Question and Answer: “Black Health and Wellness,” Dr. Natalie Cort on Black Mental Health and the 2022 Theme for Black History Month

Celebrated each year throughout the month of February, Black History Month commemorates the achievements and contributions of Black Americans to U.S. history. When Carter G. Woodson established the first commemoration in 1926, according to the Association for the Study of African American Life and History (ASALH), he realized the importance of providing a theme, "not to dictate or limit the exploration of the Black experience, but to bring to the public’s attention important developments that merit emphasis.”

The 2022 theme, “Black Health and Wellness,” recognizes the legacy of Black scholars and medical practitioners in Western medicine, along with those practiced in other “ways of knowing,” like midwives, naturopaths, and herbalists, throughout the African Diaspora. The theme also "considers activities, rituals and initiatives that Black communities have done to be well," and it incorporates emotional and mental health. "At this point in the 21st century, our understanding of Black health and wellness is broader and more nuanced than ever," wrote the ASALH. 

We spoke with Dr. Natalie Cort, associate professor of clinical psychology, and Director of the Black Mental Health Graduate Academy, about Black mental health, how the pandemic has impacted the Black community, and, in a broader sense, how stigma and biases play a role in health care accessibility.

Answers have been edited for brevity and clarity.

What does this year's theme, “Black Health and Wellness,” mean when considering mental health?

As a mental health provider, one of the things that has been very affirming and positive for me is the increased focus on Black mental health. For example, there has been a significant increase in therapists directories focused on culturally competent mental health, along with podcasts focused on Black mental health.

There are justified levels of cultural mistrust in the Black community around seeking mental health services. For a lot of Black people, especially Black women, demonstrating or disclosing vulnerability, including mental health struggles, are to be avoided. That’s a remnant of centuries of marginalization and discrimination. Pain could be used against you, so we’ve had to be self-reliant about our pain.

The past two years of the COVID pandemic has been a time that has made many of us in the Black community stand still and look at our trauma and our pain. It has been wonderful to see people who have been courageous enough to say, “I am going to get help.” To see that courage be expanded in this way, makes me proud. 

And, in particular, I am so proud of our Black Mental Health Graduate Academy scholars, and the commitment they’ve made to themselves, their families, and their communities.

You mentioned cultural mistrust, where does that come from? What can be done about it?

There are subtle ways in which communities of color are blamed for under-utilizing mental health services. These claims, however subtle, fail to appreciate the understandable reasons many in the Black community may be reluctant to seek services.

I share with my students a research study of 17,000 children conducted in 2014 that demonstrated that Black children with ADHD were 70 percent less likely to be diagnosed accurately by mental health providers. Would you utilize any service that had a 70 percent rate of failure?

Also, of concern is the fact that, rather than receiving an appropriate diagnosis of ADHD, these children are more likely to be diagnosed with conditions, such as oppositional/defiant disorder that fit negative racial stereotypes about Black children being prone to aggressive behaviors. This particular pattern of misdiagnosis of Black individuals persists across many conditions.

It is our responsibility to improve our diagnostic skill and to work to reduce implicit negative racial biases. We need our educators/professors to integrate this thinking and drive social change more thoughtfully in our classrooms.

How does an educator, or other practitioner, begin to drive this social change and address biases? Where does it start?

The answer is so easy, and so complex. Honestly, in doing this work for a while now, I’ve seen people in grow and change in brilliant ways. Basically, it comes down to cultural humility. I love that term because it highlights the need to recognize that each of us has our own values and traditions.

Our job, as ethical practitioners, is to be aware of and appreciate differences, to be humble about the things we don’t know, and to learn about the groups of people that our field has marginalized. It’s not just Black people who aren’t accounted for – it’s the LGBTQIA+ community, veterans, differently-abled individuals, religious minorities, and others. To challenge stereotypes, it is on us to educate ourselves about, and expose ourselves to, the experiences of communities who have been underserved or mis-served.

Educators, maybe ask yourself: is there a diversity of thought in what you teach and how you teach it? If all authors of articles used in a course represent one racial/ethnic group, only White authors for example, lights should be flaring for you. Challenge yourself about what type of knowledge you’re passing on, and what’s inherent in the message in who you’ve identified as knowledge creators.

We come to these fields because we care. But most of us haven’t been taught how necessary it is to challenge and explore the stereotypes that we have. I have found, if people are humble and willing, then you see change happen quite rapidly.

When change is slow or hard to see, how can people manage stress to stay present and engaged?

It can be easy to slide into despair and frustration when change is slow. I can fully empathize with that. What I do, and what I tell our Black Mental Health Graduate Academy Scholars, is: When you feel overwhelmed by all that needs to be corrected, think of the courageous and resilient human beings who were doing the best they could to survive so that we could be here.

I think of my enslaved ancestors, and I ask: what more do I need? When I think of them, and what my credentials reflect, I am the literal embodiment of change. My persistent commitment to social justice is my love letter to my ancestors. They endured, so I must fight, but we each have finite energy and focus. Make a choice about where to direct energy and attention, where you can be most effective [in fostering social change]?

On a final note, what are other ways that people who want to make a difference can help to create change?

One of the things I’ve started emphasizing, especially to young people, is that you must be politically active. Vote or, if you already vote, ask yourself what policies you’ve been voting for. In the psychology and mental health fields, we subtly convey that politics do not belong in our fields. Unfortunately, that reflects in inattentiveness to underserved and marginalized communities, whose lives are most significantly impacted by political decisions.

These communities are often the ones we’re actively trying to serve. There are a whole host of decisions made at the federal and state governments, which have oversized impact on community health and wellness, including mental health access in these communities.

For example, we don’t often think about rural America, which is 70 percent white, when looking at disparity, but this is a community that has been significantly impacted by political decisions, including decisions that have led to a lack of mental health providers and community mental health centers that focus on substance use disorders.

Disparities are not inevitable; they result from choices people make. If you choose not to vote, you are making a choice. If we’re trying to help people feel empowered, and get well, then we must think about where those challenges stem from as well as the role we play in reducing those challenges.

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