Meeting the Mental Health Needs of Black Adolescent Boys

“I’m only here because my grandma made me come here.”

When Brandon Jones was a public school counselor in Minneapolis, he heard those words regularly from a 12-year-old Black male student who wore a tough exterior amid a dysfunctional home life. But after three or four months of therapy sessions, Jones says, the young man stopped mentioning it.

“I remember I asked him, ‘Why are you still coming here? Because your grandma wants you to come here?’ He was like, ‘No, I come here because I like you,’” says Jones, who wears jeans and Jordan sneakers just like his young clients do.

Now the executive director of the Minnesota Association for Children’s Mental Health, Jones crossed paths with the student over a decade later. The former counselor sees how being “a voice of reason” and helping the student “see a future for himself” may have had a positive effect on him. A life that could have ended in incarceration or premature death transformed into one of service instead, as the student had become a basketball coach in the same school district where they’d met.

“I would just try to say, ‘Man, you have so much talent. You’re so smart. You don’t have to do these things,’” Jones recalls.

Despite having an overall positive attitude toward mental health care, many young Black males are resistant to professional care, according to the Mental Health Support for Black Families study conducted by the Child Mind Institute in partnership with The Steve Fund. The study — which surveyed 1,000 Black parents seeking mental health care for their children and 500 Black young adults seeking care for themselves — found that young male participants were less likely than their female counterparts to seek help from a mental health professional. Among survey participants, 44 percent of young Black males (compared to 31 percent of females) said they were more likely to turn to family members and friends for support, with 37 percent (compared to 24 percent of females) seeking out church leaders.

Results of the survey suggest that the hesitation of young Black males to seek professional mental health care could be due to stigma. While both parents and young people said they were concerned about stigma, young adults were more likely than parents to say that stigma prevented them from seeking care.

And lack of trust in mental health professionals may be a legacy that historians can trace back to slavery. In 1848, John Galt, the medical director of the Eastern Lunatic Asylum in Williamsburg, Virginia, said that “Blacks are immune to mental illness.” He also stated that enslaved Africans were “exempt” from mental illness because they didn’t own property, and that people who had the highest risk of psychiatric illness were those who were exposed to the “mental excitement” of a free life.

In spite of this false ideology, in 1868 the Freedmen’s Bureau negotiated with the Virginia legislature to open the Central Lunatic Asylum for Colored Insane — the first mental asylum for Black Americans. This was an important step towards acknowledging the mental health needs of Black people. But historians have noted that medical racism and implicit bias among clinicians contributed to high rates of admission and severe diagnoses.

In the late 1950s, when psychological hospitals began to desegregate and the Civil Rights Movement gained momentum in the United States, clinicians would use a schizophrenia diagnosis to categorize Black men as violent and unstable. They especially applied this label to those who spoke out against racial injustice. The rates of schizophrenia diagnoses remain disproportionately high among Black men to this day.

“Some studies have revealed that Black men see professional mental health-seeking as a sign of weakness,” says Annelle Primm, PhD, a licensed psychiatrist and senior medical director at The Steve Fund. “And with high rates of misdiagnosis of schizophrenia among Black males and involuntary inpatient hospitalization, help-seeking through informal sources may be seen by Black males as a safer alternative.”

Unfortunately, even after Black males overcome stigma and make it to a mental health professional’s office, more barriers exist. There, they may be met with continued bias.

“When a person sees a Black man who’s emotional, they see us as an angry being. They don’t see us as a person who may actually have a disorder,” says Jonathan Shepherd, MD, a psychiatrist and chief clinical officer at the D.C. Department of Behavioral Health.

A costly consequence of racial bias in a mental health setting is misdiagnosis, especially of mood disorders.

“You have to be with a skilled mental health professional who can tease out the difference between ADHD and a mood disorder, because some of the symptoms overlap,” Dr. Shepherd says. “A person who has depression has poor concentration.”

Research shows that Black kids are more likely to receive the wrong diagnosis when they show signs of a mood disorder. For example, a Black boy who is inattentive or fidgety in class may be diagnosed with ADHD or a conduct disorder, while his white classmate with the same symptoms may be diagnosed with depression.

“How you treat ADHD and how you treat depression are two totally different ways,” Dr. Shepherd says about the dangers of receiving improper treatment.

Additionally, reactions to trauma and adverse childhood experiences — such as living in a hostile neighborhood or having an incarcerated loved one — share the same symptoms of ADHD: agitation, restlessness, and volatility. Without the correct diagnosis, Black males don’t receive the proper care and risk remaining stuck in unhealthy cycles. 

For this reason, it comes as no surprise to Dr. Shepherd that young Black males are leaning on loved ones, mentors, and church leaders for support.

“It makes perfect sense. Men need to have safe, confidential, and peaceful areas to express themselves.”

As a significant percentage of young Black males in the Mental Health Support for Black Families study said they were more likely to reach out to a church leader than a mental health professional for support, experts suggested that it would be beneficial to work with churches to encourage these young men to seek mental health care.

Pastoral counseling is an important part of the faith experience. In a study that included interviews from nearly 100 Black pastors, the respondents averaged more than six hours of counseling work per week, in which they often addressed serious problems similar to those seen by mental health professionals.

Keith Pettus, PhD, serves as lead pastor at Truth Center on Long Island, outside New York City. In the four decades that he’s worked as a minister, he’s counseled many Black boys and men navigating life’s issues.

“Pastoring gives you a front row seat to the darkest moments of people’s lives and the brightest ones,” Dr. Pettus reflects. “We are with people from the cradle to the grave.”

