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Dear Professor Smyrl,
I'd say my favorite part about my essay was the solution portion. Providing a solution to the problem that has plagued humanity for ages can only be viewed as optimistic in the eyes of many. I'd say the hardest part about this essay was the conclusion and having solid analysis for my evidence. I'd say the conclusion was also pretty hard for me seeing as I always have trouble closing up my essays. The thing which I corrected was trying to discuss more of the effects on mental health of victims rather than the history of racism. Although I didn't understand which part of my MLA Formatting needed to be corrected. My peer reviews generally seemed to describe my essay as complete and didn't require any further changes.
Thank You,
Dan

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My final essay discussed the origins of racism and its various effects on its victims. After discussing the effects, in my final paragraph I proposed a solution to the problem.

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The Authors, Doctors from University of Michigan’s Department of Sociology, use data gathered across the nation pertaining to POC and their various situations: financially, emotionally, mentally, etc to support their arguments about the obvious inequality between whites and POC. The article goes on to provide more statistics such as overall happiness or stress within the two groups with POC facing many more cases of stress or depression.

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The Authors, Jessica R Graham-LoPresti and Tahirah Abdullah highlight the effects that racism can have on the health of its victims and provide ways that the victims can negate or lessen the burden of the effects that are received due to prejudice.

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Authors' Note: Within the Black community, we generally acknowledge and discuss experiences of racism and the detrimental impact of racism on equitable access to resources (including education, housing, health care, etc.). We less frequently discuss the detrimental impact racism often has on our mental health. In this article, we draw attention to the link between experiences of racism and mental health, with a specific focus on anxiety disorders and symptoms, which are among the most commonly diagnosed mental health disorders in the United States. We also discuss coping strategies that may be beneficial in the face of experiences of racism. It is important to emphasize that we, as Black Americans, are not at all responsible for the existence or experience of racism and unfairly are burdened with the responsibility of coping with the painful existence of these oppressive experiences.

Racism is a serious, prevalent issue in the US, and there is a link between racism and anxiety, stress, and other mental and physical health problems.

Nationally representative polls and surveys have indicated that the overwhelming majority of Black Americans:

Believe that Blacks experience racism in the United States (88%)¹

Characterize racism as a "very serious" or "serious" problem (87%)²

See racism as being "widespread" in the United States (78%)³

Racism can take on many forms including racial macroaggreesions, which are described as more overt racist experiences including being called a racial or ethnic slur, being physically assaulted due to race, or being denied fair wages due to race.

Racial microaggressions are described as subtle, intentional or unintentional slights that denigrate or degrade individuals of color due to race. Examples of microaggressions include assumptions of inferiority or criminality due to race, not having people who look like us represented in work, educational, or governmental contexts, being told that we "talk about race/racism too much," and assumptions of sameness due to race. In addition, racism can be experienced on the structural/institutional level (e.g., voter disenfranchisement) and on the individual level (e.g., a boss being surprised that you are intelligent or articulate).

About one in four Black Americans will experience an anxiety disorder at some point. Social anxiety disorder is the most common anxiety disorder, with a lifetime prevalence of 10.8% among Blacks, followed by generalized anxiety disorder (5.1%), panic disorder (3.1%), and obsessive-compulsive disorder (3%) ⁴ In addition, anxiety is more persistent (i.e, symptoms last longer) in Black Americans as compared to the general population. However, Black Americans seek mental health treatment considerably less often and/or dropout of mental health treatment before the recommended dose of therapy more often compared to the general population ⁵.

Understanding the Link Between Racism and Anxiety

In addition to experiencing racism at all levels frequently, we know that these experiences have significant negative effects on both physical and mental health outcomes for Black Americans 6. Some researchers have suggested that chronic experiences of racism and microaggressions result in "racial battle fatigue," which includes anxiety and worry, hyper-vigilance, headaches, increased heart rate and blood pressure, and other physical and psychological symptoms ⁷.

While the negative impact of racism on mental health is pervasive and far-reaching, these studies suggest a link between racism and symptoms associated with anxiety. There are three specific ways we think experiences of racism negatively impact stress and anxiety for Black Americans:

Perceptions of lack of control

Internalization

Avoidance of valued action

Perceptions of Control
An individual's perception of control over life contexts, safety, and environment is directly linked to stress and anxiety. We are not responsible for our experiences of racism, and we have very little, if any, control over whether or not we experience racism. So, in the context of racism, racist experiences can elicit an understandable perception of lack of control of one's environment, therefore contributing to the development and maintenance of stress and anxiety.

Specifically, as Black Americans we might work hard to provide for ourselves, our families, live in accordance with our own values and societal expectations and expect to receive equitable treatment, dignity, and respect in response to this hard work. This attempt at controlling one's environment through hard work and acting in line with society's expectations has been described as "John Henryism" ⁸. Theorists have described John Henryism as the value of hard work and determination in the face of extreme and overwhelming odds (i.e., racism and oppression; James et al., 1983). Despite hard work, determination, and perseverance, the perception that we cannot control our own safety and environmental contexts is initiated and maintained by the frequency of racist experiences. Specifically, the expectation that hard work, determination and living according to society's rules will lead to fair treatment is continually shattered by experiences of racism.

Encountering frequent experiences of racial discrimination can create a feeling of not being valued or being viewed as a person of little or no worth for both Black men and women. This sense of invisibility can contribute to our feelings and beliefs, as Black Americans, that we cannot control whether our talents, abilities, character, and right to safety are acknowledged by others in society. This experience is conceptualized as the invisibility syndrome ⁹.
Internalization
Experiences of racism have also been associated with internalized racism and negative self-evaluations, which may also contribute to the development and maintenance of stress and anxiety for Black Americans. While not all Black Americans experience internalized racism, Williams and Williams-Morris (2000) assert that Black individuals may internalize beliefs of racial inferiority communicated by the majority about us, otherwise known as internalized racism. Internalized racism is defined as the conscious or unconscious acceptance, by the marginalized group, of negative and critical beliefs about one's worth.

This can manifest in different ways, but one example is the belief that having lighter skin or softer hair is more beautiful and has more value than darker skin complexions and coarser hair textures. Many studies have found internalized racism to be linked to poor self-esteem and higher levels of psychological distress ¹⁰. In addition, we know through research and clinical presentations that critical beliefs about oneself and negative self-focused thoughts are associated with the development and maintenance of anxiety symptoms. This points to the significant impact of the negative and pervasive messages about the worth of Black Americans in our society that we see from the media, see reflected in political figures, and see in the low indictment and conviction rates for police violence against Black Americans. Furthermore, the internalization of these negative beliefs can create feelings of helplessness, worthlessness, sadness, fear, and shame ¹¹.
Avoidance of Valued Action
Finally, experiences of racism might contribute to stress and anxiety for Black Americans through avoidance of the things that are most meaningful in our lives. Wilson and Murrell (2004) describe the ways that both avoidance of our emotions and avoidance of meaningful contexts contribute to the maintenance of stress and anxiety. Specifically, we are taught that positive emotions are good and that negative emotions are bad. For instance, a little boy who cries because he gets knocked over at football practice is called a baby. An adult who is passed up for a job opportunity is told to not take it personally or to get over it.

The underlying assumption is that we must suppress, get rid of, or replace negative emotions with confidence, self-esteem, or optimism in order to move through our lives and do the things that are personally meaningful. However, an abundance of literature documents the paradoxical effects of attempts to control our emotional experiences, highlighting that avoidant coping such as pushing our feelings aside or pretending that experiences of racism do not hurt or negatively affect us, predicts poorer long-term mental health outcomes.

