Black youth face barriers in mental health care access: experts

Black youth in Canada face multiple barriers in getting access to mental health services — and health-care providers can make the situation more difficult, experts say.

The Black Physicians' Association of Ontario is holding a conference in Toronto on Saturday for family doctors, nurse practitioners, psychiatrists, psychologists, social workers and other health-care providers to address those issues and help them provide more 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," said Omole, who also works with the Canadian Medical Association Journal on addressing those issues in health care.

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

"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, that's often falsely perceived as aggression, Omole said, noting that's something she's personally observed in the hospital where she works.

Black youth often misunderstood, misdiagnosed

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 also 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, who is not Black but said she learns from her Black colleagues, patients and their families.

"Teenagers who are depressed and anxious can be very irritable. That is just like a fact about young people who are struggling with their mental health," Gajaria said.

With non-Black youth, mental health-care providers are more likely to dig more deeply into what's behind the irritable behaviour and reach a diagnosis of anxiety, depression or trauma, she said.

"Unfortunately, we know for Black youth, a lot of clinicians just stop with the behaviour," 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."

Significantly longer waits for mental health care access

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.

Fante-Coleman, who is speaking at the Saturday conference, said 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.

There are a variety of reasons for the long waits, Fante-Coleman said, including the fact that Black youth may face more financial barriers or there may be a lack of mental health care providers in their area.

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

There's a big need for more Canadian race-based data to improve care for Black youth, Fante-Coleman said.

"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," she said.

"For a lot of families, there is a fear of the medical system ... because of racism and discrimination. That means that sometimes mental health challenges aren't necessarily addressed as quickly as they could be. And so often what happens is that sometimes people end up in crisis."

All health-care providers need to be part of solution

Those crisis situations can lead to police involvement in communities that are already overcriminalized, she said.

"We know that we are viewed often when we're experiencing a mental health crisis as dangerous and seen as a threat."

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, Fante-Coleman said.

Black youth in Canada are also "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, said both Fante-Coleman and Omole, the Black physicians' association president.

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.