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Black youth face multiple barriers to accessing mental health care, experts say

TORONTO – Black youth in Canada face multiple barriers to accessing mental health care – and healthcare providers can make the situation more difficult, experts say.

TORONTO – Black youth in Canada face multiple barriers to accessing mental health care – and healthcare providers can make the situation more difficult, experts say.

The Black Physicians’ Association of Ontario is holding a conference in Toronto on Saturday for primary care physicians, nurses, psychiatrists, psychologists, social workers and other healthcare providers to address these 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’s partly due to anti-Black racism and implicit bias,” says Omole, who is also working with the Canadian Medical Association Journal to address these health care issues.

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

“What looks like apathy is a sign that you actually have problems,” Omole said.

“A lot of adjustments have been made because of the constant PTSD and just active trauma, so they don’t necessarily have the same reaction that you would see in others.”

When Black youth talk loudly, it is often mistakenly perceived as aggression, Omole said, noting that she has personally observed this at the hospital where she works.

Dr. Amy Gajaria, a child and adolescent psychiatrist at the Center for Addiction and Mental Health in Toronto, agreed that Black youth are often misunderstood — and misdiagnosed.

“(Healthcare) providers have a lot of stereotypes and, you know, we may have internalized unconscious biases against Black children and families,” said Gajaria, who is not Black but is learning from her Black colleagues, patients and their families. .

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

For non-Black youth, mental health providers are more likely to dig deeper into what’s behind the irritable behavior and arrive at a diagnosis of anxiety, depression or trauma, she said.

“Unfortunately, we know that in Black youth, many physicians simply stop this behavior,” Gajaria said.

“They see the anger, they see the irritability, and they stop doing that. And so their diagnosis goes to things like ADHD, oppositional defiant disorder, which really does a disservice to kids and misses what’s actually driving all those things.”

Gajaria also worries about Black youth not receiving mental health care at all because there are “a million barriers to getting through the door of a place like CAMH.”

Black youth wait significantly longer than other patients to access mental health care, says Tiyondah Fante-Coleman, a researcher with the Pathways to Care project at the Black Health Alliance.

Fante-Coleman, speaking at the Saturday conference, said a 2015 Canadian study found that black Caribbean children and young people waited an average of 16 months for mental health care, compared to seven months for white patients.

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

Other barriers include stigma and the mental health system being overwhelmed by current demand.

There is a dire 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 health conditions (e.g. depression, anxiety and schizophrenia) in the national population.”

The mental health system is “pretty chaotic for everyone who has access to care,” Fante-Coleman added.

“What is different for Black youth is that not only is the system difficult to access, but they also have to deal with the consequences of anti-Black racism (including) systemic, institutional and interpersonal,” she said.

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

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

“We know that we are often seen as dangerous and a threat when we experience a mental health crisis.”

Research shows that Black youth are far more likely than non-Black youth to enter mental health care through encounters with police or the legal system rather than voluntarily, Fante-Coleman said.

Black youth in Canada are also “four times as likely to first enter mental health care through the emergency department, indicating worse symptoms than white youth,” the Pathways to Care project website says.

While greater representation of Black people in the health care system could make some young people feel more comfortable receiving care, all health care providers must be part of the solution, said both Fante-Coleman and Omole, president of the Black medical association.

This includes becoming aware of their own biases and assumptions, learning about young patients’ communities, and making them feel as comfortable as possible in sharing their experiences.

“If we all have the same (cultural) competencies, it doesn’t matter,” Omole said.

This report by The Canadian Press was first published May 4, 2024.

Canadian Press’ healthcare coverage is supported through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

Nicole Ireland, The Canadian Press