The things that matter to us, our values, become limited when the focus is solely on attempts to avoid distressing emotions. Moreover, negative life events (e.g., racism) can create rigid and inflexible ways of responding that limit our ability to engage in the things that are meaningful to us. For instance, an individual who experiences social anxiety may begin to avoid places where she will interact with others because she does not want to experience anxiety. However, her avoidance of places where she might interact with others is in direct contrast to her value of making social connections with others and finding a life partner.

In the context of racism, frequent experiences of discrimination have been associated with symptoms of anxiety including elevated heart rate and blood pressure, critical and negative self-focused thoughts, and worry ¹². The overwhelming nature of these symptoms can lead to an over-identification or entanglement with these painful emotions, thoughts, and feelings. In order to manage the overwhelming emotional responses that arise in the face of racism, we may attempt to suppress these negative emotions and avoid people and places where racism related events may occur (e.g., certain stores or parts of town).

At face level, avoidance of situations where racism may occur seems adaptive (and safe); however, experiences of racism can occur at any time or place and this type of avoidance can contribute to avoidance of the things that are most meaningful to us or engaging in meaningful actions consistent with our values (e.g., deserving of equal respect at stores and in all parts of town or our rights to equal access to education, healthcare, and employment). For instance, experiencing racism at school, work, or in social environments may be barriers to engaging in meaningful or valued action including education, career goals, and making social connections. Furthermore, research suggests that lack of engagement in valued actions is associated with stress and contributes to the maintenance of anxiety symptomology ¹³.

As Black Americans there are a number of barriers to engaging in the things that are meaningful to us including experiencing racism in many contexts within our daily experiences. It is understandable and important to acknowledge that it is natural for us to want to avoid this pain. And, the avoidance of this pain can sometimes lead us down a path of avoiding things that are important and meaningful to us, which leads to more distress.

How to Cope
Valued-Living
One potentially effective strategy for responding to experiences of racism and for combating racism's effects on anxiety symptoms is the role of attending to and making choices based on our values (i.e., the things that are meaningful and matter to an individual ¹⁴;. When individuals are able to identify and understand their values, they can be more aware of what matters to them during stressful moments, make choices consistent with their values, and act upon these choices ¹⁵.

For example, during a stressful encounter, it is extremely difficult for individuals to remember that they have choices in their lives and that they can experience empowerment in the face of restricted, judgmental thoughts such as, "I have no choice but to just allow my boss to say racist things to me because I will lose my job" or "I should be able to handle myself and not feel upset when my advisor doubts my abilities." For Black Americans, in particular, reconnecting to values can be empowering such that making choices can feel natural, even in the face of racism.

For example, the individual who experiences distress from his boss' racist jokes, may choose to reconnect to his value of respect and may decide to approach his boss about the racist comments because simply accepting these comments would be living a life inconsistent with who he is and what he stands for. A Black woman who perceives that she is being treated unfairly in school by her advisor because she is Black may be able to reconnect with what is meaningful to her about being a student and make a decision to continue to engage in her value of pursuing her education in the face of this discrimination. She may decide to report this to the dean and/or seek out a more helpful advisor, which is consistent with her value of pursuing education. She may also decide that social connectedness in the midst of discrimination is an important value and begin to develop safe spaces with colleagues or other students to garner social support and process these experiences. Her decision of acting in line with her values despite these painful and unjust experiences may buffer some of the stress associated with racism.
Attending to our emotions
Attending to our emotions, as opposed to avoiding or attempting to push these emotions away, can be described as acceptance. For us, acceptance denotes an accepting relationship with our emotional reactions to experiences of racism and does not at all suggest an acceptance of the existence of racism or racist experiences. The cultivation of an accepting relationship to, and a present moment awareness of, the overwhelming and distressing emotional responses that arise in the face of racism, may lessen the intensity of our anxiety.

For instance, we know that consistently attempting to control or suppress emotions paradoxically heightens the intensity of our emotional experiences. We might begin to think about more flexibility in our coping strategies and, at times, be willing to acknowledge and discuss the deep, emotional intensity that we may experience in the face of racism. For example, as Black Americans, we may wonder how one can be strong and resilient, while acknowledging our emotions and turning towards these emotional experiences. It is important to acknowledge that controlling our emotional responses to racism can be effective and has been one of the very strategies that has contributed to our strength in many contexts.

We are suggesting that it is also important to acknowledge that emotions provide important information and are crucial to helping us navigate the world, especially a world in which we have frequent experiences of racism. Emotions can tell us several things about our experiences, in particular, they communicate to us when we are in a threatening or dangerous situation (e.g., signaling fear or anxiety), when our needs are not being met (e.g., through feelings and expressions of anger), or through sadness, which indicates that we are losing something that is important or valuable to us.

Experiences of racism can elicit any and all of these emotional experiences, sometimes at the same time. There is a way that experiences of racism can threaten an individual's safety, can be barriers to accessing resources (e.g., employment, healthcare, education, respect/validation), and can deplete an individual's sense of self-worth and value. While it is natural to want to turn away from these emotional experiences, emotions provide us with important information that, when clear, can help us respond in a meaningful way to these experiences of racism. One specific example can be found in the Black Lives Matter movement. In part, this movement arose as a meaningful response to the fear, anxiety, sadness, and anger felt by many Black Americans in the wake of the multitude of unarmed Black men killed by law enforcement officers.
Self-Compassion
As previously discussed, emotions provide us with important information and help us adapt to the life challenges that racism may elicit. However, cultural and societal norms often tell us that feeling anxiety, sadness, or anger are signs of weakness or evidence of having lack of self-control. In fact, as Black individuals who experience racism and emotional reactions to racism, we are often told that we are "overreacting" or "hypersensitive"which perpetuates the self-perception of emotion as weakness or as being out of control ¹⁶. Specifically, when we experience emotional reactions in the face of racism, we can deliberately practice being compassionate with ourselves and recognizing that the anxiety, anger, sadness, etc. that arises is an understandable reaction during and in the wake of these painful experiences. Self-compassion is described as the appreciation of our emotional responses to racism as being understandable, natural, and part of our human experience. The work here is cultivating awareness of our tendency to judge our emotional reactions in response to racism and bringing self-compassion to both the emotional experiences and the judgment or self- criticism that may also arise. For example, in the face of a racist experience, a Black woman can acknowledge that she is angry and appreciate that this anger is a natural and understandable response to an unjust situation rather than viewing her emotional response as being unreasonable or something to "get over".

Sources

1. Pew Research Study, 2013

2. CNN/Essence Magazine/Opinion Research Corporation poll, 2008

3. Gallup, 2008

4. Breslau, 2004; Breslau, 2006; Wang, 2005).

5. Jackson, Neighbors, Torres, Martin, Williams, & Baser, 2007; Snowden, 2001; Wang et al., 2005

6. Barnes & Lightsey, 2005; Donovan et al., 2012; Hill, Kobayashi, & Hughes, 2007; Pieterse et al., 2012

7. Smith, Allen, & Danley, 2007; Soto, Dawson-Andoh, & BeLue, 2011

8. Sherman et al., 1984

9. Franklin & Boyd-Franklin, 2000; Carr & West, 2013

10. Carr et al., 2013; Graham et al., 2015; Syzmanski & Gupta, 2009

11. Mckorkle, 1991; Tomes et al., 1990; Wei et al., 2010; Williams & Chung, 1999

12. Ma et al., 2008; Rucker, West, & Roemer, 2009; Soto et al., 2011; Townsend et al., 2007

13. Crocker et al., 2008; Michelson et al., 2011

14. Wilson & Murrell, 2004

15. Hayes, Strosahl, & Wilson, 2012; Roemer & Orsillo, 2009

16. Sue, Nadal, Capodilupo, Lin, Torino, & Rivera, 2008

Date of original publication: August 02, 2016

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How Black Americans Can Cope With Anxiety And Racism

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Authors' Note: Within the Black community, we generally acknowledge and discuss experiences of racism and the detrimental impact of racism on equitable access to resources (including education, housing, health care, etc.). We less frequently discuss the detrimental impact racism often has on our mental health.

