Helping Black men and boys gain optimal mental health

Black men face significant challenges compared with other groups, including economic, health care, and educational disparities as well as systemic racism and social injustice. Despite nationwide protests following a police officer's murder of George Floyd in 2020, for example, between 2 and 3 times as many Black Americans continued to die at the hands of police as White Americans, according to Statisticaopens in new window, a data analytics organization.

Sadly, and perhaps not surprisingly, suicide rates among Black men are also climbing. For the first time, so-called “deaths of despair”—deaths from suicide, alcohol use, and drug overdoses—are now higher among Blacks than Whites, tripling from 36.24 per 100,000 people in 2013 to 103.81 per 100,000 people in 2022 (Friedman, J. & Hansen, H., JAMA Psychiatry, online, April 10, 2024opens in new window). Moreover, Black men are 4 times as likely to die from suicideopens in new window as Black women, according to the Centers for Disease Control and Prevention.

Other recent studies show that childhood adversity and racial discrimination forecast later thoughts of suicide among young Black men (Kogan, S. M., et al., Cultural Diversity and Ethnic Minority Psychology, Vol. 30, No. 2, 2024opens in new window), while exposure to gun violence—far higher among Black than White Americans—is significantly associated with lifetime rates of suicidal thoughts, preparation, and attempts (Semenza, D., et al., JAMA Network Open (Vol. 7, No. 2opens in new window).

Psychologists are making strides in better addressing the mental health of Black men and boys, but much remains to be done, said APA Chief Executive Officer Arthur C. Evans Jr., PhD, who presented on the topic at a Congressional hearing in May of 2024 along with members of the U.S. Commission on the Social Status of Black Men and Boys, other Black mental health leaders, and Black celebrities.

“Effectively addressing the mental health of Black men and boys requires innovative solutions that are grounded in an understanding of the many issues affecting men’s health, informed by scientific rigor and data, and driven by the community and the men and boys whose health we are trying to improve,” Evans said. “It is critical that we use a comprehensive population health approach that addresses systemic and structural issues as well as social drivers of health. Most importantly, we need the political will to move this agenda.”

For psychologists and other mental health treatment providers, an essential ingredient in getting this work right is working within the contexts of Black men’s and boys’ lives. Otherwise it simply won’t be relevant and they won’t show up, said Howard C. Stevenson, PhD, director of the Racial Empowerment Collaborative at the University of Pennsylvania and a national expert in helping people of color address and heal from racism. For example, only 26.4% of Black and Hispanic men ages 18 to 44 who experienced daily feelings of anxiety or depression used mental health services, compared with 45.4% of non-Hispanic White men with the same feelings (NCHS Data Brief No. 206, 2015opens in new window).

“We should place less emphasis on whether Black men are resistant to therapy,” said Stevenson, “and more on understanding the contexts in which they already feel comfortable talking about their feelings and traumas. If a Black man is able to find a treatment that is culturally responsive, that he understands, and that embraces the uniqueness of his difference, he is more likely to use that service.” Examples of this include adaptations of individual therapy, community programs in barbershops and other local venues, outreach through technology and social media, and national networks devoted to facilitating Black men’s mental health and well-being.

The more that systems, programs, and providers find culturally relevant ways to foster Black men’s mental health—including directly addressing racial trauma and its effects—the more society will benefit, added Wizdom Powell, PhD, an associate professor of psychiatry at the University of Connecticut and director of the university’s Health Disparities Institute.

“Interventions shouldn’t be just about healing and restoring Black men, though that would be enough,” she said. “We also need to think about how much talent we’re hemorrhaging” by not providing Black men with the proper support. “Think of all the innovators, entrepreneurs, scientists, and physicians there would be if Black men weren’t being killed with impunity by police officers and if we were creating spaces for them to heal, grow, and thrive.”

In doing this work, it’s helpful to understand the environmental factors and disparities that underlie mental health difficulties in this population, Powell and others noted. Besides experiencing higher suicide rates that are linked to contextual factors like gun and neighborhood, Black adults living below the poverty line are more than twice as likely to report serious psychological distress as U.S. adults who enjoy greater financial security, according to the U.S. Department of Health and Human Services’ Office of Minority Health. As another example, depressive symptoms among Black people are more disabling, persistent, and treatment-resistant than they are among White people (Bailey, R. K., et al.,  Neuropsychiatric Disease and Treatment, Vol. 15, 2019opens in new window).

