Blacks or African Americans have not historically participated in systemic change related to their health and mental health in large numbers, a fact that some have attributed to disinterest. But in We Ain’t Crazy! Just Coping with a Crazy System: Pathways into the Black Population for Eliminating Health Disparities – 2012 (PDF | 10.1 MB), V. Diane Woods, Dr. P.H., and her colleagues at the African American Health Institute of San Bernardino County (AAHI-SBC) punched a hole in that myth. In fact, when they sought participants for their study, the response was overwhelming, proving that nothing more than a lack of opportunity was to blame for the prior low levels of engagement.
“Black people had a lot of things to say, and those things were very pertinent and germane to the conversation, which was prevention and early intervention in mental illness,” says Dr. Woods.
It’s a historic conversation as well. Dr. Woods says that, before they began the project, she and her colleagues looked for any study that invited black Americans to “give their input in an original manner to impact on system changes” and couldn’t find a single one. “Black people in the United States have never been engaged on this level to give their input about the services they’ve received, and then to also identify what could serve them better,” she says.
Study Focuses on People’s Perspective of Health Disparity Concerns
We Ain’t Crazy! documents the findings AAHI-SBC made through the California Reducing Disparities Project (CRDP) for African Americans, which was funded by the Mental Health Services Act of 2004. A total of 1,195 individuals participated in focus groups, public forums, one-on-one interviews, small groups, and through administered surveys over a two-year period. According to the 380-page report, the task was to gather information, identify issues, and process and report community-defined practices “from the perspective of the population that support indicators of mental health disparities for Black Californians.” Participants routinely reported shame and embarrassment around mental illness at significant enough levels to keep them from seeking professional help. Furthermore, respondents statewide said that their local Departments of Mental Health had regularly failed them in providing care.
CRDP also revealed high rates of psychological distress, depression, suicide attempts, dual diagnoses, and other mental health concerns among respondents. In addition, co-occurring medical conditions, including heart disease, cancer, stroke, substance use, and violence, were noted in large numbers. In tandem, they paint a population in crisis.
“The report is from the perspective of people, not from the established system,” Dr. Woods says. “That’s what’s so critical about it. This is the voice of the people at all different levels—we are trying to tell the story from a different perspective.”
Although the report was published in 2012, it remains relevant today, says Dr. Woods, noting that many of the issues involving black men in the news in the last six months are the kinds of systemic, intergenerational issues that are discussed in We Ain’t Crazy!. The report also has attracted considerable attention, with more than 500 hard copies sold. Dr. Woods has been invited to conduct presentations and workshops on the team’s findings in other states. California is using the report in creating a statewide strategic plan to revise its mental health delivery system to be more responsive to all of its residents.
L.A.’s Skid Row Benefits from the Study and the Project’s Work
One significant contribution to CRDP came from those people experiencing homelessness in the Skid Row section of Los Angeles. Many of them are people who’ve fallen through the cracks, Dr. Woods says, and are commonly considered “throwaways”—the rough sleepers, chronically unemployed, and others who are said to not care about the world around them.
In fact, they are participating in improving Skid Row’s environment by cleaning streets, providing toilets, helping to install clean water fountains in parks, and looking out for each other, as well as speaking up at city council meetings. One group even pooled funds to create the award-winning Skid Row City Limits mural.
Skid Row’s denizens served as a case study in We Ain’t Crazy!, listing interventions and practices that would help African Americans who are dealing with mental health issues. Suggestions included redesigning single-occupancy homes to accommodate children and families, providing mentoring services or other alternatives options to medication, using brochures and signs to better inform individuals of local mental health resources, and constructing a cultural center.
“The whole project was about moving forward and identifying community-defined evidence and then moving to the next stage of funding, testing, and replicating them and seeing how they would work in other places,” says Dr. Woods. For her, a point of pride is the report’s 20-page table listing community practices and resources available to Californians statewide. These resources range from programs to help grandparents who parent their grandchildren to afterschool programs for adolescent boys to digital storytelling, veterans’ personal care services, and anger management workshops.
“This report put a light on multiple activities that are going on that have virtually been ignored,” says Dr. Woods, and it allows individuals and groups to highlight what they’re doing to make a difference, much of it under the radar.
“They are there, they are doing this work, and they are doing the best that they can. They need to be supported,” says Dr. Woods. That’s also reflected in Dr. Woods’s next project, a community planning document that—though still in progress—already totals 500 pages.
This article was originally published to highlight the February 2015 theme of Minority Behavioral Health Conditions. Learn more about Health Disparities.
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