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Daryl Davis, A renowned musician explains his experiences with the KKK and the relationship he had with the previous Grand Klansmen. He goes over what went into their relationship and the respect between the two which allowed for them to talk normally with each other and become friends. This eventually led to the Klansmen leaving the Klan.

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Why I, as a black man, attend KKK rallies. | Daryl Davis | TEDxNaperville

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In the article "Redefining Race Relations: It Begins at Home" published by psychologybenefits.org provides a solution for racism to become fully abolished and discusses the need for education at home by parents. The article acknowledges that a majority of racism is learned at home from the parents and in order to abolish it, parents must teach their children properly.

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This is part of our ongoing series of blog posts about race, racism and law enforcement in communities of color.
By Erlanger "Earl" Turner, PhD, (Assistant Professor of Psychology at the University of Houston-Downtown) and students from his Multicultural Psychology course (Damaurriah Butler, Jonathan Otero, & Caroline Smith)
In the United States, race relations has had its challenges across history. Although strides have been made over the course of history, we continue to battle racism and injustice in the 21st century. The recent incident in Ferguson, Missouri has re-energized efforts to address race relations, racism, and discrimination. If you've been avoiding media or hiding from technology, CNN has provided information on their website detailing the events and current status.

Many may ask, "Why is Ferguson or racism an issue?" The fact is racism impacts us all on some level. According to the work of Dr. Beverly Daniel Tatum (1992), racism and oppression hurt members of the privileged group as well as those targeted by racism. For example, White individuals who support social justice for all oppressed individuals may be treated negatively by those that have been targeted in the past or may not have opportunities to interact with other racial groups due to voluntary or involuntary isolation. For people of color, racism and discrimination affects both physical and mental health. A meta-analytic review (Pieterse, Todd, Neville, & Carter, 2012) found that adults who were the targets of racism experienced anxiety, depression, decreased life satisfaction, and psychiatric symptoms (e.g., post-traumatic stress, paranoia). You can imagine that for children, both exposure via media and real life experiences will also negatively impact their psychological functioning.

Unfortunately, there is no shortage of opportunities to teach our children about racism. Racial and ethnic socialization refer to the transmission of information regarding race and ethnicity from adults to their children (Hughes et al., 2006). As with other topics that parents can offer guidance on -be it sex, religion, money, etc. -parents should be open and honest with their kids regarding race and race relations. Though adults often talk about the "colorblindness" of children, the fact is that children as young as three notice physical differences such as skin color, hair texture, and the shape of one's facial features (Tatum, 2003). Attitudes and beliefs toward such differences are simultaneously learned through family, friends, and the media. It is when people are hesitant to speak about racism that the topic becomes taboo. Given that children recognize racial differences early, some have called for anti-racist education in schools. The anti-racist education approach assumes that schools reflect the larger society where racism and injustice exists (Husband, 2012). Husband (2012) suggests that we can improve relations by education and reflecting on the beliefs, policies and practices that further injustice.

As a parent, it is important that you play a role in talking with your child about race and racism. Although the racial socializing of children can begin early, the topic of racism is quite complex and younger children may not be cognitively ready to understand the full meaning of the concept. Accordingly, it is a good idea to start slowly with very simple terms. As previously mentioned, younger children, particularly children of color, grasp the concept of racial differences as young as three. Therefore, early conversations can focus on the concept of race, race relations, and ethnic differences. As children cognitively mature, the discussions can become more complex. Your initial conversations concerning racial differences and race relations will have laid the groundwork for these subsequent more complex discussions.

Below are some suggestions to engage in healthy discussions about race and ethnic differences:

Although race and culture differ, introducing other cultures to your child at an early age would increase the effectiveness of conversations pertaining to racial tolerance and differences. This will also help your child better understand clichés such as "we are all human" or simply not overgeneralize one concept to a particular group as a whole. However, it is important that as children get older, discussions about race need to address the power and privilege that comes along with racism.

Conversations with young children about racial situations should be encouraged and related to real-life circumstances. For example, Disney movies can create opportunities to talk about differences. From Dumbo to Aladdin, each film brings to life a variety of social differences, from cultural to socioeconomic and beyond. Racism is not a problem that will go away if it is ignored.

Before providing children with your opinion and beliefs about injustice, allow your child the opportunity to give their point of view. If they provide inaccurate information or views that potentially lead to poor racial interactions, provide age appropriate information that encourages appreciation of differences. For parents of color, children may also need help in developing coping skills for dealing with racism and discrimination they will encounter in the world.

Keep things simple and use examples. As adults we are so used to interacting with other adults that we forget that young children do not view the world in terms of stereotypes, discrimination, and race. Young children view the world in far simpler terms. One example to talk with children about race is to use crayons. Every crayon is a different color with their unique characteristics. Just like some children dislike a color without any real justification, some people dislike others in the same way. In the end, it is important to remember that even though colors are different we are all still a part of the same box. We live in the same world, and when working together, we can create masterpieces.

It is important to monitor your negative emotions and "passion" surrounding racism and injustice around your children. Although it may be counter-intuitive (or feel unnatural), displaying your negative frustrations without resolution will not help your child be resilient. Inappropriate racial socialization has been found to lead to increased anger among African American youth. One study found that African American boys who reported receiving frequent messages reinforcing cultural pride also reported higher levels of situational anger (Stevenson, Reed, Bodison, & Bishop, 1997). It is possible that through socialization these boys were made aware of the unfair treatment experienced by African Americans, but were not given corresponding messages regarding appropriate ways to manage the anger that results when one feels unjustly treated.

Be proactive! As your child becomes an adolescent or experiences injustice first hand, talk with your child about ways to cope with and move beyond injustice or become an activist in your community to combat systemic racism.

Seek advice or talk with a psychologist, therapist, or pastoral counselor if you feel that you or your child needs professional help to cope with distressing events. The APA (http://locator.apa.org/) and Find a Psychologist (http://www.findapsychologist.org) provide resources for locating a therapist in your area.

Authors' Biographies:
Erlanger A. Turner, Ph.D., is an Assistant Professor of Psychology at the University of Houston-Downtown (UHD) in the College of Humanities and Social Sciences. Dr. Turner's research focuses on access to child mental health services, health inequity, help-seeking attitudes and behaviors, and cultural competency in clinical practice. He teaches courses at UHD in clinical psychology, multicultural psychology, and child psychopathology. Dr. Turner is also a blogger for The Race to Good Health. He was recently awarded the 2014 Judy E. Hall Ph.D. Early Career Psychologist Award by the National Register of Health Service Psychologists. Dr. Turner is a member of the American Psychological Association and has served in numerous leadership positions throughout APA and APA Divisions. He earned his B.S. in psychology from Louisiana State University and an M.S. and Ph.D. in clinical psychology from Texas A&M University.

Damaurriah Butler is an undergraduate psychology major at UHD. Butler‎ is interested in pursuing a graduate degree in Clinical Adolescent Psychology.

Jonathan Otero is an undergraduate psychology major at UHD. Otero‎ is interested in obtaining a graduate degree in Counseling Psychology and pursuing a career in marriage and family therapy.

Caroline Smith is an undergraduate psychology major at UHD. Smith‎ is interested in attending graduate school to study Autism Spectrum Disorders in children.
References:
Hughes, D., Rodriguez, J., Smith, E.P., Johnson, D.J., Stevenson, H. C., & Spicer, P. (2006). Parents' ethnic -racial socialization practices: A review of research and directions for future study. Developmental Psychology, 42, 747-770.

Husband, T. (2012). "I don't see color": Challenging assumptions about discussing race with young children. Early Childhood Education Journal, 39, 365-371.

