Addressing Mental Health Disparities in Black Women

The importance of mental health, although neglected in the past, has become much more prominent since the COVID-19 pandemic. Emotional, psychological, and social aspects that constitute well-being were impacted, bringing mental health to the forefront of conversations about health and wellness. Now more than ever, it is essential to consider the mental health of populations that were already vulnerable to serious psychological distress.

One of the more vulnerable populations is women, and particularly Black women. Black women constitute a priority population, given the upward trend in suicide rates seen prior to the pandemic from 1999 to 2019 among Black females between the ages of 15 and 44.¹ Within the Black American demographic, women also suffer from severe psychological distress at a rate nearly twice that of men.¹

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It is important to note that research on Black women’s mental health is minimal when compared to other counterparts. This is a dangerous literature gap, given that the lived experiences of Black females are shaped by the convergence of their racial and gender identities in society.

In pharmacy and health care in general, most patients want to receive care from someone who looks like them. For some perspective, the Black population in America is 13.6%, while Black pharmacists make up about 7% of all pharmacists, and only 4.7% of all pharmacy faculty members are Black.² Despite this disparity, pharmacists can be at the forefront of helping Black women with their mental health inequities.

Pharmacists are accessible and trusted health care professionals who have an important role in supporting people living with mental illness. There is concern for the risk of severe psychological distress among the Black female population as they face some of the largest disadvantages and outcome disparities across academic, medical, and institutional settings. Structurally and systemically, these disadvantages have placed limitations on opportunities for Black women and forced them to deal with chronic social stressors. These include subtle forms of racism, racial microaggressions, and institutionalized discrimination, all of which contribute to psychological distress among Black women.³

In addition, gendered racism is a significant social stressor for Black women that is related to increased psychological distress.⁴ On top of this, these 2 identities are so tightly knit together for Black women that trying to detect the impact of each alone may not be possible. Although racism-related events directly influence depression rates for Black women, experiences of gendered racism as well as sexual objectification can also contribute to depression symptoms.⁵

Around $280 billion was spent on mental health services in the US in 2020, but the economic burden of mental health services could be significantly decreased if pharmacists were proactively utilized. A standardized framework that coordinates care between the individual and the pharmacist while also reimbursing for services could be a viable option. Pharmacists are well placed to contribute to the mental health and wellbeing of the communities they serve in part due to their ease of accessibility. As the role of mental health pharmacists expands, so are the areas of opportunities for intervention in underserved communities.

The percentage of Black adults in the US receiving mental health services and prescribed medications for mental illness of any kind was much lower than the percentages for White adults in 2020.¹ This is another area of opportunity for pharmacist intervention. When reviewing medical history upon intake and discharge from a hospital, as well as when filling prescriptions at a community pharmacy, pharmacists should be empowered to inquire about whether mental health services could benefit their Black female patients.

There is also a longstanding and abusive history of medical mistreatment to Black patients in America, which exacerbates and contributes to these issues. This has led to widespread distrust in health care systems among Black communities. Historical events of medical racism date back centuries and include events such as the Tuskegee Syphilis Study, experimentation of medical institutions using Black bodies, and the forced sterilization of Black women. Historical implications of medical malpractice of Black Americans have led to widespread skepticism in receiving care. Once again, pharmacists knowing and understanding this puts them in the driver’s seat to ease the apprehension of patients by using clear communication and motivational interviewing.

Discrimination and bias in health care settings are still experienced to this day by Black patients and only reinforce the non-inclusive medical history and distrust.⁶ One example is the false perception that Black individuals feel less pain than other races, which can influence treatment options in health care settings. This stereotype about pain susceptibility dates back to slavery and has resulted in Black patients facing increased medical challenges when trying to get prescriptions for pain medications.⁶ This suggests that the racist practices instilled in the overall structure of the nation’s health care system are carried over into practice and patient care, further emphasizing why representation matters. Centers of academia such as schools of pharmacy are already at the forefront of changing this narrative by educating students about past medical practices and providing expert information about how to practice moving forward to have a more equitable health care system for all patients.

Representation throughout health care matters. This holds true especially as it relates to having a culturally competent workforce to address the mental health needs of Black women. Since 2014, the percentage of Black pharmacists has almost doubled, reaching 4.9% of the total pharmacist population.² Although this increase may not yet be reflective of the racial diversity seen in the US population overall, these identifiable strides towards increased representation has been an important factor and is trending in the right direction. Considering the percentage of Black physicians in the US has not seen a significant rise in almost 40 years,⁷ the increase in Black pharmacists indicates advancements are indeed being made toward a diverse workforce.

