How Racism Affects Mental Health — & What We Can Do About It

The Black Lives Matter movement may have started as a protest against police brutality, but it has since grown into a much broader discussion about how racism infects the lives of people of color on a daily basis — and that includes their physical and mental health. For decades, researchers have been interested in the health impacts of racism. They've found that experiencing racism is associated with higher blood pressure and other elevated measures of stress.
And, more recently, a 2015 review published in Plos One looked at data from close to 300 studies on the topic and found that people's experiences with racism were undoubtedly linked to poorer mental health outcomes, including higher rates of depression, anxiety, and stress. Especially in light of the recent suicide of Black Lives Matter activist MarShawn M. McCarrel II, there's also growing concern about the toll of existing in a world full of discrimination — on top of the toll of trying to change things. Yet, as clear as it is that people of color are at a greater risk for mental health issues, these communities also tend to have even less access to the necessary support and care. When Refinery29 asked Jules P. Harrell, PhD, a psychologist and researcher at Howard University, about the state of mental health care for minorities, he put it this way: "It’s that old adage: If the general population has a cold, then minority groups have pneumonia. And we know it’s very bad for the general population — mental health is being neglected." Ahead is a lightly edited and condensed version of our conversation with Dr. Harrell about how the various layers of ingrained racism in our society contribute to and perpetuate poor mental health — and why changing that requires tackling racism itself.

How does prejudice affect mental health?
"Prejudice is an individualized phenomenon that we say is [on a spectrum from] ‘attitudinal to behavioral.’ So, in other words, people have certain thoughts and feelings, and sometimes they act on them; sometimes they don’t. And, of course, being on the receiving end of that causes a certain level of discomfort. At the very worst, it makes people devalue themselves. "But the thing with racism is that it’s much broader than that. It can be at the individual level, but it can move up to the institutional, cultural, and structural levels also. And with each one of those levels, it becomes more and more subtle. But all of them can have negative effects on one’s overall sense of wellbeing. "A lot of times, what people think about with prejudice and racism is the sort of stress phenomenon — somebody says something or denies you a job, and you feel devalued by it. But with the other forms, like cultural racism, you have an implicit devaluing of one’s history or culture. Or even the structural forms: You can have much more complex situations where there’s what we call ‘racialized outcomes,’ like the incarceration rates and unemployment rates. They tend to look really bad for the particular group that’s on the receiving end. And sometimes, the person doesn’t realize that they’re thinking about it, but it can lead to a negative mental health outcome, including depression. "It’s interesting, because people might be prepared for one level of it, but not for another form. Parents say, ‘Well, I’ve always taught my child to think positively of themselves and not believe people when they say these things about you.’ But if the whole culture is saying that all you’re good for is to be a sexual object, or something like that, you may not be ready for that type of input."

What unique challenges do people of color face in getting adequate mental health care?
"Once we take cost off the table, a lot of times, within minority populations, certainly within the African-American community, there is suspicion of the mental health profession. People will say, ‘They’re gonna call you crazy, they’re gonna over-diagnose you, just go to your minister or to a bartender or to your aunt, and that’ll take care of it.’ So it’s a complex situation made worse by internal and external forces. "There’s a larger stigma that somehow [having a mental illness is] a weakness that someone shows, or that they're 'not right with God.' Somehow, the fault is always what we call an ‘internal attribution,’ that it’s something wrong with the person. And I think that’s really been a gross misunderstanding of what mental health is all about. "And [mental health care] should be multi-level. If an individual gets a prescription from either a general practitioner or a psychiatrist, there should be another level. But in some communities, it’s more difficult to find long-term interventions, like psychotherapy and group therapy. They’re less likely to be in poor communities — and communities of color a lot of times — but they’re extremely necessary. If [treatment is] just left to psychiatric intervention, that sort of takes the control out of the hands of the individual. They may feel like, The medication is making me better; it’s not something I’m doing to get my life back on the right track. So we really want to make it a multi-level kind of thing, which is less likely to happen in communities that lack resources."

Why is that kind of care so important?
"One thing [that] you get is a certain level of efficacy. People learn how to affect things in their lives, that they can bring things about. With proper care, they become change agents themselves, in the sense that people have seen them grow and want to know what they’re doing differently. So people around them start to take a little more control over their lives. It’s not so much taking your medication, but rather things like going to work and getting a promotion. That impacts the entire family structure. "So the good thing is that proper mental health is infectious — it’s a positive contagion, and people will grow from it once we can get that rolling."

What can we do to help address these disparities?
"We’ve got to get people in arts and communications on board. Our most creative people are not being encouraged in their efforts to put messages out there that would support mental health and reduce racism. There are messages that can be given out and put out there that young people would pick up on that would reduce levels of cultural, structural, and institutional racism. Artists and performers and people in the public eye can give out a lot of very positive messages and counter some of the things that are out there that are confusing people. "Once that’s done, at that level, then it will permeate the entire society, and people will see more of a role for mental health professionals. We’ve got to support our creative people’s efforts to become change agents — and they’re out there; they want to do this. For instance, I just saw Jesse Williams accepting an award on BET the other night. He gave a very, very layered acceptance speech [that addressed recent issues of racism]. You see that from time to time from artists, but they’re not supported or asked to do that. Everybody just wants to hear 'I want to thank the academy and my mom and God' and that’s it. But there’s a larger message to get out there. And these types of things need to become the rule not the exception." In the end, if we really want to improve mental health among minority communities, we need to get at the core of racism. And in order to do so, we have a responsibility to elevate messages like these.

Refinery29 is teaming up with Black Girls Smile Inc. in honor of Minority Mental Health Month to encourage women everywhere to lead their most mentally healthy lives. Because there is no health without mental health. Prioritize yours.