Mental health’s racial gap

Sharkisha Cummins found herself struggling simultaneously with depression and the difficulty of communicating with her white therapist.

“There were just too many ways that I just wasn’t (being) heard or seen or validated,” says Cummins, the married Black mother of two small children. “She was a nice lady, (but) she just didn’t understand.”

Blacks, Latinos and other people of color often have difficulty finding mental health therapists with whom they can form close bonds that are essential to healing.

“All people at one time or another do not feel well-served by the mental health system,” says Heather Newton, CEO of NAMI Rochester, the local chapter of the National Alliance on Mental Illness. “People who identify with historically underserved populations … have an even harder time finding people within the field who they can really identify with and connect with.”

Lack of minority representation among local mental health therapists could contribute to the problem.

“Many people of color kind of have to make the assumption, when it comes to mental health treatment, they will not see someone who resembles them or has their similar cultural and racial and ethnic orientation,” says Michael Boucher, co-director of counseling and community work at St. Joseph’s Neighborhood Center.

The challenge is widespread. Almost 80 percent of psychologists, nearly 67 percent of licensed social workers and just over 64 percent of psychiatrists in the U.S. identify as white. Given that members of one or another minority group account for 25 percent of the U.S. population, they could easily find it difficult to find mental health therapy when they need it.

Blacks, Hispanics/Latinos and other members of minority groups who make up more than 33 percent of Monroe County’s population can encounter similar problems. For example, of Catholic Charities Family and Community Services’ Integrated Mental Health & Addictions Clinic’s 25 mental health providers, 80 percent are white. At SJNC, no more than 25 percent of the nine mental health therapists and interns are BIPOC (Black, Indigenous and People of Color).

Notable differences

Such imbalances can limit the abilities of Blacks, Hispanics, Latinos and members of other minority groups to bond with their therapists.

“Part of making that connection is knowing that they understand where you’re coming from and why you see things the way you do or how you put things the way you do,” says Melanie Funchess, CEO and principal of Ubuntu Village Works, which creates culturally responsive healing spaces for people of color, especially those of the African diaspora.

People of color also carry the burdens of systemic and individual acts of racism.

“We’re carrying all these extra bags that our white counterparts don’t carry,” Funchess says. “We’ve got to judge every encounter on ‘Is this going to be safe?’”

That can create a gap between white therapists and people of color. The formal training that therapists undergo may widen it.

“All of that teaching is based on a dominant culture, a European cultural narrative,” Funchess says. “People of color do not operate under that narrative.”

As a result, therapists may be unprepared to discern differences between pathological behaviors and those common to people from dissimilar cultures and backgrounds. Telva Olivares says it is considered “almost normal” in many Latino cultures to hallucinate about dead relatives as part of the grieving process.

“This is common in a lot of Latinos, and it’s not necessarily pathological,” says Olivares, who heads Lazos Fuertes, a University of Rochester Medical Center mental health care program for Spanish-speaking and Latino patients.

Those not familiar with Latino cultures have sometimes misinterpreted the hallucinations as indicative of schizophrenia or other maladies, and unnecessarily prescribed medications for their patients.

“I have seen it be pathologized, and be treated with psychotropic medications, and (the hallucinations) have not gone away,” Olivares says.

Such mistakes can compound the negative feelings that some members of minority groups might already have about seeking mental health treatment.

“African Americans have been taught at an early age ‘what happens at home stays at home,’” says Stephanie Jackman, a Black woman and licensed clinical social worker who heads a small mental health treatment practice under her name. “We’ve just pretty much been conditioned to kind of keep our feelings and emotions within ourselves.”

Overcoming barriers

Rochester-area organizations and mental health therapists strive to overcome such barriers. Healing Village, an Ubuntu Village Works program, trains mental health therapists in an indigenous psychotherapy model that has been specifically developed for the treatment of people of the African diaspora.

“You help the clinician to gain new skills and learn how to work in a different way,” Funchess says. “A big part of it is them understanding themselves, their own biases and who they are … so they can bring a more full self into the work.”

Since Ubuntu Village Works began offering the three-month program a year ago, 65 clinicians have completed it, including some of the therapists at SJNC. Boucher is one of them.

“One of the ways that Melanie’s work has influenced me is to remind me to constantly ask the question, ‘Whose experience/worldview is being centered in this intervention, idea or action, and does what am I doing support Black resilience and healing?’” she says.

