Minorities and Mental Health Disparities

Written by Melissa Schenkman, MPH, MSJ

When DeAvila Sadé Ford, DBH, LCSW, went to talk with a career counselor in college about what major to pursue, little did she know it would be the turning point not just for finding her career but for wanting to counsel others like she had been that day.

“I wanted to help people, especially women that look like me to find their own voices to find ‘themselves,’“ Ford said.  

Now 32, and a practicing Millennial Mental Health Therapist, she does just that. As the owner and founder of Ask DeAvila Sadé LLC – Where Mental Health Meets the Millennial, she serves patients in her same generation as well as many from minority communities.

She combined forces with YMyHealth to shine a spotlight on the kinds of challenges today’s millennials and members of Gen Z from minority communities face to their mental health and ways to overcome them. Ford shares with us her insights about what is unique to and most commonly suffered by our generations and how mental healthcare providers can be more culturally competent to best serve the health of younger generations.

YMyHealth: Why do you think the millennial generation and members of Gen Z‘s mental health suffer more than previous generations?

Dr. Ford: I don't think there's one right answer today because I think a lot of things come into play. I won't say necessarily that it's harder for millennials regarding their mental health or Gen Z. I think we have the language. I don't think Baby Boomers and Gen Xers really had the opportunity to explore when something was wrong and recognize that this is what mental health looks like. They didn't have the language.

I always say I stand on the shoulders of giants. If it wasn't for my parents working so hard to put me through school and for me to have the privilege of not having to be in survival mode like they were, it would not have allowed me to kind of be able to check in with myself and say, ‘What is happening with me?’ I can look back now and see that I might have had a grandparent that struggled with depression or even my mom, but that's because of the privilege of not having all of these things coming at me that I can kind of sit and analyze my body and see what's happening for me.

So, I won't say that it's harder for us. I just think we have the language, and we have the privilege now of being able to address it versus previous generations.

The Impact of Mental Health Disparities on Minorities

YMyHealth: Why is this suffering even greater for the minority millennial community?

Dr. Ford: When it comes to Minority Mental Health, we definitely know that the things people of color have endured play a role. Trauma passes down from generation to generation in any family, and even more when race is involved. So, imagine you're getting passed down the traumas of slavery or the trauma of the civil rights movement—everything that has happened to my community—and you're kind of plagued with the idea that you have to be strong, that you have to survive again. So, you are passing down this survival mode and then also not having access to mental health care.

A lot of rural areas don't have access to adequate mental health care. Hello, health insurance? It’s ridiculous, and it is really not helpful, right? People don't have access to quality health care insurance and quality health care clinicians or culturally competent clinicians.

Since a lot of the evidence-based approaches that we learn in school are not catered to being able to treat minorities, it's kind of like black and white. And, a condition in a Caucasian female can look different than in an African American female, but if you don't know how to treat it, you're going to misdiagnose it, right? Oftentimes, at high rates, because the cultural competency of being a culturally competent clinician is not taught in schools. There is so much work to be done because that’s just really what impacts our healthcare system, so it doesn't really serve us as a nation.

YMyHealth: How do you think the recent ruling against affirmative action impacts mental health for millennials and Gen Z in minority communities?

Dr. Ford: I really feel like we're just in a weird time where it feels like we were just going backwards with a lot of things. I think my only concern is: ‘What about the doctors and social workers and the nurses of tomorrow if you have no affirmative action in place?’ One thing I know for sure, for my community specifically, is we just know how to pivot in adversity. So, we might see an influx in people going to historically black colleges and universities (HBCUs), whatever needs to happen so you can get your education to do what you need to do. I just I hate that we live in a world where it just seems like people are very selfish or more about capitalism.

DeAvila Ford, LCSW, PhD, is a practicing Millennial Mental Health Therapist. The Memphis native is the Owner and Lead Therapist of Ask DeAvila Sadé LLC – Where Mental Health Meets the Millennial, her private practice where she provides mental health counseling services virtually.

Ford received her Master of Social Work from the University of Memphis and her Doctor of Behavioral Health from Freed-Hardeman University. Her research and clinical interests involve connecting mental health and the millennial generation.

Stigma and Cultural Barriers

YMyHealth: Let’s talk about the cultural stigma surrounding mental health care. In terms of the minority community, what do you find to be the perception of mental health and mental health care in the Black versus the Asian versus the Hispanic millennial communities?

Dr. Ford: So, just being a black woman that has sought out mental health care, I can tell you it is thought of as really taboo. I was probably one of the first people in my family to ever go to therapy. In the Black community, it’s ‘Oh, you're fine. You're okay. Just pick yourself up. You know, pray about it. You know, go to church on Sunday and pray about it.’

So, there's this misconception that you can't have a spiritual relationship with God and seek help because then you're saying God can't help you. So, I think religion plays a role in it, but also, we're really kind of told to believe that we have to be strong all the time. We are told that anything else is weakness, and if you are weak, you will die. You will not survive. So, mental health looks like weakness, and that I think plays a role not just in my community but in a lot of people's communities.

Some people will weaponize therapy and say, ‘Oh, you're crazy; you need to go to therapy.’ Everybody benefits from seeing a therapist because not only does everybody have physical health, but they also have mental health. Everybody has it. So, just like you would go to the doctor for your annual and you would go for your checkup, you can go check in with a mental health provider. One way to change this is just learning how to destigmatize or untether ourselves from these beliefs that if we seek help from someone else, something is wrong.

