In recent weeks, an outpouring of new research has highlighted the severity of the Black mental health crisis. One new poll shows that 77% of Black and Latinx women face mental health barriers related to racism. Another new study found that Black women are undertreated for depression. Yet another shows that even vicarious experiences of racial discrimination increase anxiety. All this is on top of research showing that suicide rates for Black children are higher than for white children and increasing faster than any other ethnic group. Similar problems plague other underrepresented groups: Suicide was the leading cause of death for Asian/Pacific Islanders ages 15 to 24 in 2019, and in 2020, rates of suicide increased in Latinx and Black communities.

In short, it has never been more clear that we need a new approach to mental health for underserved communities that considers that community’s historical context. We already know that underrepresented communities are less likely to receive correct diagnoses and treatment for mental health issues. Only one in three Black adults who need mental health care receive it. The same holds true for Latinx adults. The current system is not prepared to meet the unique mental health needs of Black and brown communities.

Here are three ways to start doing that, taking Black mental health as an example.

1. Ask new (and different) questions. Access does not mean equitable treatment. There are long-standing differentials in mental health diagnosis, access, and treatment. We need to probe why this is through new questions.

• Why are Black people more likely to be diagnosed with schizophrenia and less often diagnosed with mood disorders? And why are they offered medication or therapy at lower rates than the general population?
• Why do only 6% of licensed psychologists identify as Latino when nearly 20% of the population is Hispanic? And only 5.5% therapists speak Spanish?
• Why do policymakers only expand Medicaid coverage to address health inequities in care and outcomes? Middle and high-income, educated Black Americans still experience the same health inequities in care and outcomes as their low-income counterparts. Nearly 20% of Black Americans have low income, which means 80% of Black Americans are not experiencing poverty.

2. Find solutions that address structural racism. Current and historic white nationalism greatly contributes to the ongoing trauma of racism and gendered racism Black communities experience. The legacy of sexual violence of enslaved Black women may help to explain the treatment of other marginalized women too. A deeply embedded sense of entitlement over the bodies of women who are not white may explain why three out of five Native/American Indian/Indigenous/Alaska Native women have been sexually assaulted in their lifetimes and why for every one Black woman who reports rape, at least 15 Black women do not report. The U.S. Department of Health and Human Services notes that the historical legacy of trauma resonates through multiple generations, manifesting in behavioral issues ranging from low-self esteem and depression to violent or aggressive behavior, to addiction to high rates of suicide. But today’s mental health policies have barely scratched the surface of finding new ways to address the generational trauma of the Black and Indigenous communities. The same holds true for other communities sharing histories of trauma and exclusion.

Consider just how long and far-reaching that trauma is in the Black community. For instance, U.S. colonial laws codified sexual exploitation, violence, and family separation, normalizing trauma and violence in the lives of Black communities. As far back as 1662, the Partus Sequitur Ventrem of 1662 Virginia stated, “Negro women’s children to serve according to the condition of the mother,” making it legal to assault, rape, and impregnate a Black woman and then profit off the resulting child, withholding legal paternity but claiming property ownership of both child and mother. Some 200 years later, in 1855, a 19-year-old enslaved Black woman was sentenced to death in Missouri for killing the white man who enslaved and raped her because Missouri law protecting “women” in such cases did not recognize Black women as people. From  1877 to 1945, one in four of the 6,500 Black people lynched were accused of improper contact with a white women. The legal protection of white womanhood has historically threatened the lives of Black women and men.

This all may sound like ancient history. But the remnants of that legacy echo down through the generations. White supremacy is everywhere and is particularly linked to the intersection of trauma, gender, and gun violence, as demonstrated by the anti-Asian hate during the rampage in three Atlanta spas in 2021.

In fact, Black people’s trauma, like Native/Indigenous people’s trauma, and the resulting pain and compromised mental health rise from policies that ignore our lived experience and penalize us for circumstances we did not create. Research and treatment need to start taking seriously the lingering effect of historic atrocities.

3. Ask us what we need and help us build it. Mental health status, treatment, and prevention in Black communities are challenging and complex, and its nuances are rarely teased apart. Policymakers rarely listen to and engage the population most impacted by the policy. Communities have asked for increased “racial concordance” — where the race of patient and clinicians match — which matters in patient and provider communications. However, policies have not been implemented to address the need of Black communities. According to the American Psychological Association’s Center for Workforce Studies, Black clinicians only represent 2% of practicing psychiatrists and 4% of psychologists providing care (and that’s after a 166% increase of racial and ethnic minorities within the workforce between 2000 and 2019.). We need policymakers who ask us what we need and help us obtain it.

Solutions in our own communities

One of the most effective solutions to this wide-ranging problem is fostering existing support of traditions indigenous to communities of color. For instance, Dr. Afiya Mbilishaka, a D.C. psychologist and hairstylist, has launched a movement to focus on hair-related rituals and history to foster emotional and mental health reparations in Black communities.

Similarly, we need support for existing networks of innovative, grassroots organizations embedded in Black communities. For instance, the Community Healing Network’s Emotional Emancipation Circles offers self-help support groups that share stories and healing around anti-Black racism and white supremacy. Around the country, dozens of grassroots mental health organizations, like the Black Emotional and Mental Health Collective and The Weight Room, are doing the same, providing access to innovative mental health measures addressing the specific context of Black mental health. In Native/Indigenous communities, organizations like WeRNative, StrongHearts Native Helpline, Indigenous Story Studio, and One Sky Center also stand in the gap of their communities’ mental health needs.

Black communities face unique mental challenges because the U.S. has not addressed the economic, social, physical, emotional, and mental health impact of slavery. As we confront the mental health crisis in Black communities, we must do it in the context of other conversations around reparations. From obtaining better historical data on children taken from enslaved mothers to current discussions of economic reparations by Chicago and California, the U.S. must address the trauma created by U.S. and colonial policies, which intertwine at every level of the lived experience of Black people, Native/Indigenous nations and Latinx communities share today. Such measures will model solutions for other underserved communities and pave the way for an antiracist approach to mental health. We can address mental health for healthy and whole Black communities by asking new questions, supporting communities’ self-determination and organizations, and engaging in new practices.

Jameta Nicole Barlow is a community health psychologist.