Since its founding, the United States has been built upon pillars of injustice and marginalization. Heartbreakingly, as a result, it is no surprise to us that issues such as unemployment, poverty, and poor access to healthcare strike BIPOC (black, indigenous, and people of color) communities harder than their white counterparts. Especially true in this inequality is the BIPOC communities’ disproportionate subjection to repeated, structural violence.
The continued deaths of black men and women due to violence are not isolated events, nor are they limited to recent occurrences. Our country has a longstanding tradition of brutality towards and disempowerment of BIPOC communities. We are mourning, we are indignant, and we are demanding change.
When we founded Prairie, we set out to deliver accessible anxiety and depression care regardless of anyone’s access to doctors or insurance. We won’t say that we are trying to fix a broken healthcare system because the system isn’t exactly “broken” — it is operating exactly as it was intended. In the United States, we built a healthcare system that disproportionately favors white patients, and we built a systemically racist institution. We cannot separate racism in America from health in America because the two have been intertwined since our beginnings.
Scientific racism was used to justify the transatlantic slave trade, and black men were described as having “primitive psychological organization,” making them “uniquely fitted for bondage.” Benjamin Rush, a signer of the Declaration of Independence, or as many call him, the “father of American psychiatry,” partook in this discrimination. Rush denounced “Negroes as suffering from an affliction called Negritude,” a “disorder” thought to be a form of leprosy. The only cure? “To become white.”
This is just one of the countless examples throughout history in which black people were referred to as having incurable mental illnesses, brought on simply by the tone of their skin. Even by the 20th century, “leading academic psychiatrists claimed that “Negroes” were “psychologically unfit” for freedom. And as late as 1914, drapetomania, a mental illness which caused black slaves to flee slavery, was listed in the Practical Medical Dictionary.
In the late 1960s, as black Americans fought for justice and equality, there was a rise in black diagnosis for schizophrenia. In a 1968 article in the esteemed Archives of General Psychiatry, schizophrenia was described as a “protest psychosis” in which black men developed “hostile and aggressive feelings” and “delusional anti-whiteness” after listening to or aligning with activist groups such as Black Power, the Black Panthers or the Nation of Islam. Even today, black Americans are five times as likely to be diagnosed with schizophrenia despite there being no evidence to support a greater “prevalence in the population” following genetic evaluations.
So no, the system is not broken; it was built this way.
The diagnosis process is far from being the only area of our mental healthcare system in which BIPOC people are marginalized. Let’s take a closer look at some of the challenges BIPOC people have to constantly face in order to access adequate care in this country.
Black Americans have the same rate of mental health conditions as white Americans; however, according to a study published in the National Library of Medicine (supported by the U.S. surgeon general’s report on mental health), “racial and ethnic minorities have less access to mental health services than do whites, are less likely to receive needed care and are more likely to receive poor quality care when treated.”
Our healthcare system also tends to be dismissive of black mental health struggles even before treatment, and black Americans are only 50% as likely to receive psychiatric treatment as whites for mental health conditions of the same severity. Conversely, when our healthcare system deems it “necessary” for black Americans to receive care, they are 19–39% more likely to be admitted to a mental health ward involuntarily.
Here are some other shocking and disturbing statistics about mental healthcare disparities in America:
- • Blacks and Latinos on outpatient mental health care are about 60% and 75% of white rates, respectively, after taking into account the need for care.
- • Black and African American people with mental health conditions, specifically those involving psychosis, are more likely to be in jail or prison than people of other races.
- • Access to mental health care is more difficult for Black Americans as 27% of their population live below the poverty line compared to approximately 10.8% of non-Hispanic whites.
- • There is a disparity in mental health education. For example, ethnic minority women are less likely to perceive a need for depression care than are their similarly poor white counterparts.
Educating ourselves on inequality is only half the battle. Inaction and passivity is not a response — it’s a public statement that you are comfortable with the way things are. The reality is this: these are people’s lives, and we don’t have the privilege of comfort. We need to do better.