And, Black men are not receiving the help they need for these problems, as noted by the data on help-seeking among Black, Hispanic, and White males. Moreover, when Black men do seek help and would prefer a same-race provider, it can be difficult to find the right fit, since Blacks make up only about 5% of the doctoral-level psychology workforce and most are women, according to the APA Center for Workforce Studies.

Poverty, racism, and related factors also mean that when Black men or boys seek or receive mental health services, they are often met with overt and covert barriers. These include implicit bias and attendant behaviors on the part of medical providers, and lack of access to quality psychological and psychiatric services. Compared with White people, for example, Black people are less likely to receive guideline-consistent care or to be included in mental health research. They are more likely, in turn, to use emergency rooms or primary care for mental health problems because they have not received appropriate preventive services. (For a summary of these findings, see the American Psychiatric Association’s fact sheet on mental health disparities among African Americansopens in new window.)

Given such factors, it is not surprising that many Black men also harbor feelings of mistrust toward medical and mental health systems. For instance, in a study reported in  Behavioral Medicine opens in new window (Vol. 42, No. 3, 2016), Powell and colleagues found that everyday and perceived racism along with internalized masculinity norms influenced Black men’s reluctance to seek medical help. A history of racism within psychology and psychiatry likewise plays a role, she said. For example, in 1851, physician Samuel A. Cartwright floated the idea of drapetomania, “an uncontrollable or insane impulsion to wander” among enslaved people who expressed a desire for freedom. In a similar vein, as racial protests began heating up in the 1960s, diagnoses of schizophrenia among Black men became far more common, a phenomenon highlighted by psychiatrist Jonathan M. Metzl, MD, in the book  The Protest Psychosis opens in new window (Beacon Press, 2011).

“Black men today might not know that specific history,” said Powell, “but it lives in their spirit a little bit. And it gets transmuted into practices like withdrawing from systems, having a mistrust of systems, and feeling like systems don’t have your best interests at heart.”

Culturally competent treatments for Black men take these realities into account and, as such, share certain ingredients, said psychologists involved in this work. They recommend that clinicians:

Address masculine norms: Studies find that Black men are sometimes more likely than White men to endorse aspects of traditional masculine ideology such as the need to act tough, be in control, and avoid emotional expression. But there are nuances to those findings, said Baron Rogers, PhD, a counseling psychologist at Penn State University, who studies Black men’s mental health. For example, Black men who have been historically marginalized might endorse ideals of masculinity such as financial success but not be able to access those ideals fully. Others may feel pressure to exhibit such qualities but not actually value them on a personal level. As a result, they may experience internal conflict or strain which in turn can lead to shame, anxiety, frustration, and depressive symptoms, he said.

“When men feel disenfranchised, it breeds resentment towards social and economic systems that ask them to abide by the tenets of what it means to be a successful man while at the same time being restricted by those tenets,” Rogers said.

When Black men do hold internalized views of masculinity that encourage them to act tough and withhold their emotions, “it makes a lot of Black men resistant to therapy and more likely to seek informal ways of addressing their mental health through barbershops, church, religion, or talking to family members,” said psychologist Erlanger “Earl” Turner, PhD, an assistant professor at Pepperdine University in Los Angeles. So when a Black man does enter therapy, “it’s important to tread lightly as he starts to open up and share his emotions,” he said, “because if you push to discuss emotions too soon and he isn’t ready, he may decide not to return.” (Turner’s podcast,  The Breakdown With Dr. Earl opens in new window, destigmatizes mental health treatment for Black men and boys in an engaging manner, using a psychological science focus.)

Jessica L. Jackson, PhD, a counseling psychologist in Houston and global diversity, equity, inclusion, and belonging care lead at the mental health tech firm Modern Health, has done some of this work with Black men in settings including the VA Greater Los Angeles Healthcare System, the Harris Health System (Texas), and private practice. To help these men identify and become more comfortable with their emotions, she uses a tool called the Feelings Wheel, which labels the spectrum of emotions from the most basic to the most nuanced.