Pieterse, A.L., Todd, N.R., Neville, H.A., Carter, R. T. (2012). Perceived racism and mental health among Black American adults: A meta-analytic review. Journal of Counseling Psychology, 59, 1, 1-9.

Stevenson, H.C., Reed, J., Bodison, P. & Bishop, A. (1997). Racism stress management: Racial socialization beliefs and the experience of depression and anger in African American youth. Youth Society, 29, 2, 197-222.

Tatum, B.D. (1992). Talking about race, learning about racism: The application of racial identity development theory. Harvard Educational Review, 62, 1, 1-24.

Tatum, B. D. (2003). Why Are All the Black Kids Sitting Together in the Cafeteria? New York, NY: Basic Books.

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Redefining Race Relations: It Begins at Home

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This is part of our ongoing series of blog posts about race, racism and law enforcement in communities of color. By Erlanger "Earl" Turner, PhD, (Assistant Professor of Psychology at the University of Houston-Downtown) and students from his Multicultural Psychology course (Damaurriah Butler, Jonathan Otero, & Caroline Smith) In the United States, race relations has had its challenges...

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"Racial and Ethnic Disparities in Mental Health Care:

Evidence and Policy Implications" by Thomas McGuire and Jeanne Miranda discusses the common misconceptions about racism and its effects on mental health and also claims that the common misconceptions are not what they seem. They do involve the various misconceptions and provide corrections to these misconceptions.

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Abstract

In the mental health arena, unlike general health, health care disparities predominate over disparities in mental health per se. Strategies to improve health care in general, such as improving access to care and improving the quality of care, would do much to eliminate mental health care disparities. However, a diverse mental health workforce, as well as provider and patient education, are important to eliminating mental health care disparities.

Mental health care disparities , defined as unfair differences in access to or quality of care according to race and ethnicity, are quite common in mental health.1 Although some studies question this consensus, 2, 3 the weight of the evidence supports the existence of serious and persistent mental health care disparities.

The purpose of this paper is to review briefly the evidence for disparities in mental health care, highlighting differences from the general health care literature. We orient our discussion around two questions relevant for public health care policy to reduce disparities:

First: Will policies designed to deal with broader health care disparities deal effectively with specific disparities in mental health care?

Second: Will quality improvement strategies ameliorate disparities in mental health care?

Answers to these questions can guide steps needed to reduce disparities in mental health care. The degree to which policies need to be tailored to disparities in mental health care, or whether general health care policies can be counted upon to work is addressed.

Racial/Ethnic Disparities in Mental Health

A consensus about what constitutes a "disparity" has not been reached despite a voluminous literature on the topic. The term disparity clearly connotes an unfair difference, but measurement of this difference is far from uniform. Here, we rely on the definition employed by the Institute of Medicine (IOM) in its Unequal Treatment 1 report: a disparity is a difference in health care quality not due to differences in health care needs or preferences of the patient. As such, disparities can be rooted in inequalities in access to good providers, differences in insurance coverage, as well as stemming from discrimination by professionals in the clinical encounter.

The IOM definition is distinct from that applied by the Agency for Healthcare Quality and Research (AHRQ) in its annual National Healthcare Disparities Reports, where any difference between populations is a disparity, with no adjustment for underlying need for care. The IOM definition is also distinct from much of the research literature which adjusts disparity estimates for socio-economic and geographic variables, thus disregarding disparities associated with lack of insurance coverage, geographic access to providers, education, or income that are considered disparities within the IOM concept.4 We strongly believe that disparities should be identified only when there is need for care, and that social circumstances, such as lack of insurance, constitute disparities if they lead to poorer care when care is needed.

Disparities in mental health exhibit a decidedly different pattern from disparities in health. In general, minorities, particularly African Americans, have poorer health and health outcomes than do Whites.5 Many studies show that members of minority groups have either lower or equivalent rates of mental disorders as compared with whites. For example, both Hispanics and Blacks have lower lifetime risk of psychiatric disorders than do whites6, 7 in representative samples of the U.S. English-speaking population.

The four Consortium on Psychiatric Epidemiology Studies (CPES) studies funded by the National Institute of Mental Health fielded common core questions and unified sampling weights8 to permit comparisons across U.S. Black (African American, Caribbean) Hispanic (Puerto Rican, Cuban, Mexican, Other), and Asian (Chinese, Filipino, Vietnamese, Other) groups. These studies improve upon previous surveys because they include large enough samples to study important subgroups of the population, and they are available in Spanish and several Asian languages, as well as English. These studies yielded a surprising finding, given the higher rates of poverty among minority individuals as compared with whites in the U.S..9 With the exception of Puerto Ricans, all subgroups of minorities report lower rates of lifetime mental disorders than do White Americans. Similar advantages exist for presence of a disorder in the past year, although Latino and Black American rates are relatively close to that of white Americans10. Although not part of the CPES, the prevalence of mental disorders has also been studied in two American Indian reservation populations.11 Compared with a nationally representative sample of the U.S. population, Americans Indians were found to be at heightened risk for PTSD and alcohol dependence, but at lower risk for major depression.

Another exception may exist to the lower or equal overall prevalence of mental disorders among minorities. Blacks may have higher levels of schizophrenia, a low prevalence but very serious condition, than Whites. The results of three major community prevalence studies12-14 indicate a higher incidence of schizophrenia among African Americans than Whites, but have too few cases for stable estimates. In a prospective, birth cohort study, African Americans were found to have substantially elevated rates of schizophrenia when compared with Whites.15 Furthermore, Blacks with schizophrenia are overrepresented in state psychiatric hospitals.16 While substantial evidence exists to suggest that clinicians over diagnose schizophrenia and under diagnose mood disorders in African Americans15, 17, clinical decisions do not account for the findings above based on semi-structured survey instruments.

Rates of disorders may be inadequate when considering disparities. Hispanics and Blacks report lower risk of having a psychiatric disorder as compared with their white counterparts, but those who become ill tend to have more persistent disorders.7 Similarly, Black Americans were found to have lower rates of lifetime major depression than were their White counterparts living in similar areas, but the rates of major depression in the past year were similar across groups, indicating more persistent illness. Relative to Whites, Blacks were more likely to rate their depression as very severe and disabling.18 Although rates of disorders are not higher among minorities, psychological symptoms do tend to be higher among minorities and among the poor.19 These higher symptom levels may be important because poorer functioning has been related to subthreshhold symptoms.20 For example, maternal depressive symptoms have been related to poorer mental health and functioning in offspring.21, 22 Higher rates of symptoms among poor and minority women23, mean these women may need services to improve their functioning and subsequent outcomes of their children.

In summary, few disparities in mental health diagnoses exist. Some evidence suggests that Black Americans may have higher rates of a particularly debilitating disorder, schizophrenia, although diagnostic problems may in part account for this difference. Furthermore, minorities do have higher rates of psychological symptoms that may impair their functioning.

Racial/Ethnic Disparities in Mental Health Care

Turning now to the evidence on disparities in mental health care, most research comparing mental health care across groups finds evidence of disparities in access and use. As documented in "Mental Health: A Report of the Surgeon General"24 and its supplement, "Mental Health, Culture, Race and Ethnicity"19, racial and ethnic minorities have less access to mental health services than do whites, are less likely to receive needed care and are more likely to receive poor quality care when treated. Minorities in the United States are more likely than whites to delay or fail to seek mental health treatment.25-27 After entering care, minority patients are less likely than Whites to receive the best available treatments for depression and anxiety.28, 29 African Americans are more likely than Whites to terminate treatment prematurely.30 Among adults with diagnosis-based need for mental health or substance abuse care, 37.6% of Whites, but only 22.4% of Latinos and 25.0% of African Americans, receive treatment.31 This comparison is consistent with the IOM definition of disparities based on need and not controlling for socioeconomic and health system factors when comparing rates among the groups. McGuire and colleagues32 implement the IOM definition of disparities in outpatient mental health care and find overall spending for Blacks and Latinos on outpatient mental health care is about 60 percent and 75 percent of white rates, respectively, after taking into account need for care.

