‘Stuck in a cycle’: Providers say disjointed mental health care failing to meet needs of Black youth

As a young Black person, the more mental health help you need, the harder a time you seem to have getting it.

At least, that’s what Mary, a mental health clinician, told researchers with the Black Health Alliance (BHA), whose study of the state of mental health services for Black youth in Toronto was published earlier this year in the peer-reviewed Journal of Recovery in Mental Health.

“There’s so many issues, no one wants to take ownership of that person and say, ‘yeah, I will treat them,'” said Mary, whose comments were published in the study. 

“It’s like, ‘no you’re too complex for me.'”

The pandemic exposed and worsened long-standing health inequities that research has shown to disproportionately impact communities of colour, specifically Black ones. Newer, local research has also shown many ways in which everyday experiences with racism can hurt a person’s chances at stable employment, a better income, and improved mental health.

Despite increased public awareness, mental health-care practitioners, as well as the study’s authors, told CBC Toronto that anti-Black racism remains a barrier, and organizations are not doing enough to address it.

BHA researchers concluded that systemic racism is preventing young Black people from receiving proper mental health care, and that mental health organizations are not facilitating enough connections with Black-led care groups — making it more difficult for the youth in those groups to access timely and relevant care.

Race an ‘afterthought,’ youth says 

The study was conducted by the University of Toronto and Pathways to Care — a five-year collaborative project built by the BHA along with the TAIBU Community Health Centre, Wellesley Institute, the Centre for Addictions and Mental Health (CAMH), and Strides Toronto.

From May through December 2020, researchers held seven focus groups involving 37 people. 

The groups of Black youth, caregivers, community members, and clinicians began meeting shortly after the city of Toronto declared March 2, 2020 to be Black Mental Health Day. And shortly before the city declared anti-Black racism to be a public health crisis.

“I wonder if this whole awakening when it comes to anti-Black racism is going to, I guess, happen?” said one youth named Jalisa. 

“Because even just going through the different systems and programs available in regard to mental health in Toronto, my race is always seen as an afterthought,” she said. 

“Even though being Black is not all who I am, it is a significant part of me.”

The study included a social network analysis to understand which agencies the participants worked for, which connections exist between organizations, and how all of that impacts care for Black youth. 

“They experience [anti-Black racism] both beyond the sector and inside of the sector itself, and that colours their experiences, both deciding when to seek care, and when they get care,” said Tiyondah Fante-Coleman, a researcher with the BHA, and co-author of the study.

The current mental health system is fragmented,” social worker Kevin Haynes, a senior manager of Black health strategy at CAMH, told CBC Toronto.

“We’re finding a lot that providers aren’t really talking to each other. The system’s actually not set up for information sharing collaboration avenues,” Haynes said.

“What’s often happening is our youth and families are left to figure out how to make these connections.”

Black-led organizations could help

Mental health issues can impact anyone, but for people who are Black there are daily implications of racism that a health-care provider needs to understand, psychotherapist Alice Wiafe told CBC Toronto. 

“We’ll look for a job, I’m looking for an apartment, the first thing they see is the colour of my skin,” she said.

“It amplifies the mental health issues within our community,” said Wiafe, who is also president of Black Mental Health Canada, a non-profit that serves Black communities.

“It’s why you’re seeing so many youth struggling.”

At the focus groups, researchers say they heard how even if you get a foot in the door there’s no guarantee your care provider will trust your lifelong experience being yourself — even if they consider your Blackness.

“I guess I was experiencing gaslighting by this white mental health professional, navigating the role of a 6-foot dark-skinned Black man and saying that I am being followed, or under [more] scrutiny than other populations, and they are saying, ‘how do you know you are being followed’ or ‘how do you know you are being watched?'” said Sam, who identified as an 2SLGBTQ+ Black youth. 

Having to explain themselves repeatedly to providers is “very exhausting,” they said. 

Bella, another person who identified as 2SLGBTQ+, said they have to explain to every provider why they fear police, and how it feels to be the only Black person in a space, to every provider. 

“It’s just, why am I teaching you? You are the counselor, shouldn’t you have training or something? Have someone who’s Black in your network?” she said. 

Wiafe says she was one of just three Black people at graduate school — a problem considering the “unique stressors” that may make a Black person, particularly a Black youth, more comfortable sharing with a provider who has an immediate understanding.

Mainstream organizations that diversify and work with Black-led groups will see benefits, said Wiafe, adding, “The vision would have been built, including the nuances that pertain to Black people.”

The failure of agencies to seek knowledge from Black-led mental health organizations has consequences, the researchers said.

WATCH | Canadian medical journal studies issue of anti-Black racism in health care: 

Specifically, the study points to a 2020 report showing that Black youth wait more than double the amount of time white youth do to access care. The researchers say that can be particularly problematic for those with a violent history of behavioural issues. 

It’s a point Mary the mental health clinician made in one of the focus groups: “They can’t get you through the door, you don’t have the help.”

Update national guidelines: researchers

The study’s authors are calling on the Mental Health Commission of Canada to update its guidelines to address the impacts of systemic racism. 

The current recovery-oriented practice guidelines were issued in 2016, and the organization confirmed to CBC Toronto that there have been no revisions since then.

They said the guidelines are meant to “recognize the needs of diverse populations,” but there are no current plans for an update. 

“We recognize that they would benefit from an update to ensure the validity of the recommendations,” said Julia Armstrong, manager of prevention and promotion initiatives with the Commission. 

In a statement, Armstrong acknowledged the need to have the work “be led by people with lived and living experiences,” but said, “it’s unclear whether this will be an area of future work for the Mental Health Commission of Canada.”

For more stories about the experiences of Black Canadians — from anti-Black racism to success stories within the Black community — check out Being Black in Canada, a CBC project Black Canadians can be proud of. You can read more stories here.