Unseen and Underserved: Black Mental Health in America

Written By Clara Guo

In 2023, 6M Black American adults lived with a mental illness, representing ~17% of the Black adult population. Of those, only 2.7M received past-year treatment.

In this post, we examine how trauma, racism, and systemic inequities not only increase the risk of mental illness but also shape the quality of and the ability to access care.  

Racism and Historical Trauma

Experiencing racism, whether overt or subtle, has tangible effects on mental health. Black individuals frequently face anxiety, depression, and PTSD-like symptoms due to racial trauma. To quote Keris Myrick (NY Times, 2024), “...racism eats away at the ego, and when the ego starts to deteriorate, mental health takes a nosedive.” The weight of these experiences is compounded by socioeconomic disparities and the lack of culturally competent care, making it even harder to seek and receive appropriate support.

Historical injustices, such as the Tuskegee experiment and gynecological experiments on enslaved Black women, have fostered deep-seated mistrust in the healthcare system. To quote Hankerson et al. (2025), “historical trauma” is a term used to describe “intergenerational trauma experienced by a group of individuals that have been systematically oppressed in prior generations.” This trauma can be passed down from generation to generation and can have physical, social, cognitive, and psychological manifestations. It affects not just Black Americans and America’s history of slavery, but also Native Americans, Holocaust survivors, and other marginalized, oppressed peoples. 

Bias in Care

Even when care is sought, racial bias in diagnosis and treatment remains a significant barrier to high-quality care. Because Black adults were (and are) underrepresented in research studies and clinical trials, many diagnostic classifications, medications, and other interventions were developed with little consideration for the diverse manifestations of psychiatric illness. Black individuals today continue to face significant disparities in diagnosis and treatment.

Black individuals are more likely to have their symptoms dismissed or misdiagnosed, resulting in inadequate or inappropriate treatment. For example, Black adults are more likely to be diagnosed with a psychotic illness (rather than a mood disorder) and Black teens are more likely to be diagnosed with “oppositional defiant disorder” (rather than ADHD). This affects access to the right treatment and has consequences for how individuals interact with and are perceived in the real world – in school, work, and with law enforcement. 

It doesn’t help that only 2% of psychiatrists and 5% of psychologists identify as Black – visibility and cultural competency (not just humility) matter, especially in a field where a clinician’s interpretation of a patient’s subjective inner state can mean the difference between the right and wrong treatment.

Access to Care

There are structural barriers in place affecting access to mental health treatment. In 2023, 9.7% of Black Americans were uninsured, compared to 6.5% of White Americans, making therapy and psychiatric care financially inaccessible for many.

Additionally, many predominantly Black neighborhoods are mental health care deserts, meaning fewer clinics, fewer providers, and less access to specialized care. This isn’t an accident; historical policies like redlining affected the financial health, physical health, and access of many communities of color – especially Black and Brown communities.

The Data Gap: Who’s Missing from the Numbers?

Our understanding of mental health disparities remains incomplete due to gaps in data collection. When analyzing Black mental health, a critical question arises: Who is missing from the data? Many national mental health reports, including the National Survey on Drug Use and Health (conducted by a branch of the Department of Health and Human Services), exclude incarcerated and unhoused individuals, leading to a significant underestimation of the true scope of the crisis. This gap in data distorts our understanding of Black mental health.


Mass Incarceration

  • Black Americans are imprisoned at 5 times the rate of White Americans.

  • Prisons are not built for mental health care. Nearly 50% of incarcerated individuals have a mental illness, yet treatment access is severely limited. Incarceration not only worsens mental health conditions but also increases trauma, isolation, and the risk of untreated conditions. 

Homelessness & Mental Health

  • Black Americans make up ~40% of the U.S. unhoused population, despite constituting only ~13% of the total population.

  • Being unhoused exposes individuals to extreme stress, trauma, and risk, often exacerbating mental health conditions and complicating long-term recovery.

Why This Matters

If major mental health reports exclude those who are incarcerated, unhoused, or institutionalized, the true number of Black Americans facing mental health challenges is significantly underestimated. This invisibility in data leads to fewer resources, less funding, and ineffective policies that fail to address the most urgent gaps in care. Without acknowledging these hidden populations, efforts to improve mental health equity remain incomplete.

Support for Black Well-Being

Mental health is health. Recognizing and addressing the impact of racism on mental well-being is essential for fostering equity in mental health care. This requires:

  • Increasing culturally competent mental health services to ensure Black individuals receive proper care. We need more Black mental health clinicians. 

  • Addressing systemic barriers. We can’t fix the historical harms, but we can at least take a look at the racial biases in our diagnosis and treatment protocols and how we conceptualize illness.

  • Reforming policies that exclude vulnerable populations from data collection.

  • Expanding mental health resources for incarcerated and unhoused individuals to ensure no one is left behind.

  • Providing accessible mental health resources through therapy networks, community-based support, and culturally affirming spaces. Center the community and the people that are affected – give them a voice.

  • Encouraging advocacy and policy engagement to drive systemic change and increase funding for Black mental health initiatives.

Here are a few of the organizations and resources that exist to support Black mental well-being:

  • Black Men Heal – A dedicated service providing free mental health therapy sessions specifically designed for Black men.

  • Black Mental Health Alliance – A comprehensive platform offering educational materials, supportive resources, and a specialized directory for connecting individuals with culturally responsive mental health practitioners.

  • Black Mental Wellness – Mental health support and services designed specifically for Black communities, incorporating culturally relevant approaches and addressing the unique experiences of Black individuals.

  • Black Women’s Health Imperative – An organization dedicated to advancing health equity and social justice for Black women by engaging in policy development, advocacy initiatives, educational programs, research projects, and leadership training.

  • The Boris Lawrence Henson Foundation – An organization that provides access to mental health resources and financial assistance through therapy scholarships specifically for Black individuals.

  • Therapy for Black Girls – A specialized platform featuring a comprehensive directory of Black female therapists and targeted mental health support services designed for Black women.


Although Black History Month is drawing to a close, the fight for equitable care and collective healing remains a priority year-round. Share resources, challenge biases, and uplift voices that matter. 

Sources:

By Julia Norfleet, MS, and Clara Guo, MD/MBA

Clara Guo
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