yegthecomeup.com

THE COME UP

The surge in awareness and research on mental health over the last few years has been encouraging to see. It’s not unusual to log onto Twitter and be met with a thread on symptoms of anxiety, or ways to support a loved one with bipolar disorder, or how watching Beyoncé’s Black is King can cure mild depression. However, there remains a significant lack of awareness and research available specifically on the mental health of youth of African, Black, and Caribbean (ABC) descent. This is why research projects such as the one conducted by Dr. Bukola Salami and her team are of critical importance. On top of analyzing the reasons why the gap in research exists in the first place, Dr. Salami and her team propose practical recommendations on improving the mental health of our ABC communities from policy-making to community action. 

FACTORS IMPACTING MENTAL HEALTH

Poor mental health has negative effects on physical health and social outcomes and these effects are even more pronounced in ABC youths (Anderson et al., 2015). Over the course of 7 months, researchers conducted interviews with ABC youths with the aim of understanding why ABC youth have a greater risk of poor mental health, as well as the factors that contribute to such poor outcomes (while making sure to centralize youths’ perspectives throughout). This project holistically investigated the mental health needs of ABC youth with the goal of developing culturally relevant strategies and policies to cater to ABC youths’ needs, as well as making mental health services more accessible.

The team identified four factors as being the most prevalent in contributing to poor mental health:


Cultural Expectations

These include academic pressures and social stress from relationships. Education and family relationships are both highly valued in ABC communities. Because many ABC parents emphasize the importance of education, youth may experience extreme pressure to do well in school. These effects may be even more severe due to the culture of academia, where students are valued for their grades rather than the effort they put into their work.

The other cultural expectation of maintaining relationships (including but not exclusive to family and friends) is another aspect that has a negative impact on mental health; youth feel obligated to support and be available for the people in their social spheres, even though they lack the mental/emotional capacity to do so at times. A participant describes the struggle of balancing their own mental health needs and the expectation of supporting a family member at the same time:

“How do you balance your own mental health and knowing that, like, your sister almost had a mental breakdown? And you don’t want that to happen to her again, so it’s like I still have to be there for her too. So it’s just juggling both. And then it’s like no one knows that I’m going through this…”

Racism and Discrimination

Experiences of racism at a young age resulted in internalized racism; this caused unnecessary stress in their daily life that their white/non-racialized counterparts did not experience. Feelings of insecurity, self-loathing, inferiority and detachment from their community were expressed by several participants.

Also, the constant awareness of participants’ racial identity places a standard they feel they must adhere to; they feel like they must overperform, overcompensate or completely align with societal expectations of Blackness.

Even within ABC communities, the systematic nature of racism manifests itself; sentiments of colourism and anti-Blackness are prevalent and shape communal conceptions of self-worth, desirability, idealism and preferences.

Outside ABC communities, participants experienced microaggressions (defined as instances when behavior, verbal and non-verbal cues suggest racist sentiments). These encounters make it difficult for youth to maneuver and navigate predominantly White spaces. One individual described how microaggressions can induce a feeling of being out of place:

The ones that even say like, ‘Oh I’m not racist.’ But, you know, it’s not… like I feel there’s just this disconnect. Being racist is not just saying the N word. By the way you treat me, microaggressions are a big one…” 

Essentially, racism and discrimination permeate through various sectors of society and have a detrimental effect on the mental health of ABC youth. 

Openness About Mental Health
The ability to be open and honest about mental health has a positive impact on overall mental health. If we can speak openly about mental health, we avoid the buildup of issues that may otherwise cause mental health to deteriorate even further.

In the words of an interviewee;

“I talk to ‘X’ about my mental health, and like, that has a positive experience on my mental health… it helps me get through it…”


Establishing a Sense of Community Belonging

The cohesiveness and ability to connect with other ABC individuals allows for youth to feel comfortable within themselves and has a positive influence on mental health. In this study researchers made use of conversation cafes, which were essentially a safe space where ABC youth could comfortably share thoughts and opinions on sensitive topics. The positive effects of community belonging were evident even as interviews were being conducted in these cafes; participants fostered connections with others who had similar experiences as well as built understanding with others who had different experiences. They also indicated a strong interest to continue conversation cafes as they provided them with a sense of belonging.

