tended to repress feelings, let frustration build and release tension through tears or conflict. The findings of the study, which included a series of focus group discussions across the state, led Slack to launch a mental health initiative to improve African American women’s acceptance of and access to mental health treatment.

The California Black Women’s Health Project launched several programs to address the disparities in black women’s mental health in the state. In August 2002, the project began hosting town hall meetings that bring together black women, mental health providers and state and local policy makers to discuss black women’s health concerns. They have held four meetings in Southern California and started outreach in the northern part of the state with a town hall meeting in Oakland last weekend.

Through the course of these meetings and their annual policy summit, held in Sacramento in February, the organization has developed the 12 Commandments of Mental Health, a secular self-help tool for African American women. Still in draft form, the list of guidelines includes "Self care is not selfish–take care of you so you can take care of others," and "Recognize something is wrong–you deserve to feel well." "We’re working on getting women to accept mental and emotional well-being as their birthright," said Slack.

New ‘Commandments’ for Use in Churches

Since the California study revealed that more than 90 percent of black women believe their spiritual and religious beliefs affect their health, Slack plans to use the 12 Commandments in an outreach program with local churches. She recently submitted a proposal to the California Department of Health to organize a group of licensed mental health providers who would commit to partner with and serve faith-based institutions and their members.

The California Black Women’s Health Project is also working with state lawmakers to create a student-loan-forgiveness program for licensed mental health providers who serve low-income communities of color. In addition, the project is advocating a voluntary cultural-competency certification program for licensed mental health providers. The certification would prove that providers had completed training in how to recognize and respond to the cultural differences among their patients.

These programs could serve as a model for national efforts to address black women’s mental health needs, said Cole.

Gloria Morrow is a licensed clinical psychologist in Pomona, Calif., with a private practice in which 90 percent of the patients are African American women. Having heard the collective grief, pain and worry of her patients, she said these efforts to highlight their mental-health needs are crucial because "there’s nothing worse than suffering in silence." She says that, for many of her patients, racism and sexism play out in the workplace, in their relationships with men and often lead to low self-esteem, depression and anxiety.

"This whole notion that racism is dead is a falsehood because people continue to suffer," Morrow said.

Morrow said that the distrust and stigma that black women feel about mental-health treatment, in her view, arise in part from their difficulty in finding a therapist to whom they can readily relate. African Americans comprise less than 2 percent of licensed psychiatrists in California and less than 4 percent of mental-health care providers nationally. Overcoming this shortage may be crucial to improving treatment outcomes for African American women. In her work as a consultant for a local mental health facility, Morrow has so far found from interviews with clients that mental-health practitioners "don’t get it when they are working with people who don’t look like them."

Pursuing Perfection Amid Criticism, Doubts

In the California study conducted by the California Black Women’s Health Project, one focus group participant described the pressure she felt juggling school and work while dealing with society’s negative perception of black men as she tries to raise her son. Another described the racism she encounters at her bank job, where she is the only black employee and where she feels white customers frequently treat her as if she doesn’t know what she is talking about. Overall, the focus group discussions revealed that black women are overwhelmed by the pursuit of perfectionism, meeting goals, mediating family conflicts and challenging the criticisms and doubts of others.

Racism also feeds the violence experienced by black women, as the internalized rage of African American men against their mistreatment may manifest itself in anger and violence toward women, according to the 2002 Women of Color Health Data Book, a report released by the U.S. Department of Health and Human Services. More than one-third of black women in California have been victims of physical violence and more than one half have been victims of verbal abuse, according to the California Black Women’s Health Project study.

Nationally, 43 percent of black women report they were verbally or emotionally abused while growing up. Approximately 20 percent reported they were physically abused as a child and another 22 percent said they were sexually abused, according to a 2001 study conducted for the Black Women’s Health Imperative. In the California study, a majority of survey respondents said violence has had an impact on their health.

Besides racism and violence, African American women also struggle with economic insecurity. The poverty rate for black women is 25 percent, more than twice the rate among white women, according to the latest statistics from the U.S. Census Bureau. In addition, 43 percent of black families are maintained by women with no spouse present. The stress of trying to make ends meet may translate directly into the finding that African Americans living below the poverty level have the highest rate of depression for any racial or ethnic group, according to research cited by the Women of Color Health Data Book.

But mental health problems are not confined to low-income women. African American women higher on the socioeconomic ladder experience their own set of pressures, especially in the workplace, where they feel they are often treated as if they do not deserve to be there, said Morrow. As a result, black women struggle with a pressure to out-perform others just to gain acceptance. She used her own career as an example.

"I had to be at the top of my class," said Morrow in a phone interview, "I was always seeing myself being compared and competing with this white ghost . . . These issues play out in the lives of black folk. It is impacting how they feel about themselves and it is impacting their physical and mental health."

Sixty percent of African American women have symptoms of depression, according the national study conducted for the Black Women’s Health Imperative. In addition, research indicates that the stress in the lives of African American women contributes to poor physical health. Stress related to racism may underlie the poor diet and resulting obesity among black women and may be associated with the high prevalence of high blood pressure and diabetes, according to the Women of Color Health Data Book.

Lack of insurance also contributes to the low percentage of black women who seek mental health treatment. Nearly one in four African Americans is uninsured. Even among those who have coverage, mental health may not be included in the policy or the cap on covered expenses may be low. But better insurance coverage alone is not enough get more women to seek help. African American women also struggle against the stigma associated with mental-health treatment.

One study found that the proportion of African Americans who feared mental-health treatment was more than twice that of whites, according to the surgeon general’s report. Part of the fear stems from wariness of the medical establishment that arises from past abuses, said Slack, such as the Tuskegee experiment. (In 1932, the federal government sponsored a study to examine the impact of untreated syphilis involving black men. The experiment went on until 1972 without the test subjects’ knowledge and most of the subjects died without receiving treatment.) As a result of the distrust engendered by the now-infamous experiment and the stigma associated with seeking help, many black women rely on spiritual leaders and community members to handle personal problems. There’s also an added pressure from the ethic of the strong black woman, a cultural value that promotes toughness and self-sacrifice.

"There are so many women who are not diagnosed or are under-diagnosed who are just existing on a thread," Slack concluded. " . . . They think ‘My mother suffered. My grandmother suffered. It’s just the lot of black women in America.’ It doesn’t have to be that way."

Shauna Curphey is a freelance writer in Long Beach, California. 

For more information:

California Black Women’s Health Project:

Black Women’s Health Imperative: