hi, i'm lisa fletcher. and you are in the stream. depression, bipolar disorder, schizophrenia, although mental health awareness has improved, for african-americans a major stigma remains. why is dealing with mental illness different for blacks? ♪ our digital producer, wajahat ali is here bringing in all of your important feedback. waj we're going to try to peel

back some of the layers of mental illness, and why it is dealt with differently in the black community. >> yeah, as the viewers know there is a third host to this show, and they have been tweeting us asking for a show on mental illness. >> yeah, we have been tweeting out statistics all day long, and people were reacting pretty strongly to a lot of them. including ones like this. african-americans seek treatment for mental health issues at a rate half of whites.

>> black folks do not go to therapy, because who wants anybody sitting there telling them what is wrong with you or what you should be doing? >> i think it's from a medical deal and not trusting white doctors, and just the whole idea of you have to stay strong and hold it in. >> depending on who you talk to, you better not admit that you are going therapy. >> that sigma is echoed across african american communities. the question is can it be overcome. >> joining us we have the author of black pain, and psychiatrist and mental health advocate for more than three decades, and an assist important professor for public health. welcome everyone to "the stream." >> you have had your own

struggles with and try everyone over mental health issues. why is it so different to deal with these issues in the african american community. >> primarily because it is seen as a sign of weakness, a character flaw, and we do not believe in telling other folks our business. we don't know what it looks like, feels like, sounds like, and we're a very faith-based people, so to do anything other than to pray to god is really -- [ technical difficulties ] particularly class issues are there. many of my white friends and colleagues will tell you they can't go to a staff meeting. why? because they are going to see their therapist. and will tell you what

antidepressants they are on. >> that doesn't happen in the black community? >> uh-huh. there is a woman in my community who all of her coworkers think she is going to her aller gist. >> did you confy in your friends and family? >> no, i didn't. some very close friends saw he unravelling, and help me get to a therapist. it was taking me down -- my family was moving in the house i grow up in, my office where i had been for ten years, i was sub leasing space so i had to move, and a very close aunt passed away. so just a lot of things

converged at once. >> doctor why are blacks half as likely to seek treatment than whites? >> well, the main reason, and it's crazy, if you are black in america, it's already one stigma. you don't need two. a study out of the university of michigan did a study on this, and blacks were first expected to minister, then they will go to family, and then a primary care doctor, and lastly is a psychiatrist. >> dr. bell, we have our community criming in . . .

and here is a video comment from perry. >> i lucked out because my parents were very supportive of what i was going through. so they formed a rock for me. but beyond that i got the message that i was my fault. i would need to pray for this and that, and you would start to feel like there was something very wrong with you, because you can't be fixed, and everyone sees it but you. >> daryle why don't you give us some incite on this phenomenon. >> sure. i think we have touched on a number of different issues. i think there is a great stigma against having a mental disorder and seeking treatment. there is also access issues as well. a few years ago there is a [ inaudible ] which tries to

make reimbursement on the same footing as medical disorders. like one on the panel mentioned that the stigma against this is such that people will make up excuses or stories to mask the fact that they are looking for -- for treatment, so it's not just -- it's still -- it's a combination of different things, awareness, accessibility, accessibility to their treatment. a lot of people don't like the idea of therapy, because they don't want to labeled as crazy. so that -- those are all factors that are largely at play. >> doctor bell is mental illness truly more prevalent in the black community or just more untreated? >> well, it depends on which

studies you read, there is some study -- [ inaudible ] out of atlanta has research that shows that black people are more [ inaudible ] than white people. now that's -- depending on who you are studying, and what you are studying. that's one issue. the other issue that happens that black people don't go to therapy is because they [ inaudible ] majority culture. so you have heard black people talking about going into the store and the security guard following them out. the white woman clutching their purses when a black man walks buy. those are stereo types that the medical profession makes all the time. plus you have another issue of

misdiagnosis, black people are forever getting the short end of the care stick, and being misdiagnosed, and that's no fun. >> are black men more likely to be diagnosed with a conduct disorder, rather than a mental health disorder. >> a lot of young black men, maybe a third, might suffer -- depending on which population you look in. in you look in the cook county detention center, you'll fine about 50% of the men there are diagnosed with conduct disorder, when actually they have fetal alcohol syndrome brain damage. and the research is clear that white men use more illegal drugs and are just as violent as black men, but they are not

concentrated in jails. white men have scattered houses so it let's hear what the community is saying. >> yeah. >> beyond the personal toll, not getting help for mental disorders has a significant community impact. we're going to look at those very real impacts after the break. this is from the heart of activist who lost her friend to depression. >> this is about humility and admitting that you need help and sleep and hugs and permission to cry despite the strength you are often accused of. this is about relinquishing control, taking a breath, stepping back. ♪

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we're back. we're discussing why dealing with mental illness is different in the black community than others. there is a treatment where your mental state is actually making you sick. and that is more common amongs african-americans. why is that? >> there is some connections between physical and mental health. part of it could be people are -- there's some amount of literature that perhaps there's a difference in symptomology, particularly the symptoms that african-americans feel or are willing to admit compared to whites. so there has been some work to look at the differences there. so the fiscal nature of it so part of it, but there's also some links, a growing body of literature that shows a link

between mental health and physical health. a good example is depression and diabetes. we're not quite sure what the connection is. is people are diagnosed with the disease, and then people are depressed or if there's a physiological pathway between that disease and physical depression. so there are a number of reasons why we can see that connection. >> doctor you have done some significant research on fetal alcohol syndrome in the african american community. talk a little bit about that. >> it turns out that fetal alcohol exposure is the leading cause -- or attention deficit hyperactivity, learning disorders, and mild intellectual disability in speech and

language problems. those are the four most common problems that children have, and as a result when you -- so i treat black people, and they come in, and i say what brings you? and they say i'm bipolar, i'm depressed, and i'm schizophrenic. and i say really? at which point i ask them if they have special education in the school and do they have a bad temper? and what you find if you look at special education populations a good 50% of the black children in special ed have fetal alcohol brain damage. if you look in corrections populations in detention centers you'll find a good 50% there. if you look in a mental health population, a third of the patients, in or outpatient have fetal alcohol brain damage and if you think about poor black communities, the main business

that is thriving are liquor stores. and some young black women are drinking before they find out they have pregnant, and then they stop, but the damage is done. >> give a listen to this video. >> i think that the stigma of mental illness is different for african-americans because we are held to stereo types like the strong black women that are just impossible to adhere to, and there's also this perception that therapy is for white people. that black people who have mental disorders are being dramatic, or it's viewed as a weakness or a failure, and this just impedes those who need to get mental health care. >> talk about the stereotypes that exist within the african community. the strong black woman and proud

masculine man. >> absolutely. >> and how do these play particularly with the youth. >> first of all, therapy is the gift that keeps on giving. that's what i just wanted to say at the outset, but i was thinking about something that karl had said about the number of black folks in special ed, but i think it also has to do with the amount of violence and trauma in our communities. you see somebody cut down right in front of you, and then you get up and go to school or work as if you didn't just witness that. and nobody is getting any help. i just thought about that -- but i don't think i really answered your question. >> no, please go ahead. i know you said this image that people have to hold up in the african american community of being the strong black woman or man, it seems it adds another

layer of shame. >> it does. as a young african american -- any man growing up, you have to be strong. you cannot show emotion. you can't go run and tell mommy this, so eventually you just stop talking about then that comes out in an explosion. one kid got up after watching the public service spots, and he said i stabbed someone seven times, and then he said and he wasn't even the one i was mad at. >> oh. >> so it's when you adopt have anywhere to go, you'll take it out on anyone. and it's why we really need to get ours help. >> professor hudson, because the obvious impact, there's a huge economic impact here. talk about what you have seen in regard to that. >> sure. so here in st. louis there's an incredible amount of economic

costs associated with mental disorders. generally african-americans, cost about $96 million in hospital visits to treat for mental disorders, compared to about -- almost $300 million for whites. so it's lower, but african-americans only make up about 15% of the st. louis region, so they can costing almost half of what white costs in terms of mental health treatment. but those numbers are diluted, because we're not talking into account, loss of productivity, days off work. days that you are not feeling well and productive. there is a somebody of estimates that indicate on average in st. louis, the average person spends about 4.5 days not feeling quite well, and so those -- those impacts are incredibly difficult to encompass.

we have data within mental health, but we know that the cost is much more than just the treatment that we see in hospitalizations. >> daryle, i want to mention, the community is talk about the systemic inequalities and racism that exists. and give a listen to jewels. >> from my own experience as well as a services provider in the mental health community, i found that many african-americans are reticent to speaking mental health services because many providers are of anglo or middle class background and may not explore

issues that are contributing factors that go into the degradation of the african american community. >> what is your response? >> she is absolutely right. when one goes into corporate america, especially if you are a big black man who has a booming voice. there was a piece in the "wall street journal" about a black man lowering their voices so they don't seem as intimidating. and if you don't get that out, you can have more problems at home. they have such influence over the community. >> dr. bell i want to give you a chance to jump in on this. >> well, let's be clear.

the majority of black people in america are getting psychiatric and mental health treatment in special education, corrections and child protective services. we need to be real clear about that. black people are getting mental health care through the public systems of again, corrections, child protective services and special education. >> and that indicates it would be a crisis level at most of those points? >> i'm not sure it's at a crisis level. i think daryle mentioned access. black people don't have access. poor black people don't have access to a black psychiatrist or any psychiatrist. so they wind up being put in

special education, corrections, or special services. >> how can decades of this stigma be undone to improve this care. our panel has some solutions, tweet us yours, and we'll get to it all after the break. al jazeera america - a new voice

welcome back. we're discussing the silence that surrounded mental health issues within the african american community. and now what is the way forward. terry, what is the role of churches in addressing this issue? >> it's growing. i'm happy to say. there are more and more ministers who say in can't of the congregation, there are more that are establishing counseling rooms in the church, and mental health professionals donating their services, so i see a growing trend. and then on the other hand there

are those who will say that it's a sign of weakness to go to a therapist, because you take everything to the lord in prayer. >> and what do you assay to that? >> it was my god who led me to the right psychiatrist. that's what i know. you know? but it's an issue we have to continue to work on. the church influences everyone, so that's a great place to start and we head to to do more. >> daryle, talk about the role of culturally competent care in the mental health field. >> sure, provider bias is a m major issue. many people think if you are a medical professional, you lose the stereo types that you are exposed to. but all of the things are embedded so deeply in our

society, that oftentimes when people go through training, do four years of medical school or complete a master's et cetera, et cetera, they don't believe those biases at the door. so that could be where there's a difference in diagnosis. african american men are overdiagnosed as schizophrenics, and unless diagnosed as depressed. >> our community seems to be agreeing with you . . .

so dr. bell we keep seeing this mistrust of, quote unquote, white america or the medical profession, how do we overcome this? >> i think the answer to the healthcare crisis in america in general is prevention. we were part of a 2009 prevention report from the institute of medicine, and if you look at how much of it has been reduced there is a lot of prevention. there's prevention for depression, possible prevention for schizophrenia, prevention for fetal alcohol syndrome, so there are a lot of ways to do preventi

prevention. all of the other industrialized countries are spending money on prevention. >> i want to give you the final thought. >> we look at people's masks every day, and if you have the courage to share your story. it helps people understand that they are not alone. you look at someone's face and they are smiling, you think everything is okay. but you have no idea what that person's journey has been. >> thanks so all of our guests tonight. we'll see you online. ♪

good evening, everyone. welcome to al jazeera america. i'm john siegenthaler in new york. >> we're well into a tech surge to fix the problem. and we are confident that we will get all of the problems fixed. >> the white house tries to fix the government healthcare website, but critics say that is just part of the problem. we ran across the field, and while we were running we heard four or five more shots. >> another school shooting, and authorities still don't know why. and transit talks, strikers and management start talking again. ♪