He agrees that one of the main reasons why Black males avoid mental health providers is due to a general distrust in medical professionals.

“The challenge with Black boys is they become Black young men, and they become Black adult men who don’t go to doctors,” says Dr. Pettus, who encouraged the men in his congregation to get check-ups after he survived prostate cancer last year.

Because therapists may be viewed as just “another doctor,” he believes it’s easier for his congregants to seek him out for support. Two of the main reasons why young Black males come to him is for low self-esteem and anxiety about the future.

As a former school counselor, Jones appreciates when faith leaders are involved in resolving the mental health needs of community members. He hopes to see more innovation and collaboration between the two groups in the future.

“It’d be amazing if there were therapists that were housed inside churches,” he suggests. “A lot of church buildings are not active after Sunday…. They could be mental health centers at this point. Or they could have therapists in there working.”

Historically, the church has functioned as a social service hub for Black Americans, providing information and resources that might otherwise be inaccessible. Church members also use it as an emotional outlet. With that in mind, researchers and organizations are utilizing the institutions to find new ways to address mental health needs.

In 2019, the University of Pittsburgh’s School of Social Work launched CHURCH (Congregations as Healers Uniting to Restore Community Health), a research initiative that seeks to develop evidence-based training to build more capacity for African American faith leaders to provide mental health support to their congregation members.

For the past four years Deborah Moon, PhD, a mental health therapist and assistant professor in the School of Social Work at the University of Pittsburgh and the CHURCH project team, has worked alongside local Black pastors to develop a training that would equip local Black pastors with the knowledge and skills in cognitive behavioral therapy (CBT), a form of talk therapy that helps people change negative thought patterns and behaviors.

“There’s lots of evidence that CBT works,” Dr. Moon says. “But then [in CHURCH], we try to highlight that those same principles that are proven by science are already in the Bible.”

She and her team compiled a day-long workshop as the final curriculum. The program was separated into four sessions that covered the relevance of mental health topics in Black churches and the various levels of human cognition that are targeted in CBT. All sessions integrated core CBT principles and skills with spiritual teachings in Black churches. The workshop also included a music therapy element within the faith-based praise and worship. Their main goals were to change attitudes toward evidence-based mental health treatment, raise confidence in providing informal mental health support, and increase the knowledge of CBT concepts and skills among faith leaders in culturally sensitive ways through spiritual integration.

“We saw significant improvement in all of those areas in a recent pilot,” Dr. Moon says. The team is planning to conduct larger studies with a sufficient number of participants to more rigorously test the training effects. Like the participants of CHURCH, Jones recommends that all pastors who respond to mental health needs take up some form of CBT education. Dr. Pettus, the pastor at Truth Center, agrees but also sees the limits of what spiritual advisors can do. If he feels that a matter requires clinical services, he refers congregation members to therapists in the area.

“I’m not the last step. I have people above me that can take them even deeper.”

Jones offers the following tips to parents and mentors who seek to support young Black males:

Parents:

• Keep an open space for your child to talk to you. If your children are coming to you, that’s a big plus. A lot of times when kids are avoiding talking to their parents, Jones has found, it’s because the parents are part of the problem
• Model healthy habits and behaviors. Your children are watching what you do. If they come to you for help and you’re not utilizing the advice you’re giving them, they’re not going to believe what you say. They’ll revert to poor habits
• Find ways to engage in healthy activities. Talking is great, but actions are also important. Without activities, children may fall into an idle mindset, where they’re entertained and informed by the world or whatever they can get access to. Playing games, helping them with homework, and going for walks are all therapeutic opportunities

Mentors/youth workers:

• Understand that you have an opportunity to build a level of trust that youth may not have with their parents. You may be able to get through to the child or young adult a little easier than a parent or caregiver. Utilize that
• Similar to parents, model healthy behaviors and be active.
• Keep the mentor-to-mentee power dynamic in play. Many mentors and youth workers slip into friendships with the young people they work with. This isn’t inherently a bad thing, but it can become challenging if you become stuck as a friend instead of an authority figure. This, in turn, hinders the help that the young person can receive. Make sure to let them know, “Hey, I’m an adult, and I’m here to listen and be helpful to you”

For pastors:

• Soul Shop for Black Churches is a one-day workshop designed for clergy, staff, lay pastors, and faith-based clinicians in Black churches. The training was developed by the American Foundation for Suicide Prevention to address the rates of suicide within the Black community
• The American Psychiatric Association offers “Mental Health: A Guide for Faith Leaders,” a free resource guide for faith leaders who work with congregation members facing mental health challenges
• Learn more about religious CBT via this training video from the Center for Spirituality, Theology, and Health at Duke University

For parents and mentors/youth workers:

If you or someone you know needs help now, call 988 to reach the Suicide and Crisis Lifeline. The lifeline is available 24 hours a day, seven days a week, and is staffed by trained counselors.

The National Alliance on Mental Illness (NAMI) is a national grassroots organization that supports people and families affected by mental illness. The organization provides free mental health support, educational programming, and a helpline via its state and local chapters.

The Black Emotional and Mental Health Collective (BEAM) connects Black people to Black therapists and provides microgrants to Black and marginalized parents living with mental illness or supporting children living with mental illness.

Black Men Heal is on a mission to remove stigma and eliminate cost to care by connecting Black men with therapists and providing eight free sessions. The nonprofit organization also hosts a virtual weekly meetup to discuss male depression, anxiety, anger management, self-care, and more.