Each of these factors had implications for academic performance, the status of relationships, willingness to speak about mental health, and overall connections with their communities.

BARRIERS TO ACCESSING MENTAL HEALTH SERVICES

One main goal of this project was to identify the barriers that ABC youth face while trying to access mental health services. Both formal and informal barriers were listed as preventing access to such services.

Cost of Mental Health Services
To the majority of youth, mental health was classified as a luxury, something outside of their financial reach. Further, some participants mentioned that the cost of the academic/technical programs they are enrolled in, as well as the costs associated with supporting their families, often took precedence over their mental health. In the words of one participant;

And do I know I’m not making as much. I’m making enough. And then when you contribute that on top to help out the family, there’s not that much left sometimes to like, go for services, to like for health services.”

Evidently, the youth perceived mental health services as a system designed for the wealthy, a category that not many ABC youth could identify with.

Geographical Barriers
The location of mental health services are not accessible to ABC youth either because they are not located in Black-dominated areas or are inaccessible by public transportation. One participant shared the following words, whose sentiments were echoed by several others;

If it’s in my neighborhood I feel like it’s I want to go there, because it’s in my neighbourhood. It’s… and they probably thought about me when they were making it.”

The inaccessibility of mental health services gives many ABC youth a sense of otherness that makes seeking mental health services very unappealing, despite the services being meant to be open spaces for healing.


Lack of ABC Representation

A lack of ABC representation is apparent across industries, but it becomes especially apparent within mental health service providers due to the severe lack of diversity. ABC youth prefer dealing with mental health service providers who are ABC themselves, as they have an increased understanding of the ABC community, its values and dynamics.

One participant shared her perspective on this issue;

Like whatever I’m going though, a lot of it will have something to do with … my life as a Black woman, as an immigrant….as an African woman. And I… never want to feel like my experiences are…not valid. … I need you to understand my life.”


ABC youth often find themselves having to translate their experiences to a lens that is not their own, so that outsiders can try to understand them. This task is viewed as an added stress and emotional labour that youth would like to avoid. There is a need for more ABC professionals in general, but it became clear that more female ABC mental health service providers are especially needed.

Minimal (at best) cultural training and a predominance of non-ABC mental health professionals results in a system of health professionals that are ill-equipped to comprehensively deal with the needs of ABC youth.


Lack of Knowledge on Mental Health and Services

Individuals cannot access services they do not know exist. A lack of promotion of the available mental health services, combined with some ABC communities’ negative perceptions towards these services, have led to this lack of knowledge. One youth explained the cultural aspect as such:


I feel like there just might be a fear, because of the limited perceptions they have of mental health. So they have like one sort of like little idea, like, “Oh, like one time I heard like this person with schizophrenia lashed out and killed somebody.” You know what I mean? And they sort of just run with that story, and like that’s what they think of mental health or mental illness as a whole. So yeah.”


Stigma and Judgmentalism
ABC youth experienced more stigma against the mental health system within their communities than is typically found in the dominant Western culture. Some ABC youth reported that they are sometimes treated differently by their communities if they utilize mental health services or even openly acknowledge the presence of mental health problems. Speaking about the tendency to ostracize such people, one youth said the following;


They kind of exclude people with mental health issues most of the time, so it’s like an outcast from the rest of the family or community. And yeah, I guess that’s really, really it”.


A lack of knowledge on the nature of mental health is a main underlying factor for the stigma that people have with the ABC community.


Intergenerational Gap

Although the culture surrounding mental health in mainstream media is becoming more accepting, this change is far less prevalent in older generations. These generations were not exposed to mental health and its related topics, and so there is a gap in understanding of mental health between youth and adults; because of this, the stigma towards mental health issues continues to be perpetuated. In the words of one youth, “They don’t know mental health because they’ve only known like civil war and like running away, and like you got to move on.”