Some studies have begun to track trends in mental health care disparities. Three use the IOM definition of disparities. Using a national data set (MEPS), Black-White and Hispanic-White disparities in rates of any mental health care use worsened from 2000/1 to 2003/4.33 Using another nationally representative sample of service use (NAMCS), no evidence was found for progress against disparities in depression and anxiety care in either primary care or psychiatric settings over the past decade.34 Similar findings from a nationally representative sample of English-speaking individuals35, overall rates of treatment for psychiatric disorders increased between 1990 and 2003, in both years, but Blacks were only 50 percent as like to receive psychiatric treatment as whites for diseases of similar severity.

In summary, disparities exist in access to and use of mental health services for ethnic minority individuals. Furthermore, during the past decade, efforts to eliminate these disparities have not been successful in primary care or specialty psychiatric services.

Mechanisms behind disparities in health and mental health care show some differences. A broad distinction, introduced by the IOM1 is between disparities due to discriminatory behavior of providers (i.e., treating otherwise similar patients differently according to race/ethnicity) and disparities due to access, insurance, and other factors associated with the operation of the health care system. In the health care area, both geographic and provider level differences are major sources of disparity3. Provider A may be low quality for all patients and Provider B high quality for all patients, and if minorities are more likely to be seen by Provider A, these across-provider differences will account for some of disparities. Geographic-level factors can work similarly.

As in health care, mental health care disparities associated with access in general, and lack of insurance, are significant in minority communities36, but inadequate access in a poor rural community may largely be shared by everyone living there.

Provider discrimination, including bias and stereotyping on the part of providers is another source of disparities.1, 37 However, no research that we know of to date makes the empirical link between the stereotypic belief or bias and actual clinical discrimination. One recent study comes close by using innovative methods to measure stereotypes and links this to physician recommendations based on case vignettes randomized by race, but the link to actual practice remains speculative.

Provider discrimination recognizes that physicians work with another type of belief, a "prior" about the likelihood a patient has a condition, and update this prior according to the strength of information received in a clinical encounter. Even when physicians are "rational" and hold no ill will or stereotypes, different underlying assumptions about the distribution of disease or communication problems can lead to discrimination. This provider discrimination has been documented in two studies of mental health care38 in which clinicians respond with less alacrity to variation in severity of depression among minority patients than whites, implying that clinicians are less able to "read" severity among minorities.

The concept of provider discrimination ties together a number of the salient features of disparities in mental health care as compared to health care. The prevalence of mental disorders is generally lower among minorities so that a clinician's "prior" encountering a minority patient should be that they are less likely to be a "case" in comparison to an otherwise similar white patient. If so, a more serious indication of symptoms would be necessary to cause a clinician to revise the prior enough to justify recommending treatment. In health, where minorities may on average be worse off than whites, application of population priors will tend to favor rates of treatment for minorities. Our hypothesis here, consistent with some of the fact pattern of disparities in health and mental health, is that disparities arising within the clinical encounter are more important in mental health than in health. In the case of mental disorder, where population prevalence is generally lower for minorities, and where communication/understanding may be worse, this type of provider discrimination leads to lower rates of treatment for minorities.39

Issues for Policy Considerations

Will Policies Designed to Deal with Health Care Disparities Overall Deal Effectively with Disparities in Mental Health Care?

Discussion of mental health policy often centers on the issue of mental health "exceptionalism:" Is mental health different from the rest of health care in some way that justifies special policy? In mental health economics, for example, higher demand response for mental health services once supported arguments for less insurance coverage. Similarly, the inadequacy of case mix adjustments for hospital care to capture expected resource use argued against use of diagnostic-related group based payment for hospital care for mental illnesses.40

In the case of mental health care disparities, appeal to exceptionalism does not seem necessary to reduce mental health care disparities. The major recommendations for eliminating health care disparities from the IOM Unequal Treatment report appear applicable to mental health care. Specifically, the report recommends that health care systems should take steps to improve access to care, ensuring that they do not disproportionately burden or restrict minority patients' access, as well taking further steps to improve access when necessary, such as providing interpreter services. Further, they recommend that economic incentives should be considered for improving patient-provider communication and trust, as well as rewarding appropriate screening, preventive, and evidence-based clinical care. If followed, these general policies would likely improve disparities.

Increasing the proportion of racial minority providers is considered an important factor for improving health disparities. This is even more important for mental health care where ethnic minorities are even more poorly represented than in health care in general, and where diversity may make more of a difference in addressing minority patients' concerns about trust. A more diverse workforce would likely provide not only more culturally appropriate treatment, but language skills to match those of patients. A federal commitment to the outreach and educational support necessary to build a truly diverse mental health workforce is a critical policy recommendation for decreasing disparities in mental health care.

A promising direction in mental health care picks up on our hypothesis about the relative importance of understanding of the circumstances and symptom reports from minority patients (referred to as "priors"). Mental health care is somewhat different from some of the rest of health care in its heavier reliance on understanding and communication to determine patient needs.41 Culturally appropriate education for providers is important, as well as education to patients for better understanding disease and disease management. For example, ethnic minority women are less likely to perceive a need for depression care than are their similarly poor white counterparts.42 Clearly, routine screening for depression in healthcare settings, as well as educating providers about ethnic minority patients, and educating patients about mental illness and interventions, could help to reduce disparities.

Will Quality Improvement Strategies in Mental Health Care Ameliorate Disparities?

Although quality improvement strategies and steps to reduce racial/ethnic disparities do not need to be seen as alternatives, an issue of relative emphasis exists: Should quality improvement efforts be focused on low quality or should care for minorities get special attention? One argument is that the overall gaps in quality are so large that they dwarf differences among groups. Baicker and Chandra43 argue "Policies should focus on getting the rates right, rather than solely on racial differences."

Low quality healthcare and racial/ethnic healthcare disparities are indicators of failure to attain social and healthcare objectives, in the first case for all patients and in the second case for a subgroup of patients. According to the IOM, equity is one of the 6 domains of quality of healthcare. Both low quality and disparities can be seen as manifestations of the same underlying issue. However, recent empirical research suggests that the quality of health care and disparities in health care are not invariably related. In Medicare, health plan outcomes and the magnitude of disparities are not related.44 Asch et al.2 found no racial disparity in care among a population of patients with access to care in twelve communities, despite the average low quality for patients in this study.

Should health care providers pursue one set of interventions that will address both quality and disparities or two sets of interventions--one set addressing quality and a second set addressing disparities? Two studies have looked at interventions designed to improve quality of mental health care and minority outcomes. In a large trial of quality improvement for depression in older patients, a collaborative care intervention improved care significantly more than care as usual for African American, Hispanic, and white patients similarly.45 A similar study of two quality improvement interventions for depression (psychotherapy and medications) in large managed care medical settings found that clinical outcomes at one year were greater for Latinos and African Americans than for white patients.46 Five years later, the interventions were found to improve disparities markedly by improving health outcomes and unmet need for care among Latinos and African Americans relative to whites.47

Taken together, these studies suggest that improving the quality of medical care in general is likely to benefit minority patients who have access to care. General improvement may also help to decrease disparities. In the one study showing such an effect, efforts were made to make the quality improvement interventions appropriate for ethnic minorities. Specifically, experts in mental health interventions for minorities participated in designing all of the quality improvement materials in English and Spanish. Videotaped educational materials for patients included African American and Hispanic providers and patients. Furthermore, information on cultural beliefs and ways of overcoming barriers to care for Latino and African American patients were included in all training. Finally, the psychotherapy intervention had specifically been developed for use with low-income and minority patients. Overall, quality improvement interventions have the potential to decrease disparities.

