When patients and providers don’t communicate well, health issues are more likely to be misdiagnosed, improperly treated or overlooked entirely. And patients are more likely to skip out on care. One area with notable communication gaps, research suggests, is mental healthcare in the Black community.
Rosalyn Denise Campbell, an assistant professor at the University of Georgia’s School of Social Work, recently co-authored a study exploring how Black Americans describe mental health issues. The findings revealed a generational divide: While younger Black patients tend to talk about mental health in the same clinical terms therapists and other mental health providers use, older Black patients default to more colloquial language.
“Many Black folks talk about their psychological distress in physical terms,” says Campbell. “If you ask them how they’re feeling and they say ‘tired,’ they may not mean that they are not getting enough rest; they may mean that they are ‘stressed out’ or ‘depressed.’”
The study emphasizes the need for providers to be familiar with small but important cultural nuances in the way different patient populations label symptoms or interpret diagnoses, and then adapt their communication habits accordingly. Otherwise, critical health information may be lost in translation.
Campbell’s firsthand healthcare experiences shaped her research interests. She dealt with anxiety and depression. But she didn’t realize what was wrong until she started therapy as an adult, because she didn’t have the right labels for her emotions. Today, Campbell studies how Black people interact with the mental healthcare system, with the goal of “informing how providers design and deliver services that holistically meet the needs of this group.”
For her study, Campbell and colleagues surveyed nearly 400 members of a large Black church in the Midwest. “This church actually sought me out,” says Campbell. After several mental health clinics in the area closed, the church wanted to develop effective resources for people in the community. “They were thinking of expanding their existing counseling ministry to a counseling center, but wanted more information before they moved forward. One of their mental health counselors knew I did research in this area.”
In particular, the church’s counseling team wanted to make sure they were able to adequately discuss depression, trauma, anxiety, grief and loss with the church’s congregants.
“The counseling team saw the church as a welcome alternative given that they were located in the community and a trusted institution that felt not only comfortable and safe enough to use, but also that the clinicians there would understand their experiences as African Americans, Christians and/or Black Christians,” says Campbell.
Surveying the community
Campbell’s research showed that middle-aged and younger Black adults were comfortable using clinical terms when discussing mental health; they embraced diagnostic labels like depression and anxiety. But older Black adults tended to rely on euphemisms instead. They called depression “the blues,” for example, and described anxiety as “nerves.” And only clinicians called “trauma” by its name. “ [In general, community members] were more likely to describe the nature or circumstances of what they experienced and its impact,” Campbell says.
In her own work, Davia Roberts, a therapist and consultant in Washington, DC, has noticed similar language trends in Black patients. “When you have communities that have their own distinct cultures, naturally we speak in different ways,” she says. “As practitioners, we have files and paperwork that list all these ‘proper’ terms, but they don’t account for cultural nuances.”
Plus, in communities of color, seeing a therapist still carries a stigma — despite conversations about mental health becoming more prevalent. As a result, many Black people still suffer in silence. Not to mention, many Black people remain mistrustful of the medical establishment on account of historical exploitation and nonconsensual experimentation. If a Black client shares concerns about suicidal ideation, says Roberts, they may have a legitimate fear of being hospitalized or having their children taken away from them as a result of disclosing those thoughts.
There are ways to bridge this language gap, experts say. For starters, Campbell is teaching her social work students about cultural competence, a concept gaining steam in the patient-care universe. Researchers define cultural competence in healthcare as the “ability of providers and organizations to effectively deliver healthcare services that meet the social, cultural and linguistic needs of patients.”
“The way our healthcare system is set up, it’s very much about fitting people into boxes. And when they don’t fit into boxes, then we say, ‘We can’t help you,” Campbell says. “What it comes down to is doing really good assessments and asking really good questions.”
Campbell teaches her students to take a slower, more intentional approach when it comes to conversations with Black patients. Instead of asking patients to fill out checklists describing their mental health needs, Roberts puts this approach into practice by asking patients clarifying questions and offering them context.
“I’ll ask, ‘Are you experiencing anxiety? Are you experiencing suicidal thoughts?’” she shares. And when the clients say yes or no, I clarify and say ‘sometimes this can look like feeling nervous, or having thoughts like, I think it would be easier if I just didn’t wake up in the morning.’ Typically, that’s when our conversation changes.”
In the grand scheme of things, Campbell hopes her study can help clinicians understand that a wide array of demographic and individual factors affect mental well-being and how people talk about it — and that Black people aren’t a monolith.
As for patients, seeking help from resources such as Therapy for Black Girls, Therapy for Black Men, Inclusive Therapists and Therapy for Queer People of Color is a great way to find affirming practitioners who use culturally competent treatment. That being said, Black therapists, who currently make up only 3% of the US psychology workforce, are busier than ever.
Campbell’s message to patients? “Remember you’re the expert on yourself. You know what you need and what you’re looking for, so seek out a clinician who’s going to give you that.”