Providing Mental Health Support for People Affected by Systemic Racism
By: Melissa Nunes-Harwitt, L.M.S.W.
Systemic racism has had a longstanding and continued impact on our society. Increased awareness about the racial disparities in health care necessitates a closer look at the effects of racism on the mental health of Black, Indigenous, and other people of color (BIPOC). Racism takes a toll on BIPOC whether they experience a racist act firsthand, witness it happening to another person, or learn about the act indirectly, such as hearing about it from a friend or reading about it in the news.
People act in racist ways regardless of the behavior, appearance, or social class of the person being targeted. Some examples include microaggressions, acts of discrimination, and violence. The racist words or behavior often seem to come out of the blue, whether initiated by strangers, acquaintances, coworkers, or friends. In reality, racism is rooted in ongoing structural practices as well as individual internal beliefs and biases. The continual manifestations of racism are detrimental to their subjects. Among other effects, racist actions may be emotionally hurtful, interfere with acts of daily living, and exclude BIPOC from opportunities and experiences meant to enhance their lives. The associated distress and avoidant feelings, thoughts, and behaviors listed below can lead to stress, anxiety, depression, and anger. Symptoms may also include difficulty concentrating, racing thoughts, disrupted or excessive sleep, feeling low or on edge, changes in appetite, panic attacks, crying, and thoughts of worthlessness or there is no point or meaning to anything.
When working with BIPOC, understanding the impact of racism on each individual is crucial to providing quality care. This article will focus on how systemic racism contributes to alterations in the feelings, thoughts, and behaviors, and how clinicians can support BIPOC in addressing their mental health.
Feeling out of control and always on alert. For psychological health, people need to have a sense of control over their actions and well-being. The more essential something is to basic health and survival, the more upsetting to have its continuation called into question. Humans are wired to be alert in the presence of a threat; being constantly in danger has cumulative and negative consequences for both the body and mind. The frequency of racist actions leads to a constant awareness that racism can happen at any time, with no effective means of protection. The heightened awareness is a response to the reality of life as a BIPOC.
Self-blame and minimization. As a way of coping with bad things happening outside their control, people frequently consider themselves at fault in order to regain a sense of autonomy. This can occur in the face of racism. BIPOC may focus on the idea that the occurrence will not take place again if they change their behavior, or may hold on to the thought that the act is uncommon or not a big deal. There may be a feeling of secrecy or taboo, which can be heightened when a clinician is silent on the topic of race or does not center their BIPOC client’s lived experience with racism.
Avoiding valued actions. BIPOC may find it difficult to participate in activities they would otherwise enjoy due to the emotional and physical vulnerability of widespread and systemic racism. The fear or memory of losing a loved one to racist violence can complicate the feelings of family closeness. A BIPOC’s choice to stay away from particular people, places, or pursuits should be understood in light of these factors. Any attempt to help someone reconnect with meaningful behaviors needs to include consideration of how racism may block those efforts.
Therapy requires a level of trust for clients to discuss anything that is bothering them. BIPOC in particular should not have to fear that their concerns will be dismissed, ignored, met with hostility, or used as cause for reprisal. Those reactions lead to institutional mistrust, making it harder for BIPOC to access mental health services in the future. To better serve BIPOC, organizations and individuals providing therapy can incorporate cultural humility training and anti-racist education and practices into their learning and growth. Supervision can offer opportunities for clinicians to explore implicit biases and their discomfort around the topics of race and racism. It is the responsibility of the clinician to recognize their own participation in systemic racism so they can provide appropriate and effective care to all of their clients. This includes openness to feedback from clients about the way race is addressed in the therapeutic relationship.
Clinicians are familiar with helping people with feelings, thoughts, and behaviors that are interfering with desired ways of life. This process can include developing acceptance of situations in order to choose healthy methods of moving forward, building self-compassion, noticing emotions, and changing recurrent negative thoughts. However, when the patterns being addressed are coping mechanisms for the ongoing trauma of systemic racism, the usual techniques may need to be adapted to incorporate that reality. BIPOC struggling with the barrage of racism they encounter daily may find mindfulness useful to stay in the moment. Therapists should also practice mindfulness themselves so they can remain present, validate their clients’ experiences, and notice their own reactions to learn from in later reflection.
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Many thanks to Jewell Hopkins, LCSW, and Kwasi Boaitey, LMSW, for their insightful critiques and for their time. Anything problematic about this article is the author’s.
References
Alang, S.M. (2019). Mental health care among blacks (sic) in America: Confronting racism and constructing solutions. Health Services Research, 54: 346-355. doi:10.1111/1475-6773.13115
Graham-LoPresti, J.R., Abdullah, T., Calloway, A., and West, L.M. (August 02, 2016) The link between experiences of racism and stress and anxiety for Black Americans: A mindfulness and acceptance-based coping approach. Retrieved August 18, 2020 from https://www.anxiety.org/black-americans-how-to-cope-with-anxiety-and-racism
Williams, D.R. (2018). Stress and the mental health of populations of color: Advancing our understanding of race-related stressors. Journal of Health and Social Behavior, 59(4): 466-485. doi: 10.1177/0022146518814251
Keith Stein | 10/1/2020