Clients that I’ve treated from the Asian community deal with a lot of impostor syndrome as far as they have to be who their parents want them to be. That's something that you see in a lot of different races, where you feel like you have to be who your parents want you to be even if you have to be the doctor. You have to be the top of your class, and it's so much pressure. So, I see that being a reason why a lot of Asian Americans will seek therapy, and when it comes to Hispanic Americans as well. In both communities, there is this need that ‘I have to take care of everyone. I have to make sure everyone is okay. We've got to make sure the elders in the family are okay.’ So, you have to make sure everyone's okay so much that there's no room left for you to take care of yourself. A lot of that is not having healthy boundaries, and I see a lot of that.

YMyHealth: What are some of the common mental disorders that you have seen millennials and Gen Z come to your practice for?

Dr. Ford: What I see or that I treat that is really common is your depression and anxiety disorders. And the reason that depression I feel happens often in just everybody is because their life is hard. Life is so hard, and you go through so much. You lose people, people pass away, you have failures, you have successes, and you just have so much going on that you experience trauma, even if it's experienced vicariously.

I tell people, you literally only have to meet five symptoms in a two-week period to get a diagnosis of depression; that's how easy it is to get it. So, I think that's something that's just really common and a lot of what I'm seeing, at least in the millennial generation and Gen Z is so much worry.

You're seeing some social anxiety, some generalized anxiety, but you're just seeing a lot of anxiety because it's the extreme worry: ‘Where am I going to succeed? What if I fail? What if I never find that partner for me? What if I never have kids? What if I never hit six figures?’ It's just living in you every day, right? And a lot of times, they don't know how to decrease those symptoms.

What I like to educate on is what happens in your body if your body stays in a stressed-out state. So, when we're stressed, we know that cortisol releases in our body and it's helpful if we're in a situation where we need to survive; adrenaline and cortisol are great. But if you keep staying stressed and cortisol stays high in your body, you're more susceptible to getting sick; it suppresses your immune system. Not only are you more susceptible to getting the common cold, but you're more susceptible to getting the flu, COVID, migraines, heart disease, even cancer. They are all linked to stress, and anxiety and stress, they are hand in hand.

Access to Mental Health Services

YMyHealth: In your practice experience, what are some of the challenges you’ve seen that millennials who are part of the minority community face in terms of their mental health and when it comes to getting mental healthcare?

Dr. Ford: I think there are a lot of things that are impacting people accessing adequate health care. We can always talk about that it's just not affordable. If we're honest. It's the lack of affordability, and what I mean by that is, even if people have insurance, insurance only pays a certain amount of money.  And so, what we're seeing is just not in the mental health field, but also in the healthcare field. People are leaving, like general practice, and going into this specialty practice, just so they can make money to pay off student loans. So, it's a broken system, but affordability definitely plays a role.

If you don't have insurance. You know, even if you're going to maybe a community health center, in your community. They're booked, they're full, and they have a waitlist. If therapists get burned out to the point they quit, but their caseloads are so high, there are not enough therapists to treat everybody.

Transportation plays a role for some people, and that's why telehealth has been so helpful, especially for kids because sometimes their parent has to go to work. So, if they can’t take them, this way they can still get therapy some way. So, being able to do it from their tablet or their phone has helped so many people to gain access, especially in rural communities where you might be 50 miles from your nearest clinician,

Another challenge my clients really face is not recognizing the symptoms of any mental health diagnosis or feeling you’re crazy if you seek help. I just feel like we have so many faux therapists on Instagram, TikTok and Twitter, throwing out these buzzwords for mental health and then people think ‘Oh, I know this word, or I think I know how to use this word, so I'm going to use it to weaponize your mental health.’ That’s really concerning to me and a challenge. So, just being able to, again, destigmatize what mental health has actually meant in the past and what it can mean for you today is really important.

Culturally Responsive Approaches to Mental Health Care

YMyHealth: What are some ways the minority millennial community can overcome these challenges?

Dr. Ford: One piece of advice would be to just reach out to a real therapist. If you have insurance, look through your insurance plan’s network. If you don't, there are a plethora of resources that will help pay for some sessions. Like we have the Loveland Foundation that works with therapy for black girls to help pay for a certain number of sessions for black women. Just do your research.

Also, reach out to therapists like me included. There are therapists that take pro bono clients. So, you might get a lot of “no’s,” but you might get that one “yes,” so it never hurts to ask, ‘Do you have a sliding scale? Or, do you offer pro bono sessions, you know?’

When it comes to digesting all the information on social media about therapy, take it with a grain of salt. Therapy cannot be given through social media platforms. If you don’t go to therapy and really do the work that it takes to heal through some of those childhood traumas, you’re not getting healed. So, you can learn all these buzzwords all you want to, but the way to really heal is going to be going to a trained clinician.

YMyHealth: How can clinicians provide patients with culturally competent mental healthcare?

Dr. Ford:  What you see or hear about in each cultural community is not the end all be all, it's really talking to the people that are in the cultures and letting them tell you what people in their community face and what their needs are, that is. A lot of times, I think some clinicians will go into the mindset of, ‘I know what you need, right?’ You don't know what the other person needs, whatever culture they are a part of. So, you should ask them: ‘What do you need?’ or even if it's in session, say, ‘What do you need in this moment?’

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