Policy Implications for Overcoming Mental Healthcare Disparities

Because mental health disparities are rooted almost entirely in mental healthcare disparities, policy efforts should focus on improving access to and quality of mental healthcare for diverse Americans. For the most part, these policy efforts do not reflect exceptionalism for mental healthcare, apart from general healthcare. Specifically, policies that would result in universal coverage for mental health care would significantly improve access for ethnic minorities. Similarly, improving the quality of mental health care treatments would likely improve, but not eliminate, mental health care disparities. These quality improvement efforts would need to include screening to increase appropriate identification of disorders for minorities, as well as modest accommodations for minorities (providing language appropriate educational and treatment materials, and culturally sensitive training for providers). Of particular importance for eliminating mental health disparities for minorities, federal policies should provide the outreach and education support necessary to train a diverse workforce to meet the mental health needs of our nation.

Acknowledgments

The authors are grateful to the MacArthur Foundation for support of this research. In addition, McGuire's research was supported by grants P50 MH073469 from the National Institute of Mental Health and P20 MD000537 from the National Center on Minority Health and Health Disparities, and Miranda's research by Resource Centers for Minority Aging Research/Center for Health Improvement of Minority Elderly (RCMAR/CHIME) funded by the National Institute on Aging (3P03AG021684); UCLA/Drew Project EXPORT funded by the National Center for Minority Health and Health Disparities (1P20MD00148-01); and the UCLA-RAND Center for Research on Quality in Managed Care funded by the National Institute of Mental Health (MH068639-01).

Contributor Information

Thomas G. McGuire, Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave., Boston, MA 02115.

Jeanne Miranda, Center for Health Services Research, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, 10920 Wilshire Blvd, Ste 300, Los Angeles, CA 90024.

References

1. Smedley B, Stith AY, Nelson AR. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Institute of Medicine of the National Academie; 2002. [ Google Scholar]

4. For a discussion and empirical comparison of these approaches see Cook et al (2007) and Cook MaZ.

9. DeNavas-Walt C, Proctor BD, Lee CH. Income, Poverty, and Health Insurance Coverage in the United States: 2005. 2006 [ Google Scholar]

10. Data from the CPES have not yet been combined to compare populations within the same statistical model afflaag. Given the evidence from a number of studies comparing rates of illness across whites and minorities, the general conclusion of lower or equivalent rates among minorities is justified.

14. Robins LN, Regier DA. Psychiatric Disorders in America: The Epidemiologic Catchment Area Study. Free Press; 1991. [ Google Scholar]

19. U.S. Department of Health and Human Services. Mental Health: Culture, Race, and Ethinicity-A Supplement to Mental Health: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services; 2001. [ Google Scholar]

24. U.S. Department of Health and Human Services. Mental Health: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health; 1999. [ Google Scholar]

27. Zhang AY, Snowden LR, Sue S. Differences between Asian and White Americans' help seeking and utilization patterns in the Los Angeles area. Journal of Community Psychology. 1998;26(4):317-326. [ Google Scholar]

30. Sue S, Zane N, Young K. Research on psychotherapy with culturally diverse populations. In: Garfield AEBSL, editor. Handbook of psychotherapy and behavior change. 4th edition. Vol 4. NY: Wiley & Sons; 1994. pp. 783-820. [ Google Scholar]

33. Cook BL, McGuire TG, Miranda J. Measuring Trends in Mental Health Care Disparities, 2000-2004. Psychiatric Services. In Press. [[ PubMed] Google Scholar]

34. Stockdale SE, Lagomasino IT, Siddique J, McGuire T, Miranda J. Ethnic Disparities in Detection and Treatment of Depression and Anxiety Among Psychiatric and Primary Health Care Visits, 1995-2003. Under review. [[ PMC free article] [ PubMed] Google Scholar]

39. Although statistical discrimination is "rational" in the sense that providers use information as best they can to assess clinical condition of the patient isltaup. Thus, statistical discrimination can be a cause of health care disparities as we have defined them.

41. Furthermore sreLaspfrmip.

42. Nadeem E, Lange JM, Edge D, Fongwa M, Belin T, Miranda J. Does Stigma Keep Poor Young Immigrant and U.S.-born Black and Latina Women from Seeking Mental Health Care? In Preparation. [[ PubMed] Google Scholar]

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Racial and Ethnic Disparities in Mental Health Care: Evidence and Policy Implications

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In the mental health arena, unlike general health, health care disparities predominate over disparities in mental health per se. Strategies to improve health care in general, such as improving access to care and improving the quality of care, would do ...

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The Article "Racial Trauma is Real: The Impact of Police Shootings on African Americans" published by psychologybenefits.org discusses the effects that racial trauma has had on its victims. It discusses the symptoms that occur because of the killings that have been brought upon the black community. Many of the killings have been the cause of mental health disorders such as PTSD within these communities.

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By Erlanger A. Turner, PhD (Assistant Professor of Psychology, University of Houston-Downtown) & Jasmine Richardson Note: An earlier version of this blog was published on
There have been many changes within the criminal justice system as a means to deter crime and to keep citizens safe. However, research demonstrates that often times men of color are treated harshly which leads to negative perceptions of police officers. The recent shootings in Baton Rouge, Falcon Heights, and Dallas have exposed many individuals and their families to incidents of police brutality that reminds us that as a society work needs to be done to improve police and community relations.

In light of these recent events, many people have witnessed these traumatic incidents through social media or participation in marches in their cities. The violence witnessed towards people of color from police continues to damage perceptions of law enforcement and further stereotype people of color negatively. In a study published in the American Journal of Public Health (Geller, Fagan, Tyler, & Link, 2014), the authors reported that 85% of the participants reported being stopped at least once in their lifetime and 78% had no history of criminal activity. What is more concerning is that the study also found that those who reported more intrusive police contact experienced increased trauma and anxiety symptoms. Furthermore, those who reported fair treatment during encounters with law enforcement had fewer symptoms of PTSD and anxiety.
What is Racial Trauma?
In addition to the mental health symptoms of individuals who have encounters with law enforcement, those who witness these events directly or indirectly may also be impacted negatively. In an attempt to capture how racism and discrimination negatively impacts the physical and mental health of people of color, many scholars have coined the term "racial trauma" or race-based traumatic stress. Racial trauma may result from racial harassment, witnessing racial violence, or experiencing institutional racism (Bryant-Davis, & Ocampo, 2006; Comas-Díaz, 2016). The trauma may result in experiencing symptoms of depression, anxiety, low self-esteem, feelings of humiliation, poor concentration, or irritability.
Effects of Racial Trauma on Communities of Color
Decades of research have noted the impact of discrimination and racism on the psychological health of communities of color (e.g., Bryant-Davis & Ocampo, 2006; Carter & Forsyth, 2009; Comas-Díaz, 2016). Although not everyone who experiences racism and discrimination will develop symptoms of race-based trauma, repeated exposure may lead to the following. According to a report on The Impact of Racial Trauma on African Americans, Dr. Walter Smith notes the following effects of racial trauma:

Increased vigilance and suspicion - Suspicion of social institutions (schools, agencies, government), avoiding eye contact, only trusting persons within our social and family relationship networks

Increased sensitivity to threat - Defensive postures, avoiding new situations, heightened sensitivity to being disrespected and shamed, and avoid taking risks

Increased psychological and physiological symptoms - Unresolved traumas increase chronic stress and decrease immune system functioning, shift brains to limbic system dominance, increase risks for depression and anxiety disorders, and disrupt child development and quality of emotional attachment in family and social relationships

Increased alcohol and drug usage - Drugs and alcohol are initially useful (real and perceived) in managing the pain and danger of unresolved traumas but become their own disease processes when dependency occurs

Increased aggression - Street gangs, domestic violence, defiant behavior, and appearing tough and impenetrable are ways of coping with danger by attempting to control our physical and social environment

Narrowing sense of time - Persons living in a chronic state of danger do not develop a sense of future; do not have long-term goals, and frequently view dying as an expected outcome
Coping with Racial Trauma
Racial trauma or race-based trauma often goes unnoticed. These hidden wounds that adults and youth of color experience are worn like invisible weights. Hardy (2013) provides the following eight steps to heal after experiencing racial injustices in our community.

