New insight from a Washington University study could improve access to mental health care for African-American men.
Wash U professor Darrell Hudson organized a series of focus groups in north St. Louis in 2014, which occurred before and after Michael Brown's death in Ferguson. Racism, both overt and structural, emerged as a major source of stress in the men's lives — so much so that authors titled the study “Racism?!?... Just Look at our Neighborhoods.”
St. Louis Public Radio’s Durrie Bouscaren spoke with Hudson, who teaches public health to master's degree students, to hear more about those conversations. Here are some highlights, edited for length and clarity:
On how men in north St. Louis experience racism
HUDSON: The biggest thing to me is the structural racism. African-American men in the groups that participated wanted to be productive citizens, and they wanted to be good fathers, they wanted to be good husbands and partners. Many of them felt like they didn’t have the opportunity to do so, whether that be because of the educational system in which they were schooled, whether it be because of a lack of employment opportunities or a lack of transportation options to get to employment opportunities.
One man that was in the focus group, I’ll never forget what he said: “I feel like I’m a Ninja Turtle.” Meaning that he felt like he had been depressed all of his life, from all the things that happened to him in terms of exposure to trauma, losing people close to him to premature death ... financial strain, not having opportunities to provide for his family. All of those things put him in a constant, perilous situation in his eyes, and he felt quite overwhelmed, often. And so he said, “I feel like I’m a Ninja Turtle. And I feel like I’ve been in the sewers for my entire life.”
For men who had come off the track somehow, where their expectations weren’t met in terms of what they thought life would be, they could pinpoint things that happened either in early childhood or adolescence that they felt like derailed them.
On the 'significant impact' of St. Louis' disparities in education, criminal justice
HUDSON: In terms of educational equality, a number of men had attended different types of schools, and they could see the differences in quality of schools and differences in quality of education. A lot of them wondered out loud what life would have been like if they had attended a school in a different area.
There were differences in sentencing. I wasn’t thinking about criminal justice, but that was a major, salient issue in this group. People talked a lot about being monitored or being harassed by police.
People talked about being exposed to overt forms of racism at an early age, being called names, being harassed by different types of people, and those things making a significant impact on them for a long period of time.
On discrimination's toxic effect on health
HUDSON: Discrimination is bad for your health in a number of different ways. Can you imagine being unfairly denied a job promotion or not being hired because of your race, or someone following you in the store? Those things are weighty in terms of mental health. So people ruminate on those experiences — not just in the short term, but over a long period of time. There’s this vigilance that occurs when people are exposed to discrimination. The accumulation of all those stressors can lead to atherosclerosis (heart problems) or high blood pressure, differences in sleep quality, even.
People talked about positive coping mechanisms, like church or spirituality. But also people talked about self-medication — using alcohol or using marijuana as a way to cope with the overwhelming amount of stress that people were under. Our average age was about 43, so many men in our group talked about how they didn’t want to do those things anymore; they didn’t find those things to be helpful long-term.
On finding openness to counseling and treatment
HUDSON: A lot of things didn’t surprise me. From a personal standpoint, growing up in Detroit and seeing some of the things I saw growing up, a lot of the things the men in our groups said didn’t really surprise me.
One thing that was certainly interesting was people’s willingness to talk about mental health, and people wanting to talk about stress, and their desire to find positive coping outlets. A lot of people think African-American men won’t talk about stress and depression, and that’s certainly not true.
Almost to a man, everyone in our groups said that they would be open to seeking treatment, under certain circumstances. They either didn’t know how to get treatment because they didn’t know if they were covered or they knew they weren’t covered. They didn’t want to be judged by providers — educationally, culturally — they didn’t like somebody sitting across from them, not saying anything, not sharing anything, and writing things down. They felt judged. And they knew that the providers didn’t necessarily relate with the lives that they lived, they didn’t live in the neighborhoods that they lived in.
They did say that they would find it advantageous to participate in social support groups. A number of participants described their experiences with organizations like Narcotics Anonymous and Alcoholics Anonymous and said they saw value in that, and they felt like it was less judgmental than participating in formal mental health services. So I think there's natural networks that exist in this region, where we can strengthen those.
Some men said, "We would love to participate in more focus groups. When's the next focus group?" They wanted to keep on talking. They enjoyed being heard, because oftentimes people didn't ask them what they thought about anything. So they enjoyed the fact that people were listening, they enjoyed bouncing ideas off each other. People found support.
On what he hopes comes from the study
HUDSON: I would hope this is another piece of evidence to indicate, "We do have to do something about structural racism, that it’s not enough to give lip service, but we have to actually do something." African-American men are underserved in regard to mental health services. There’s a lot of different reasons as to why — some of it could be stigma, some of it could be their interactions with providers. So I wanted to figure out, what could we be doing to get people who might need help into services?
I have a number of different papers that will come out of this data. Some will focus more on mental health and perceptions of mental health care. Others will focus on masculinity. I’ve just started collaboration with a couple other faculty members at the Brown School — called it Collaboration on Race, Inequality and Social Mobility in America. So we’ll be studying these issues and trying to come up with solutions to the very questions that we’re asking, trying to figure out why do these inequalities exist, and not only that, but what can we do about them?
Follow Durrie on Twitter: @durrieB.