A racially and ethnically diverse clinician population is key for understanding culturally significant mental health influences. The cultural aspects that influence mental health are complex and varied for Black women. Take the “Strong Black Woman” ideal, which is deep-rooted in Black culture and places emphasis on strength and resilience. Although endorsement of this ideal among Black women can be a positive coping mechanism, it can also lead to adverse mental health outcomes.⁸ This includes depression and anxiety symptoms for Black women, as well as loneliness.⁹ The negative effect of endorsing this ideal is attributed to the expectation felt by Black women to live up to the ideal of consistently being strong and the underlying governing principle of self-reliance.⁸ The adverse effect is that Black women do not feel persuaded to look for mental health resources and services when navigating their mental health issues.

Stigma around mental health within the Black community is also one reason for a lack of help-seeking behavior.¹⁰ For Black women, cultural beliefs that mental illness displays weakness goes against the ideal that they must be strong at all times and leads them to downplay their mental health symptoms and avoid seeking care. As pharmacists, especially in the ambulatory care setting, we have an obligation to identify some of these issues and provide the necessary resources and guidance to patients.

The socialization challenges and interactions experienced by Black women are multidimensional. In order to support Black women’s mental health moving forward, pharmacists must understand the social and cultural factors that contribute to psychological distress among Black women. In turn, disparities in access to care and treatment for mental illness must also be acknowledged by all health care professionals in order to care for Black women to a higher standard. Pharmacists are being trained to curb these inequities by implementing diverse learning opportunities in all sectors and by training to be the most culturally competent providers. Hopefully, pharmacists will be able to influence positive change for this vulnerable population for years to come.

References

1. The Office of Minority Health. (2023, February 17). Mental and Behavioral Health - African Americans. minorityhealth.hhs.gov. https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=24

2. American Association of Colleges of Pharmacy, & Rooney, J. (n.d.). Confronting Racial Injustice. Retrieved August 10, 2023, from https://www.aacp.org/article/confronting-racial-injustice

3. Vance, M. M., Wade, J. M., Brandy, M., & Webster, A. E. (2022). Contextualizing Black Women’s Mental Health in the Twenty-First Century: Gendered Racism and Suicide-Related Behavior. Journal of Racial and Ethnic Health Disparities, 10(1), 83–92. https://doi.org/10.1007/s40615-021-01198-y

4. Jones, M. S., & Day, S. X. (2017). An exploration of Black women’s gendered racial identity using a multidimensional and intersectional approach. Sex Roles, 79(1–2), 1–15. https://doi.org/10.1007/s11199-017-0854-8

5. Carr, E., Szymanski, D. M., Taha, F., West, L., & Kaslow, N. J. (2013). Understanding the link between multiple oppressions and depression among African American women. Psychology of Women Quarterly, 38(2), 233–245. https://doi.org/10.1177/0361684313499900

6. Simmons, A., Chappel, A., Kolbe, A. R., Bush, L., & Sommers, B. D. (2021). Health disparities by race and ethnicity during COVID-19 pandemic: current evidence & policy approaches. In The Assistant Secretary for Planning and Evaluation (ASPE). https://aspe.hhs.gov/sites/default/files/private/pdf/265206/covid-equity-issue-brief.pdf

7. Ly, D. P. (2021). Historical Trends in the Representativeness and Incomes of Black Physicians, 1900–2018. Journal of General Internal Medicine, 37(5), 1310–1312. https://doi.org/10.1007/s11606-021-06745-1

8. Stanton, A. G., Jerald, M. C., Ward, L. M., & Avery, L. R. (2017). Social Media Contributions to Strong Black Woman Ideal Endorsement and Black Women’s Mental Health. Psychology of Women Quarterly, 41(4), 465–478. https://doi.org/10.1177/0361684317732330

9. Liao, K. Y., Wei, M., & Yin, M. (2019). The Misunderstood Schema of the Strong Black Woman: Exploring Its Mental Health Consequences and Coping Responses Among African American Women. Psychology of Women Quarterly, 44(1), 84–104. https://doi.org/10.1177/0361684319883198

10. Misra, S., Jackson, V., Chong, J., Choe, K., Tay, C., Wong, J., & Yang, L. H. (2021). Systematic Review of Cultural Aspects of Stigma and Mental Illness among Racial and Ethnic Minority Groups in the United States: Implications for Interventions. American Journal of Community Psychology, 68(3–4), 486–512. https://doi.org/10.1002/ajcp.12516