What does it take to get more of us into therapy?



Aside from July being a month to take a vacation, fire off fireworks on Independence Day, and face the rising temperatures, July is also the perfect time of year for women and men to take stock of their health – especially mental health – do.

July is actually Minority Mental Health Awareness Month. Mental illness rates among black people are comparable to those in the rest of the population, but we often lack access to adequate care. According to a 2017 survey by Psychiatry.org, only one in three African American people who need mental health services actually get them.

But that doesn’t mean we should stop getting them. With this in mind, we worked with Dr. Angela Diaz of the Mount Sinai Adolescent Health Center in New York, which provides free comprehensive health care for young people between the ages of 10 and 24, spoke about this important topic and time of year. Here’s what she had to say about the importance of mental health services being more relocatable, sensitive, and overall more accessible.

MadameNoire: A lot of people these days will say that young people seem more depressed these days and there are a lot more cases of suicide. Would you say that’s true? If so, why does this happen more often than in the past?

Dr. Angela Diaz: I think it’s true. I think it’s a very complex subject. I think young people have stressful lives, sometimes a lot of conflicts with their peers, family. Many of them have a history of childhood trauma, sexual abuse, physical abuse, or other types of abuse. Also, seeing on television, especially children of color, that they are portrayed in very negative ways doesn’t help. The number of suicides has risen to about 64 percent in the past decade, and that happens across the country. I think it’s really tedious for kids and especially for kids with color.

Do you think the mixed news on social media plays a role in any way?

I would say youth in general, but especially young people of color are often portrayed very negatively in all forms of media. You keep seeing young people who look like themselves get killed and called criminals and all that stuff. I think that contributes to that. The other thing that contributes to this, and why I think there are some differences, is that poor people in general, and people of color in particular, do not have access to mental health services. In New York City, for example, class and race often go together. This leads to a real lack of access to medical care.

With this in mind, how important is it that the Mount Sinai Adolescent Health Center and similar medical facilities offer free access to psychiatrists and psychotherapists? Therapy is very difficult to come by and very expensive, especially for young people who need it most.

There are very few services. These services are not intended for young people. And then you need to have insurance or money to pay for your service. This is generally the case. And even if you have insurance or money to pay for, sometimes there isn’t enough capacity or services to meet demand. And most young people with a mental health need are actually missing out on the services they so desperately need. That is why we have the Mount Sinai Adolescent Health Center. We believe that young people have a right to have their needs met, be it physical health or sexual and reproductive health or mental health, dental health, optical health. They really have a right to the services they urgently need. And since 70 percent of the young people who come here have no insurance at all, we make these services free because we don’t want any barriers. You can come from anywhere. You must be between 10 and 22 years old to enter the program. You can stay until you turn 24. We offer MetroCards and sometimes we buy their medication because we really want them to be fine.

Black people are often very dependent on our trust in the faith and the church. When you feel down, people say, “Just go to church and pray about it.” Do you feel that this has helped or hurt people trying to obtain necessary services?

I think belief is very important in the black community and other communities and I think it plays a constant role. The thing is that there aren’t enough services. But one role that the church or places of worship can play is to make it more natural for people to choose mental health. If they have a problem that they are depressed about, the Church can help remove the stigma around it. It would be helpful to say, “Mental health is very important. When you feel depressed, you should get services. ”But I think even if people want services, there aren’t enough. I think that’s the main problem. Until we get more, I think we need to find a good way to deal with the stigma because young people are unlikely to go to a psychiatric program and correctly say, “I am depressed or suicidal.” It just doesn’t happen. But people are more likely to come to primary care because they need a medical exam, have a cold, or think they are pregnant. When you have a primary or primary care service, clinicians who understand young people and can recognize depression, those needs can be met. So what we are doing here with the youth health center is that psychologists, social workers, child and youth psychiatrists work with a doctor in primary care. I am a trained doctor. So when I see a young person and see that they are depressed or have a history of childhood sexual abuse, that same day, on the same visit, I get a mental health person to meet them about these issues. It is not, “I will refer you to mental health or another visit.” We just have to just do it. No stigma or judgment. It’s only part of what you need. It’s only part of your health. Simply more natural and part of the well-being.

Would you say that race plays a role in access to mental health services? That’s a big part of the discussion when it comes to many other health inequalities – maternal and infant mortality rates, and even just the treatment we receive for serious illnesses.

I would generally say yes. One reason I mentioned is that there are people with color who are less likely to be insured, but even if they have insurance, the services are usually not culturally relevant and sensitive. For young people they are not suitable for young people, they are designed to be youth-friendly. So if you don’t have services for that particular demographic, they probably won’t come. Or there are people who make it difficult for these people to get them because when you call they say, “We have a week to wait.” If they weren’t motivated to begin with, then after four weeks they are or have not been motivated dealing with a major crisis or they killed themselves. God only knows. I think the problem is the design of the services and the fact that there are not enough. The existing ones are not made population specific. They make it to the population not easy to get into the country and provide culturally relevant services that understand the specific population they serve, so there is absolutely a discrepancy based on class, based on race, based on gender – like the gay -lesbian and transgender youth. It is not easy for them to get the services they need. And when you are poor and black and part of the LGBT community, these things intensify. And then these young people are not doing well unless they get the services they need. But when they get the services they need and people really know how to work with them, then they do it wonderfully.

What can people outside of professional care do to manage their mental health and that of the people they care about?

Have a communication style that helps young people open up and share more, in a way that doesn’t make them feel like they are being criticized. Talk to people who accept you and make sure that people feel connected and that people care for them. And make sure they are not isolated. The worst thing for a person, especially a young person, is feeling lonely and isolated. Also meditation and yoga. This connection of mind and body. To dance. Doing things that are physical exercise, eating healthy, eating healthy. And just being part of a family, being part of a unit helps you feel valued. I think these things are all important, but if a person needs psychological help they should also be able to get professional mental health services.

We also need to be comfortable saying, “I’m depressed so I might need help.” And when you see someone you know and they don’t eat as usual and don’t seem to care, say something . Say, “You seem downcast. What’s going on? “It could be a long way. You can eventually help connect them to services. But just being there, being a helping hand, being an ear to listen to them, that helps. Trying to Relieving stress and creating a more positive environment is very helpful for communities everywhere.

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