1. Affirmation and Acknowledgement: This involves professionals helping the individual to develop a sense of understanding acceptance of racial issues. This step is important because it opens the door for us to dialogue about issues related to race.

2. Create Space for Race: Creating space allows an open dialogue with our communities about race. Hardy notes that we must take a proactive role to identify race as a significant variable and talk openly about experiences related to race.

3. Racial Storytelling: Gives individuals an outlet to share personal experiences and think critically about events in their lives. This provides an opportunity to hear others voice how they have been treated differently due to their race and it helps expose hidden wounds through storytelling.

4. Validation: Can be seen as a personalized tool used to counter devaluation. This provides confirmation of the individuals' worth and their redeemable qualities.

5. The Process of Naming: With the scarcity of research on the effects of racial trauma on mental health, there is of course no name as of yet making it a nameless condition. This in turn increases the doubt and uncertainty. By naming these experiences we give individuals a voice to speak on them and also recognize how they impact them. If we apply a mental health condition, individuals may experience symptoms similar to post-traumatic stress disorder (PTSD).

6. Externalize Devaluation: The aim for this step is to have people focus on increasing respect and recognizing that racial events do not lower their self-worth.

7. Counteract Devaluation: This step uses a combination of psychological, emotional, and behavioral resources to build self-esteem and counter racial attacks. This helps prevent future loss of dignity and sense of self.

8. Rechanneling Rage: By rechanneling rage, individuals can learn to gain control of their emotions and not let emotions consume them. This is an important step because it empowers people to keep pushing forward after adversity. This may include taking steps to engage in activism or self-care strategies such as spending time with family.

For related blog posts, check out our blog series on law enforcement in communities of color.
Biographies:
Erlanger A. Turner, PhD, is a Clinical Psychologist and an Assistant Professor of Psychology at the University of Houston-Downtown (UHD) in the College of Humanities and Social Sciences. Dr. Turner's research focuses on access to child mental health services, health inequity, help-seeking attitudes and behaviors, and cultural competency in clinical practice. He teaches courses at UHD in clinical psychology, multicultural psychology, and child psychopathology. Dr. Turner is also a blogger for The Race to Good Health. Dr. Turner is a member of the American Psychological Association and the Association of Black Psychologists. He has served in numerous leadership positions throughout APA and APA Divisions. He earned his B.S. in psychology from Louisiana State University and an M.S. and Ph.D. in clinical psychology from Texas A&M University. Dr. Turner is currently Chair-Elect for the APA Board for the Advancement of Psychology in the Public Interest and he was recently appointment to the Behavioral Health National Project Advisory Committee for the U.S. Department of Health and Human Services, Office of Minority Health.

Jasmine Richardson, BS earned her psychology degree from the University of Houston- Downtown (UHD) and is a former research assistant at the UHD Race, Culture, and Mental Health Research Lab under the supervision of Dr. Turner.
References:
Bryant-Davis, T., & Ocampo, C. (2006). A therapeutic approach to the treatment of racist-incident-based trauma. Journal of Emotional Abuse, 6(4), 1-22.

Carter, R. T., & Forsyth, J. M. (2009). A guide to the forensic assessment of race-based traumatic stress reactions. Journal of the American Academy of Psychiatry and the Law Online, 37(1), 28-40.

Comas-Díaz, L. (2016). Racial trauma recovery: A race-informed therapeutic approach to racial wounds. In Alvarez, A.N. (Ed); Liang, C. T. H. (Ed); Neville, H. A. (Ed), The cost of racism for people of color: Contextualizing experiences of discrimination. Cultural, racial, and ethnic psychology book series (pp. 249-272). Washington, DC, US: American Psychological Association.

Geller, A., Fagan, J., Tyler, T., & Link, B. G. (2014). Aggressive policing and the mental health of young urban men. American Journal Of Public Health, 104(12), 2321-2327

Hardy, K. V. (2013). Healing the Hidden Wounds of Racial Trauma. Reclaiming Children And Youth, 22(1), 24-28.
Image source: Flickr user blogocram via Creative Commons

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Racial Trauma is Real: The Impact of Police Shootings on African Americans

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There have been many changes within the criminal justice system as a means to deter crime and to keep citizens safe. However, research demonstrates that often times men of color are treated harshly which leads to negative perceptions of police officers. The recent shootings in Baton Rouge, Falcon Heights, and Dallas have exposed many individuals...

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This is a survey I conducted among friends and family members which included a variety of races, whites included.

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questions regarding struggles as a minority

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David Eagleman explains the mechanics of the brain and delves into the deepest parts. He explains the meaning behind movements, behaviors, emotions, and even decisions. Eagleman does a great job in teaching readers that the human brain deserves much more credit than it receives.

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David Eagleman, Neuroscientist and author

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In the article "Police Killings Have Harmed Mental Health in Black Communities, Study Finds" The Author, Jon Eligon, a writer for The New York Times, uses the various killings of unarmed African Americans within the country as his main point throughout the article. He also includes data reported by a survey of over 400,000 from the Americans Behavioral Risk Factor Surveillance System, as well as data from “Mapping Police Violence” a website which tracks how many people the police have killed. His argument that the result of these killings has been an overall decrease in morale within African American Communities is backed up by the evidence which he provides.

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A protester with a portrait of Stephon Clark at a demonstration in Sacramento in March after Mr. Clark, who was unarmed, was shot and killed by the police there. Credit... Max Whittaker for The New York Times

Activists for racial justice have long expressed concern that the rash of headline-grabbing police killings of black Americans was damaging the mental well-being of African-American communities.

A report published in The Lancet, a leading British medical journal, on Thursday appears to give credence to those concerns.

Using mental health survey data and a database of police shootings, a team of health researchers concluded that when police officers in the United States kill unarmed black people, it damages the mental health of black Americans living in those states.

The mental health of white Americans was not similarly affected, the researchers found. Nor were negative health effects associated with police killings of unarmed white Americans or armed black Americans.

While these findings might seem unsurprising, particularly to African-Americans, the researchers contended that their study was a significant attempt to assess the measurable, if indirect, harms that police violence has inflicted on the broader psychological and emotional well-being of African-Americans.

"'Having seen something so horrific and traumatic that happened to someone else, I'm reminded in a very painful and salient way that the deck might be stacked against me,'" Atheendar S. Venkataramani, one of the study's authors, said of how black people might perceive police killings. "It's really about all the kinds of insidious ways that structural racism can make people sick."

Dr. Venkataramani, an assistant professor of medical ethics and health policy at the University of Pennsylvania, conducted the study along with Jacob Bor of Boston University, David R. Williams of Harvard and Alexander C. Tsai of Massachusetts General Hospital.

The researchers analyzed responses from 2013 to 2016 to the Behavioral Risk Factor Surveillance System, a national survey that interviews more than 400,000 adults, selected at random each year, about their health. They juxtaposed responses to questions regarding mental health with data from Mapping Police Violence, a database of police killings around the country.

The annual health survey is done by telephone on a rolling basis throughout the year, and the researchers analyzed responses given by residents in states where a police killing had occurred in the three months before they were interviewed. They found that black Americans reported more "not good" mental health days in the period after a police killing of an unarmed black person, and that the killings accounted for up to 1.7 additional days of poor mental health a year.

The study's authors could not say definitively that the respondents to the health survey knew about the police killings that had happened in their states, or describe how, precisely, the news about the killings might have harmed their mental health.