Culture of Independence
In such a culture, self-reliance is emphasized – the individual shoulders the full burden of everyday life by themselves.

Interestingly, this factor has two main effects on the ways youth seek support:

  • Youth rely too much on their informal support instead of seeking mental health help.

  • Youth rely too little on their informal support, and rely on themselves instead.

Although these two coping strategies seem contradictory, they are both produced because of an eagerness to avoid burdening others. Youth who self-rely feel that they are a burden if they relay their struggles to anyone at all, while youth who rely too much on informal support are trying to avoid being a burden on their family.

Even more interesting is the fact that youth do not cite this same sense of burden when dealing with physical health, viewing physical health as a more acceptable reason to ask for help. They feel that mental health problems are not a valid reason to push past this culture of independence and ask for help (but have no problem pushing past this culture of independence for physical health issues).

SELF-STRATEGIES

Because youth don’t have access to mental health services, they developed strategies to alleviate their mental health struggles.


Peer Supports

Participants valued the support and insight of people who experienced similar mental health issues or were willing to provide comfort. Communicating problems with their peers is one way that ABC youth cope with mental health struggles.

This strategy has proven to be beneficial; participants share their mental health struggles with peers who they trust and feel are non-judgmental as mental health is a personal matter to them.


Religious Teachings and Practices

These values and teachings are instilled in ABC youth, as most immigrant communities have some form of higher belief. During hard times, the youth explained that they turn to these teachings to alleviate the issues they face. However, they also seemed to recognize that religious practices alone were not sufficient to combat struggles related to mental illness- this led them to seek out the help of formal services. One participant explained how the use of prayer helped them come to this realization:


I mean, I agree that prayer can help, but I also feel as if you need to have that interaction with like friends and family, or just like that support, like from a mental health professional, for example. But I feel like if you need it, then you need it. Sometimes… like me, I’m just like, “Doesn’t prayer point you to those like signs?” [Laughs] Like if you’re praying and you’re like, “Oh, my goodness, like I need help with this,” and that kind of stuff, and then you have access to a mental health resource, maybe that’s where the prayer is pointing you to, you know?”


Self-Imposed Isolation

Isolation was another method that youth coped with mental health issues. Importantly, although they recognized this method’s potential to worsen mental health struggles, the stigma surrounding mental health and the lack of trust in other services lead individuals to isolate themselves.


RECOMMENDATIONS 

Based on the findings in the previous sections, the researchers proposed recommendations for policymakers, service providers, and ABC communities. 


Policy-Makers

Subsidize the cost of mental health services by providing funding for ABC communities. 

This would ensure free community-based services that factor in the influence of anti-Black racism on the health of ABC youth.

Address socioeconomic outcomes of ABC communities.

Youth cannot access services because they are costly. Further, an underlying reason that youth feel the pressure to over-perform in school is that even after earning a university degree, they still face barriers to economic success. By over-performing, youth may feel that they are putting themselves in a better position in future; the better they do in school, the more likely they can secure a well-paying job in future and alleviate some of the financial burden that they themselves or their families face.

Policy makers should address systemic racism and barriers faced by ABC youth in all stages of the education system. Specifically they should address the unconscious bias that predisposes ABC youth to be advised against pursuing university education, microaggression faced by ABC youth in academic institutions, and selection barriers to upward career mobility in ABC youth. Simply put, Canada needs a policy focused on addressing anti-Black racism.

Implement mental health into the school curricula.

There needs to be an earlier introduction to mental wellness, preferably in elementary education curricula. This will lead to youth becoming more familiar with the concept of mental health long before they may experience any related issues. They will then be better equipped to recognize within themselves if they are experiencing a mental health crisis.

Provide campaigns/programs aimed at increasing knowledge of mental health, targeted at immigrant communities.

Media campaigns should be designed by policy-makers via television/radio broadcasting, pamphlets, advertisements, etc. These must target the ABC community in such a way that the information is readily accessible.

