Racial Trauma: The African American Experience _ _______________________________________________
across races” [13]. Although drug use rates are roughly the same across race/ethnicities, Black persons are much more likely to be arrested on drugs charges. In 2010, African American individuals were 3.7 times more likely to arrested on cannabis possession charges than White individuals, despite similar usage rates [13]. Interaction with police is also increased among African Americans. While Black drivers are somewhat more likely than White drivers to experience a traffic stop, they are significantly more likely to be searched and arrested [13]. When they are arrested, African Americans are more likely to be denied bail, to have their case taken to trial, and to be more strictly sentenced. ACCESS TO HEALTH AND MENTAL HEALTH CARE Individual and systemic racism have resulted in considerable disparities in the rates of access to health and mental health care (including diagnosis, prevention, and treatment) for African Americans, and these gaps adversely impact community health. Historically, slavery, sharecropping, and segregation, as well as other forms of race-based exclusion from health care, education, and social and economic resources, have contributed to disparities in the African American community. Institutional racism is represented in American medical education, medical practice, and scientific studies, all factors that continue to affect the community. Studies reveal that African American or Black patients are [11]: • More likely to obtain mental health treatment in emergency and hospital settings • Misdiagnosed or diagnosed at dispropor-tionately higher rates with schizophrenia and other psychotic disorders • Less likely to be provided antidepressant therapy, even after controlling for insurance and financial conditions This, along with decreased rates of access to mental health treatment for African Americans, adversely affects physical and mental health and diminishes relationships with the mental health community [11]. Some African Americans view the healthcare system as a racist institution [3]. In general, this has been attributed to a general mistrust of societal institutions [14]. At times, individual experiences or family recollections of racism experienced in health care contribute, and in the United States, there is a history of damaging racism in health care (e.g., the well-known Tuskegee study of untreated syphilis in African American men, the nonconsensual harvesting of cells from Henrietta Lacks for medical research). These historical examples highlight the racial inequities entrenched in American research studies and healthcare systems and emphasize the historical disregard of patient consent and privacy for African Americans. Family and community pressure is another consideration. In one study, African American patients with PTSD refused to access treatment due to shame and fear of family or cultural disapproval [15].
In order to enhance the lives of African American patients, mental health practitioners should strive for an understanding of historical, sociocultural, and individual issues that influence the treatments offered to this population. To this end, and to help alleviate racial and cultural prejudices, mental health providers should: • Re-evaluate professional practices to determine whether these practices relate to the fundamental values of African American culture, such as family, kinship, community, and spirituality. • Analyze how apparent racial discrimination may cause hypervigilance, anxiety, or depressive symptoms among African Americans. • Understand and acknowledge personal biases in treatment and bear in mind that African Americans may feel rejected or disregarded by mental health practitioners who misinterpret expressions of emotion by this population. • Seek out and learn about the experiences of the local African American community. • Unite with community organizations and leaders to understand more about the range of African American cultures within the community and opportunities to work in partnership. • Actively listen and genuinely assess every relationship to develop and improve alliances with patients. • Accurately screen and follow through with quality assessments that employ a biopsychosocial model. • Maintain talk therapy as a top priority of treatment models from the beginning and offer consistency in treatment.
HEALTH AND MENTAL HEALTH OUTCOMES
As mentioned, racism, racial bias, and discrimination have been linked to poor physical and mental health outcomes among minorities [16]. Institutional racism is a key social determinant of health, along with educational attainment, housing opportunities, accessible employment, health care, and environment, each of which can negatively impact health. Implicit bias remains a significant issue in health and mental health care. While implicit bias is distinct from racism, the two concepts can overlap. Implicit bias is very basically defined as unconscious or pre-reflective attribution of qualities (usually stereotypes) to a member of a group. These biases affect one’s understanding, actions, and decisions and can be related to racial profiling. For example, young African American men are often presumed to be criminals or delinquents, with providers and authorities assuming they are involved in illegal behavior and unlawful activity. These biases can affect the type of care and treatment offered.
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