When Black men start to gain a more extensive emotional vocabulary, it provides fuel for the next stages of therapeutic work: addressing past traumas and learning how to communicate more effectively in relationships, Jackson said. She knows they are making progress when they start to bring what they have learned home—for example when they begin communicating with their partners about their feelings instead of brooding or responding with anger. “It’s like they’re getting unstuck,” she said.

Address racism: Culturally informed treatment for Black men also involves directly and therapeutically addressing issues of racism, said Rogers. He suggested that by  educating men on the impact of racism and supporting them to align with their own cultural and personal values, clinicians can  empower Black men to engage with their lives using their own strengths and relational resources. 

So along with treatments that specifically address intergenerational trauma and racial trauma, “Black men need connection to their own communities and their own inner worlds, and to learn ways to be internally flexible in relation to rigid masculine ideals so they don’t feel run by them,” he said. 

In addition, therapists should be aware that issues of racism and masculinity can intersect in complicated ways, Rogers added. In his dissertation, he surveyed more than 600 Black men on their endorsement of views related to Black male identity, manhood, and the Black experience. He found that prosocial aspects of masculinity such as being responsible and confident were related to strength-based Black values but also with experiences of racial discrimination, perhaps suggesting a strong need to define oneself as a man in the face of oppressive experiences.

For White psychologists to work effectively with Black male clients, it is imperative that they develop a deeper understanding of racism and its impacts by keeping abreast of the latest scholarship, taking continuing-education classes, and getting training in the area, other psychologists noted (in fact, for license renewal, several state licensing boards specifically require courses in cultural diversity). White clinicians should also become familiar with the  APA Guidelines on Race and Ethnicity in Psychology opens in new window, approved by the APA Council of Representatives in 2019. Among other points, the guidelines state that psychologists should consider their own biases, privileges, and socialization in relation to race and ethnicity and work to address organizational and social inequities and injustices inside and outside of the field.

In a general sense, encouraging clients to talk about racism opens the door to more fulfilling therapy overall, Turner added. “It allows clients to feel that they can talk about anything in this room,” he said. “For me, that’s a really important piece about having that conversation.”

Address within-group differences: Working in culturally responsive ways with Black men also means understanding individual differences in terms of socioeconomic status, age, education, U.S. region, country of origin, belief systems, level of acculturation, sexual orientation, and more, Turner said.

On a broad scale, it is helpful to recognize that Black men born in the United States probably incorporate some version of both African-American cultural values—which emphasize the importance of extended family networks, interdependence with groups and relationships, spirituality, and flexible notions of time, for example—and Eurocentric values—which emphasize individuality, nuclear family structure, and competitiveness, Turner noted.

It is also important to understand the complex issues of intersectionality that Black gay, transsexual, and bisexual men face, said Lisa Bowleg, PhD, a professor of applied social psychology at The George Washington University in Washington, D.C. Her research shows that gay Black men often experience racial discrimination from gay men who are not Black, for example, while bisexual Black men experience race and sexual orientation discrimination in both gay and heterosexual communities ( Sex Roles , Vol. 68, No. 11–12, 2013 opens in new window).

“Any effective mental health programs need to work with these men holistically and intersectionally,” she said. She also recommends focusing on these men’s strengths and assets—because many of their problems arise from external factors, not internal ones—and holding therapy groups specific to the sexual orientation and race of the men served.

Clinicians also need to be aware of differences in Black men’s backgrounds and countries of origin and incorporate that knowledge into therapeutic work, Turner emphasized. For example, 8% of Black people in the United States are immigrants from countries in the Caribbean, Africa, and elsewhere, and there are significant differences among them. Those who grew up in predominantly Black cultures, for example, are less likely to view themselves as inferior because they have not been exposed to historical racism in their home country. Hence, their cultural identity may serve as a buffer, he noted.

There are many other cultural differences among these groups as well. For example, Jamaicans often identify themselves first as Jamaican and tend to frame mental, psychological, and psychiatric issues as medical or spiritual conditions that need interventions from spiritual healers such as shamans, said Turner, who discusses these topics in his book  Mental Health Among African Americans: Innovations in Research and Practice opens in new window (Lexington Books, 2019).

“As a mental health practitioner, you should be aware of these different cultural and spiritual values,” he said. “But you should also avoid overgeneralizing this information.”