Still, Dr. Venkataramani said the effects were observable and real. If anything, he said, the findings might understate the extent of the trauma, as some police killings of unarmed African-Americans have become events of national significance, reaching far beyond the states where they occurred. (The study cited, among the most notable examples, the police killings of Oscar Grant III in California, in 2009; of Michael Brown Jr. in Missouri and Eric Garner in New York, in 2014; of Walter Scott in South Carolina and Freddie Gray in Maryland, in 2015; and of Stephon Clark in California, earlier this year.)

"Maybe this is the tip of the iceberg," Dr. Venkataramani said.

While a study like this one helps to underscore the impact of police killings on black communities, what's important is what is done with the findings, said Mama Ayanna Mashama, an activist and organizer in Oakland, Calif., who practices natural wellness healing. Ms. Mashama said she had seen firsthand how police violence can cause anger and angst, and damage the self-esteem of black Americans.

"We have to find ways of de-escalating police response to black people," she said. "It has to become policy. It has to become part of how it's implemented from the top down. We have to have trauma-informed practices everywhere: in the schools, in families, in workplaces."

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Police Killings Have Harmed Mental Health in Black Communities, Study Finds (Published 2018)

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Activists for racial justice have long expressed concern that the rash of headline-grabbing police killings of black Americans was damaging the mental well-being of African-American communities. A report published in The Lancet, a leading British medical journal, on Thursday appears to give credence to those concerns.

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The article "Toxic Exposure: The Impact of Racial Inequality on The Brain" Is similar to many of the previous articles which I've used. A majority of the articles highlight the effects that prejudice can have on the mind of the victims. It highlights the various mental health issues which are a result from prejudice.

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This is part of our ongoing of blog posts about race, racism and law enforcement in communities of color.
By April D. Thames, PhD (Assistant Professor, University of California Los Angeles)
National media coverage of various troubling incidents have sparked outrage and forced the conversation of race relations and biases within the justice system against individuals of color. These include the Ferguson protests of the shooting of Michael Brown, an unarmed teenager, by a police officer; the brutal beating of Marlene Pinnock, a homeless grandmother, by a California Highway Patrol officer; and the harassment and arrest of Arizona State University Professor Ersula Ore for jaywalking. We know that psychology has much to contribute to the discussion of racial inequalities and the unresolved conflict of race in America. For further reading on this issue, see "Taking a Stand Against Racism: A Time to Act".

While the tragic consequences associated with racial inequality, discrimination and racial profiling are emphasized and highly publicized; the cognitive outcomes receive far less attention. Research shows that perceiving discrimination against oneself is detrimental to mental and physical health, including significantly heightening stress responses (Pascoe & Richman, 2009). Studies conducted by Drs. Landfield and Sapolsky in the late 1970s and early 1980s were among the first to demonstrate how stress results in the loss of neurons in a brain region that is involved in learning and memory (i.e., the hippocampus). It is thought that chronic stress exposure may also lead to either chronic hyperarousal or dissociation, both symptoms that are associated with post-traumatic stress disorder.

A recent study in Molecular Psychiatry uncovered how chronic stress creates long-lasting changes in brain structure (Chetty et al., 2014). Dr. Daniela Kaufer from UC Berkeley and colleagues discovered that chronic stress and elevated levels of cortisol increased production of ogliodendrocytes (cells that protect and insulate neurons) and decreased the number of stem cells that mature into neurons within the hippocampus. The overproduction of ogliodendrocytes is thought to be responsible for the long-term and perhaps permanent changes in the brain that could set the stage for later mental problems and problems with learning and memory. While neuroscientists are discovering multiple ways that general chronic stress affects the brain, fewer studies have focused on the effects of chronic race-related stressors.

In addition to changes in brain structure, derisive terms such as " Driving While Black " reveal the day-to-day stress among racial minorities of knowing that their skin color is "evidence" to some of the propensity to commit crime. Researchers have demonstrated how race-related anxiety surrounding negative judgment about performance and discrimination is associated with lower cognitive performance among Black participants (but not White participants). This impacts a number of cognitive processes that include attention/working memory, learning and memory and executive functioning (Barnes et al., 2012; Thames, 2013; 2014). These results suggest that in some cases test performance may not represent actual brain functioning among ethnic/racial groups, but rather race-related anxiety about their test performance.

Although the precise interaction between psychosocial stress, brain function and cognitive outcomes still remain to be fully understood, the growing evidence suggests that individuals of color may be at risk for poor cognitive outcomes due to stressors that are tied to self-identified race/ethnicity including the stress of discrimination. Hence, it is time for scientists, mental health professionals, and policy-makers to " Stand Our Ground " and deal with the toxicity of racial inequality that not only impacts the individual, but society as a whole. These are critical issues that we simply cannot ignore, or hope that they will somehow disappear.
References:
Barnes, L. L., Lewis, T. T., Begeny, C. T., Yu, L., Bennett, D. A., & Wilson, R. S. (2012). Perceived discrimination and cognition in older African Americans. Journal of the International Neuropsychological Society, 18(05), 856-865.

Chetty, S., Friedman, A.R, Taravosh-Lahn, K., Kirby, E.D., Mirescu, F., Guo,D.....Kaufer, D. (2014). Stress and glucocorticoids promote oligodendrogenesis in the adult hippocampus. Molecular Psychiatry. doi:10.10138/mp.2013.190.

Landfield, P. W., Waymire, J. C., & Lynch, G. (1978) Hippocampal aging and adrenocorticoids: Quantitative correlations. Science, 202(4372):1098-1102.

Neville, H., & Rom-Rymer (2013). Taking a stand against racism: A time to act. American Psychological Association. http://www.peacepsych.org/images/Trayvon_Martin_Statement_Final_10-31-13.pdf

Pascoe, E. A., & Richman, L. S. (2009). Perceived discrimination and health: A meta-analytic review. Psychological Bulletin, 135, 531-554.

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Thames, A. D., Hinkin, C. H., Byrd, D. A., Bilder, R. M., Duff, K. J., Mindt, M. R., ... & Streiff, V. (2013). Effects of stereotype threat, perceived discrimination, and examiner race on neuropsychological performance: Simple as black and white? Journal of the International Neuropsychological Society, 19(05), 583-593.

Thames, A.D., Panos, S.E., Arentoft, A., Byrd, D.A., Hinkin, C.H., Arbid, N. (2014). Mild test anxiety influences neurocognitive performance among African American and European Americans: Identifying interfering and facilitating sources. Cultural Diversity and Ethnic Minority Psychology [E-pub ahead of print]. http://psycnet.apa.org/index.cfm?fa=buy.optionToBuy&id=2014-32911-001
Biography:
Dr. April Thames is an Assistant Professor and Clinical Neuropsychologist in the Department of Psychiatry and Biobehavioral Sciences at the University of California Los Angeles. Dr. Thames has an active research program (supported by NIH) that focuses on the neurological and neuropsychological effects of aging, infectious diseases, and substance abuse on "real world" functional outcomes among underrepresented groups (e.g., ethnic/racial minorities, low SES). Her recent work has demonstrated how psychosocial factors (e.g., stereotype threat) impact neuropsychological performance among African Americans. She is currently Chair of Division 40's ( Society for Clinical Neuropsychology) Ethnic Minority Affairs Subcommittee and serves as a liaison for APA's Committee for Ethnic Minority Affairs.
Image source: iStockPhoto

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Toxic Exposure: The Impact of Racial Inequality on the Brain

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This is part of our ongoing series of blog posts about race, racism and law enforcement in communities of color. By April D. Thames, PhD (Assistant Professor, University of California Los Angeles) National media coverage of various troubling incidents have sparked outrage and forced the conversation of race relations and biases within the justice system against individuals of...