Boucher has also adapted his counseling techniques to make them more effective with people of color. He sometimes brings up his own race in order to give a client a chance to voice any concerns about working with a white man.

“It gives us permission to speak about race in the room,” he says. “Clients wouldn’t always assume that that’s an OK thing to do because of the (therapist-client) power differential.”

SJNC has sought to diversify its pool of clinicians, but the going has been tough.

“We would love to have a Spanish-speaking clinician in place … but have not had candidates apply,” Boucher says.

Olivares saw early in her career the need for mental health services for the area’s Spanish-speaking population. Using interpreters to facilitate treatment just wouldn’t do.

“Psychiatry is all about having a relationship that you use to improve these people’s lives,” she says. “Through interpreters, you can’t make a lasting relationship with patients.”

Olivares created Lazos Fuertes (“strong ties” in English) in 1999 to meet that need. Her 10-person staff, including the licensed clinical social workers, psychologists, interns, the post-doctoral fellow and the psychiatrist herself, are bilingual in English and Spanish.

“We are probably the only bilingual, and mostly bicultural, mental health care service in Upstate New York,” Olivares says.

Most of the approximately 400 patients on the nonprofit’s roster identify as Spanish-language speakers or expressed the desire to be treated by Latino therapists.

Only five of the mental health providers at Catholic Charities Family and Community Services’ Integrated Clinic identify as Hispanic, Black or Asian, but all of its clinical staff have undergone training to help them overcome the problems that racial or cultural differences could cause in therapy.

“Our clinicians are versed and have professional training in cultural competency,” says Jamie-Lynn Bishop, the clinic’s associate director. “They’re given the groundwork for how to work together with folks of varying cultural backgrounds.”

Bishop says that any problems that emerge in therapy can be dealt with during the regular sessions that the clinic’s supervisors hold with the clinicians under them, and in the monthly meetings of its diversity, equity, and inclusion committee.

The Integrated Clinic also used to provide training sessions that were designed to help its clinical staff meet the needs of minority populations. Those were suspended during the pandemic, but the nonprofit hopes to restart them.

Dealing with trauma

As a Black woman and a therapist who has practiced for 17 years, Jackman recognizes the impact of society on minorities.

“When they have pressured speech and (are) speaking animatedly and loudly, I know they’re not angry at me,” she says. “They’re angry at the trauma which they’ve had to experience.”

The pandemic increased that trauma, as did the deaths of two Black men who were in police custody in 2020—George Floyd in Minneapolis and Daniel Prude in Rochester. Their deaths sparked days of protest in Rochester, some of which turned violent.

“It was a collective degree of trauma, because we all know an African American male that could’ve been Mr. Prude (and) could’ve been Mr. Floyd,” Jackman says.

The multiple traumas doubled Jackman’s roster of clients, forcing her to hire more staff. She now has three clinicians working under her, one of whom is Black. About 75 percent of the practice’s approximately 80 clients are Black.

Cummins is one of them. When she and her husband, who is white, lived in Silver Springs, a small village in Wyoming County, their small children had to endure scrutiny because they are mixed-race. After the family moved to the Rochester area roughly a year ago, Cummins feared they might be mistreated in the Penfield school in which they were enrolled, which is almost all white.

In addition, the deaths of Floyd, Prude and other Black people at the hands of police left Cummins feeling nervous whenever she saw a police car in her rearview mirror. She found herself struggling with depression, and turned to a white therapist for help.

Cummins found the therapist to be a nice person, but the woman couldn’t understand why she was so disturbed by the deaths of Black people she didn’t know.

“These are people who look like me, who could be my son, my daughter,” Cummins says. “I was trying to explain that to her, and I don’t think she got it.”

The therapist also encouraged Cummins to see the local police as being there for her safety, and that her odds of being mistreated by them were low.

“Those kinds of words are triggering for me, because it doesn’t matter, I feel, if I’m a law-abiding citizen or not,” she says.

Cummins gave up trying to make her white therapist understand her feelings and began looking for someone who is Black. After a great deal of searching, she found Jackman.

“It’s so much of a relief,” Cummins says, “having someone who gets, like, ‘I know why you’re upset, I understand the fear, and these are things that you can do (that) can help you feel less fear.’” Cummins says.

Mike Costanza is a Rochester Beacon contributing writer. The Beacon welcomes comments from readers who adhere to our comment policy including use of their full, real name.