Incorporate group work:  Working with Black men in group formats can also be a powerful intervention, thanks to the sense of camaraderie these groups foster. Seeing that other men have similar difficulties can make care less stigmatizing, Jackson explained.

When she was doing her postdoc at the Los Angeles VA, for example, Jackson and a colleague launched a racial trauma support group for veterans of color. That arrangement proved at least as effective as one-on-one therapy, she said.

“Even after they finished the group, the biggest feedback we received is that they continued to meet outside of that setting,” Jackson said. “They became friends, and they wanted to continue. They knew they had a language [for their emotions], and they were able to use it with each other.”

Rogers is launching another group-related effort as founder of an antiracist task force within APA Div. 51 (Society for the Psychology of Men and Masculinities), of which he is racial and ethnic minority member at large. There, a team of researchers and practitioners will examine individual and group-oriented ways to promote growth and flourishing among Black boys and men as opposed to working from deficit or more pathology-focused models, Rogers said.

“Our aim is to create approaches that will benefit men and communities for years to come,” he said.

Meanwhile, other psychologists are leaving standard treatment modalities and venues behind entirely and bringing interventions into communities that embrace the background, culture, and challenges of men of color, including Black men. Stevenson and Powell, for example, are both well known for their research and interventions in barbershops, which demonstrate that these central social meeting places and their staff can be powerful vehicles for encouraging healthy and help-seeking behaviors. In a similar vein, mental health advocate Lorenzo Lewis leads the Confess Project, which seeks to promote a mental health culture among boys and young men of color and their families by training barbers as mental health advocates.

Among the country’s most innovative and comprehensive programs is the National Compadres Network, founded in 1988 by psychologists Jerry Tello and Ricardo Carrillo, PhD. At the time, they and like-minded providers were fed up with the mass incarceration of men of color, feeling that alternative culturally based supports and interventions were desperately needed.

“It was really just throwing men away because there was no proper therapy for them,” said Tello, who is Mexican and Native American and grew up with many Black peers in Compton, California. “The therapy they received just did not fit—there was no understanding of what was really going on.”

The first meeting included a small group of mental health providers, lawyers, teachers, advocates, and others who worked in communities of color. The men soon realized they had their own racial traumas to address before they could help others. After an emotion-packed gathering, “we made a commitment that we first had to recover our own sacredness as men and heal from generations of wounds due to racism and oppression,” Tello said.

The group has since blossomed into a major national network that includes hundreds of providers in more than 40 U.S. cities who have worked with thousands of men of color, including a large proportion of Black men. It has satellite offices around the country and a variety of programs and trainings that cover topics including parenthood, teen fatherhood, relationships, addiction, rites of passage, acclimating to society after leaving prison, and more. Since 2011, the group has also collaborated with the Brotherhood of Elders Network, an organization that creates programs and interventions to impact the lives of Black boys and men in positive ways. Together, the organizations have launched the Healing Generations Framework, which fosters family and community healing by incorporating Indigenous, culturally based practices.

A central format for these programs is extended kinship circles, where men and boys—sometimes from multiple generations—come together to talk, share in communal ceremonies, and heal racial wounds, said Tello. The circles create a space for honest sharing about life’s realities, including the internalized experiences of racism, its emotional and psychosomatic effects, and how these problems can affect members of the group as well as their community and family members.

“Black and brown people kill ourselves because we’ve been indoctrinated [about how bad we are] and now we believe that,” said Tello. “So that woundedness is very deep.”

To counter these traumas, group leaders hold that all men—like all beings—are sacred and have a sacred purpose. When men or boys have trouble believing this because of internalized self-hatred or actions they have taken because of it, program guides underscore that it is their wounds that are talking, not their authentic selves. For example, a man may confess that he has harmed his wife, taken drugs, or acted out in another way. But leaders do not chastise him. Instead, they ask him to take responsibility for his actions, and then they support him in exploring the underlying trauma and sometimes intergenerational wounds that led to those actions and drew him out of his sacredness.

Thanks to this deep, community-oriented support, members eventually see themselves more clearly and gain insights that lead to healthier behaviors, Tello said. The overall aim, he added, is to help men of color make positive choices despite their lived experiences and traumas.

“Yes, we experience racism,” he said. “But the choice is, do you transform it, or do you transfer it? If you want to transform it, come sit with us. If you want to transfer it, then keep doing what you’re doing.”