Barriers to Mental Health Care Affect Black Youth Nationally

Black youth in Canada encounter numerous barriers in accessing mental health services, and health-care providers can exacerbate the situation, experts say.

The Black Physicians’ Association of Ontario is holding a conference in Toronto for family doctors, nurse practitioners, psychiatrists, psychologists, social workers, and other health-care providers to address these issues and promote culturally-safe care.

“Black youth experience the mental health system very differently than other races,” said Dr. Mojola Omole, president of the association and a general surgeon in Toronto. “That is in part due to anti-Black racism and implicit biases.”

Many Black youth have experienced trauma, sometimes stemming from racism or discrimination, which can affect their mental health and the way they express themselves.

“What might seem like apathy is the sign of actually having problems,” Omole said. “There’s been a lot of adjustment made from constant PTSD and just active trauma that they don’t necessarily have the same reaction that you would see in others.”

If Black youth speak loudly, it’s often falsely perceived as aggression, Omole noted.

Dr. Amy Gajaria, a child and adolescent psychiatrist at the Centre for Addiction and Mental Health in Toronto, agreed that Black youth are often misunderstood and misdiagnosed.

“(Health-care) providers have a lot of stereotypes and, you know, we might have internalized unconscious bias towards Black kids and families,” said Gajaria.

Teenagers who are depressed and anxious can be very irritable, Gajaria said. With non-Black youth, mental health-care providers are more likely to investigate the cause of the irritability and reach a diagnosis of anxiety, depression, or trauma.

“Unfortunately, we know for Black youth, a lot of clinicians just stop with the behavior,” Gajaria said. “They see the anger, they see the irritability, and they stop there. And so then their diagnosis goes to things like ADHD, oppositional defiant conduct disorder, which really does a disservice to kids and misses what’s actually driving all those things.”

Gajaria also worries about the Black youth who aren’t getting mental health treatment at all because there are “a million barriers to get through the door of a place like CAMH.”

Black youth wait significantly longer than other patients to get access to mental health care, said Tiyondah Fante-Coleman, a researcher with the Pathways to Care project at the Black Health Alliance.

A Canadian study from 2015 showed Black-Caribbean children and youth waited an average of 16 months for mental health care, compared to seven months for white patients.

Other barriers include stigma and the fact that mental health services are overwhelmed by the current demand.

There is a big need for more Canadian race-based data to improve care for Black youth.

“We have very little data on the incidence and prevalence of mental illnesses (e.g., depression, anxiety and schizophrenia) throughout the national population.”

The mental health system is “quite chaotic for all accessing care,” Fante-Coleman added.

“What’s different for Black youth is that not only is the system difficult to access, they’re also having to deal with the consequences of anti-Black racism (including) systemic and institutional and interpersonal.”

For many families, there is a fear of the medical system because of racism and discrimination.

Research shows that Black youth are much more likely than non-Black youth to enter the mental health system through encounters with the police or justice system instead of voluntarily.

Black youth in Canada are “four times more likely to first enter the mental health care system through the emergency department, which suggests worse symptoms than white youth,” the Pathways to Care project website says.

Although more Black representation in the health-care system could help some youth feel more comfortable receiving care, all health-care providers need to be part of the solution.

That includes becoming aware of their own biases and assumptions, learning about the young patients’ communities, and making them feel as comfortable as possible in sharing their experiences.

“If we all have the same (cultural) competencies, then it wouldn’t matter,” Omole said.