Addressing the barriers to ABC access to mental health professions.

The lack of representation in the mental health field can deter ABC youth from accessing the services they need. Policy makers must address the systemic racism that ABC mental health professionals face, prioritize admitting ABC youth into mental health programs by considering both academic and community strengths, increase access to educational funding opportunities and address systemic barriers (such as limited finances) to accessing the profession.

Fund safe spaces for ABC youth.

ABC youth emphasized the need for safe spaces that address youth mental health. Such spaces should be youth-led, participatory and located in an accessible location


Mental Health Service Providers

Develop cultural competency training programs for mental health professionals, with components on anti-Black racism.

Youth perceive a lack of cultural competency within the services available, and so they find it difficult to seek out these services. There is an urgent need for the development of training programs that equip professionals with the necessary skills to assist ABC youth. These programs must move beyond an essentialist perspective of Blackness and instead acknowledge the diversity of ABC youth.

Hire more ABC service providers.

An increase in the representation of ABC therapists, counsellors and psychiatrists will promote the uptake of services.

Provide easily accessible information on the types of services available.

The data from this study showed several times that participants did not access services because they were unaware of their variety, as well as how to seek them out. Hence, service providers must actively deliver information about the services they offer in a way that targets ABC youth communities

Partner with ABC communities.

Service providers must engage with ABC communities to establish and strengthen connections with those who may need the services. They must also be willing to reduce the cultural insensitivities that participants have described facing.

Increase services available in predominantly Black areas.

Delivering mental health services in areas where Black youths congregate, such as recreational centers and malls in Black-dominated areas, will support the access and use of these services

Develop services and programs that address specific needs of ABC youth.

ABC youth have unique needs due to the influence of anti-black racism on their lives. Intersectional experience and anti-Black racism should be considered within service delivery and programs.


ABC Communities

Create mental health spaces within the community.

Community leaders should aim to create spaces where youth can seek the support and socialization of their peers, as well as participate in extracurricular activities as a way of improving their mental health. These spaces will also help reduce the stigma surrounding mental health.

Reach out to the community to participate in mental health activities.

ABC communities should encourage both elders and youth to participate in relevant workshops/seminars/community events. This will strengthen community ties.

Develop mentor relationships.

Successful professionals within the mental health fields, although few and far between, are valuable resources. ABC youth could benefit from the mentorship they could provide.

Strengthen intergenerational relationships.

Tensions in the intergenerational relationships between ABC youth and parents have an influence on their mental health. Parents need to be educated about the youth’s mental health. Community and religious leaders need to integrate mental health into the work they do in the community (including sermons and religious teachings).

Integrate an intersectionality perspective.

The conversation cafes emphasized the need to support non-binary youth who may experience increased mental health vulnerabilities. We need broader discussion and education on the mental health of LGBTQ2+ individuals within the ABC community.


CONCLUSION

African, Black, and Caribbean youth in Canada experience poorer mental health outcomes than their non-Black counterparts. This research project revealed why:

  • Systemic and cultural barriers that are underlain by the presence of stigma

  • Limited knowledge of mental health

  • Inequities within the current health system

All these factors lead to less use and uptake of the services available. Further research should investigate the nuanced factors that contribute to these poorer outcomes.

Increasing the knowledge of mental health, diversifying the workforce to increase ABC representation, increasing availability of free mental health services and creating Black mental health safe spaces are strategies with immense potential to improve the mental health outcomes of ABC youth.

Our Little Black Book is a great place to start; curated with you in mind, it has several wellness resources to support you in your journey to improved mental health. For those in the position to do so, hiring more ABC service providers is a crucial step in further increasing the availability of these resources.

References

  1. Anderson, K.K., Cheng, J., Susser, E., Mckenzie, K.J., & Kurdyak, P. (2015). Incidence of psychotic disorders among first-generation immigrants and refugees in Ontario. Canadian Medical Association Journal, 187(9), E279-E286. https://doi: 10.1503/cmaj.141420