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African-American Mental Health Care and Cultural Awareness

Culturally Competent mental health care for African-Americans requires a therapist who understands the cultural influences that may affect outcomes for the individual receiving treatment, says Brenden Hargett , Ph.D, LPC, LCAS, NCC, a manager on Cardinal Innovations Healthcare’s Utilization Management team.

“National data and research demonstrate poor retention rates for African-Americans. You have to question what that is about,” Hargett said.

Hargett leads a training called, “Effects of Cultural Trauma in African-Americans: Implications for Clinicians,” intended to help clinicians understand the African-American experience and cultural differences so they have a better understanding of the individual seeking treatment. This training examines cultural and historical trauma among African-Americans and offers a culturally determined framework using trauma-informed principles to understand and address this phenomenon. The next class is on February 22 in Charlotte, N.C.

“After working with individuals in a number of settings, I’ve observed many times the behavioral health needs of African-Americans are under-addressed and often unidentified,” Hargett said. “Just from an observational perspective, the question is are you taking that group’s experiences and who they are into context?”

African-Americans are 20 percent more likely to experience serious mental health problems than the general population, according to the Health and Human Services Office of Minority Health. Common mental health disorders among African-Americans include: depression, attention deficit hyperactivity disorder (ADHD), suicide and Posttraumatic stress disorder (PTSD). Meanwhile, only about 25 percent of African-Americans seek mental health care compared to 40 percent of whites, according to the National Alliance on Mental Illness (NAMI).

Hargett said part of the reason for that is a distrust of health care systems because of negative experiences that African-Americans have had with the health care in the past. Another problem is misdiagnosis and a lack of culturally competent care to provide the appropriate treatment.

When a 75-year-old African-American male comes through the door, for example, he comes bringing all of his life experiences with him, Hargett said.
“If he grew up in rural Mississippi, you should ponder, what were his life experiences? You’re talking about a life experience that most likely, during his life, involved blatant racism and discrimination. This will affect his desire to seek help and to respond to treatment,” Hargett said.

These experiences are then passed on from generation to generation. “What they (African-Americans) think or how they perceive the world can impact their emotional response. Behavioral health professionals should take into consideration all of these factors. We should honor them while guiding them towards wellness,” Hargett said.

Also, culturally acceptable behavior differs for every group of people and, if this is not understood by a therapist/clinician, it can negatively influence the outcome of treatment, he said.

“African-Americans in general, may make less direct eye contact.  From a cultural aspect in families, younger children didn’t always look directly into the eyes of their elders,” Hargett said. “When this is experienced in treatment, it can easily be misinterpreted that they are avoiding eye contact or are not truthful. Even nonverbal and expressiveness can be misinterpreted. In general, African-Americans are expressive, animated and demonstrative. Some might see that as aggression.”

Years ago, in a past workshop Hargett led, on perceptions of African Americans and working with families, he wore jeans, a football jersey and boots and walked into the classroom and engaged with the class as a participant. A colleague would start the class. Hargett would eventually take off the jersey and go to the front of the room to begin instruction.

“I watched the reactions of participants to my being in the room. Then I’d walk to the front of the room and pull off my outer layers and say let’s talk about what you experienced,” Hargett said. “When our members walk through the door, whatever you feel about them comes out in your disposition. In my opinion, one goal of a first session with a person of color is to get them back for a second session.”

Often, African-Americans don’t return because they are not entreated and engaged from the beginning, he said. “When they walk through the door, they’re looking to see whether you are going to embrace them (emotionally) and treat them in a manner that shows you have their best interest in mind,” he said.

Hargett encourages therapists to start by asking what the individual wants. You want to try and engage the individual by building trust.

“Let’s talk about you. Let’s talk about your experiences,” he said. “I’ll talk about something real or uncomfortable and then I’ll talk about something soft or not as intrusive.”

Hargett also encourages African-Americans to begin treatment with an open mind.

“Advocate for what you think you need. Don’t necessarily settle for what someone tells you. Verify your information,” he said. “Trust the process and ask questions. I think a lot of African Americans are disengaged and don’t trust the process because of history and historical trauma. Trust the process. Advocate for yourself. If you need to solicit others to be there with you, do that.”

For more information or to register for the “Effects of Cultural Trauma in African-Americans: Implications for Clinicians,” training, click here.
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