Working Effectively with African American Patients A Seminar about African American Mental Health Is

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Working Effectively with African American
PatientsA Seminar about African American Mental
Health IssuesWilliam H. Anderson, Jr.February
8, 2004
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African Americans

• 33.9 million people (12 of Population)
• Includes African immigrants Individuals from
  Caribbean Countries
  
• 53 live in the South
• 37 live in the Northeast and Midwest
• 10 live in the Western United States

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The Scope of this Seminar

• 1) Socio-cultural characteristics affecting
  mental health services
  
• 2)Attitudes toward mental health services
• 3)Some common problems facing therapists treating
  African Americans
  
• 4)Therapeutic approaches and issues related to
  process, outcome, and patient satisfaction

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A Working Framework vs. Stereotypes

• 1)These issues should not be rigidly viewed as
  applying to all African Americans
  
• 2) Throughout our discussion we should be
  cognizant of individual differences that do not
  conform to any stereotype

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Premises

• African American culture is distinct yet shares
  similarities with other cultures
  
• There is considerable cultural diversity among
  African Americans
  
• Class does not trump race
• Both the popular media and the scientific
  literature have emphasized black dysfunction
  deficits more than strengths
  
• Empowerment must become a central part of any
  treatment plan
  
• Adopt from Nancy Boyd-Franklin (1989)
• Black Families in Therapy a multisystems
  approach.
  
• New York Guilford

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Hills Five Positive Characteristics

• 1) Adaptability of family roles
• 2) Strong kinship bonds
• 3) Strong work orientation
• 4) Strong achievement orientation
• 5) Strong religious orientation
• Hill (1972) The Strengths of Black Families
  A National Urban League Research Study New
  York Emmerson 6 Hall

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Dimensions of Black Subsocieties

• Social Class
• Rural or Urban Residence
• Region of Origin and Domicile
• Billingsley, A. (1968) Black Families in
  White America
  
• New Jersey Prentice-Hall

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• Education does not always provide upward mobility
  for African Americans in the same way that it
  does for the majority population

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• Among the multiple causes of economic
  disadvantage, there remain racist policies and
  attitudes that hold African Americans down

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• Economics, political and social forces of the
  larger society strongly affect the conditions
  determining the life styles of African Americans

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Social Class Life Styles

• Upper Class
• Upper middle class
• Solid middle class
• Precarious middle class
• Working non poor
• Working poor
• Non working poor
• Billingsley (1968)

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The Black Upper Class

• Heads of household are highly educated
• Very high income levels
• Secure occupations in which advancement is
  possible
  
• Comfortable housing

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The Black Middle Class

• Upper middle class
• Solid middle class
• Precarious middle class

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The Black Lower Classes

• Working non poor
• Working poor
• Non working poor

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Working Non Poor

• Semiskilled workers
• Stable and secure job niche

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Working Poor

• Unskilled service occupations
• Marginal incomes
• Often have to hold down multiple jobs in
  attempting to make ends meet

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Non Working Poor

• Unemployed or intermittently employed
• Supported by relatives and friends
• Often on public assistance
• Sometimes in prison

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Attitudes of American Society and Mental Health
Professionals
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Identity, Self-esteem Skin Color

• Any area as toxic as this one is fertile ground
  for the development of family myths and secrets.
  This is compounded by the fact that these issues
  are rarely discussed openly in many Black
  families. Given the many family secrets about
  birth, paternity, and informal adoption, a child
  who looks very different from the rest of his
  family or household members may have a very
  difficult time while growing up. Children may be
  favored or rejected because of lighter skin
  color. A child may be scapegoated as the darkest
  member of the family or favored because he
  resembles an ancestor. (Boyd-Franklin, 1989)

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The Role of Community Networks

• Relatives
• Non-relatives
• Pastors
• Teachers
• Other responsible adults role models
• Professional Helpers

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Cultural Factors vs. Resistance

• Stepping out of the expert role
• Listening and Learning
• Communication styles
• Common experiences
• Unique needs

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The Bottom Line

• In addition to getting as much training and
  knowledge as possible regarding the patients
  ethnicity, strive for sensitivity, and work to
  establish a trusting patient-therapist
  relationship.