The mental health of Black women and their ability to seek care for mental illnesses like MDD and PTSD are significantly impacted by structural barriers that contribute to a lack of mental health support and resources in the Black community. These barriers arise from systemic racism, socioeconomic disparities, and cultural factors that intersect to create unique challenges for Black women’s mental well-being.
Structural barriers, such as limited access to affordable and culturally competent mental health services, contribute to disparities in mental health outcomes for Black women. The scarcity of mental health providers who understand the specific experiences and needs of Black women can result in misdiagnosis, inadequate treatment, and a lack of culturally appropriate interventions.49 This lack of representation and understanding can lead to feelings of alienation and mistrust, further deterring Black women from seeking help.
Socioeconomic disparities also play a significant role in limiting mental health support for Black women. Economic inequality and limited resources can restrict access to quality healthcare, including mental health services.50 The financial burden of seeking treatment, coupled with the lack of insurance coverage, can create barriers to accessing necessary care. Additionally, the intersectionality of race and gender can compound these challenges, as Black women often face employment discrimination and wage disparities, further limiting their ability to afford mental health services.
Cultural factors within the Black community can also contribute to the lack of mental health support. Stigma surrounding mental health issues persists, leading to a reluctance to seek help due to fears of judgment and social repercussions.51 The strong emphasis on strength and resilience within the Black community can discourage individuals, particularly Black women, from acknowledging and addressing their mental health needs. The pressure to conform to societal expectations of strength and self-reliance can prevent Black women from seeking support and expressing vulnerability.
Furthermore, the historical and ongoing experiences of racism and discrimination contribute to the mental health challenges faced by Black women. Racial trauma, microaggressions, and systemic racism can lead to chronic stress, anxiety, and depression.52 The cumulative effects of these experiences can result in a range of mental health issues, including post-traumatic stress disorder (PTSD) and racial battle fatigue. The lack of mental health support exacerbates the impact of these experiences, leaving Black women without the necessary resources to heal and recover.
Addressing the structural barriers to mental health support for Black women requires a multifaceted approach. It involves increasing access to affordable and culturally competent mental health services, improving the representation of Black mental health professionals, and destigmatizing mental health within the Black community.53 Community-based initiatives, such as support groups and outreach programs, can provide safe spaces for Black women to seek support and share their experiences. Additionally, addressing the socioeconomic disparities that limit access to mental health care is crucial, including advocating for policies that promote equitable healthcare and economic opportunities for Black women.
Addressing these barriers requires a comprehensive approach that includes increasing access to culturally competent care, destigmatizing mental health, and addressing the socioeconomic disparities that limit access to mental health services. By dismantling these barriers, we can create a more inclusive and supportive environment for the mental well-being of Black women.
One therapist who is working to create these types of environments is Ashley McGirt, MSW, LCSW, a racial trauma therapist and founder of WA/CA Therapy Fund Foundation. She explains54 how racial trauma compounds the challenges of seeking mental health therapy for Black people, especially due to the dearth of Black mental health providers:
Well, your story is my story. It is the story of so many other Black women, so many other Black people who look like us and are presented with these challenges. When I was young, my grandmother passed away, and I experienced grief that turned into major depression. I ended up seeing a counselor who was a white woman, and she did not understand the role of grandmother[s] in Black families. She didn’t understand anything about Black culture. Here I was, educating this white woman on Black life; on the intricacies of race, relationships, at nine years old.
I actually wanted to be a lawyer. I was really obsessed with the law, and I just knew that was the path that I wanted to take. But through the experience of losing my grandmother and having these sessions with this white woman who didn’t understand me, I told my mom what was going on. She searched and searched and tried to find a Black therapist for me, and she didn’t.
[…] I experienced a huge bout of depression. I’m like, “There’s got to be other Black children, other Black people, who are experiencing these things. And we should not have to spend our therapy session educating the counselor on what life is like for Black people in America.” So, I did a whole three-sixty.
I still love the law. I still do a lot of work…[related to] criminal justice [and] ending mass incarceration, but ultimately, I wanted to understand depression, suicidal ideation. My research is on African American suicide because I suffered from those things. I didn’t want to live when my grandmother passed away. I didn’t understand death. […] I do a lot of work around death and dying. I also ended up being a hospice therapist, and the majority of my Black hospital patients were extremely young, like my grandmother, who died at sixty-two years old. My grandmother passed [away] from a stroke. The leading cause of stroke is stress. What is it about the Black community that we are so stressed? Well, racism, systemic oppression, all these different things, and I’m a social justice advocate at my core.
Dr. Jessica Elizabeth Isom, MD, is a full-time psychiatrist, clinical instructor at Yale University, and attending psychiatrist at Boston Medical Center. She advocates55 for the importance of culturally competent mental health services and treatment that extend beyond simply pathologizing the mental illness of Black patients:
…throughout my professional journey, it’s been a very interesting experience, to say the least, of Blackness mostly being pathologized in ways that I couldn’t put language to until I went to public health school, and that’s where I learned that the reason why Blackness is listed as a risk factor, for example, all these different organ systems, and like medical issues, the reason why is because of racial racism, not necessarily because of race, so [it] kind of added a larger context, like a bigger lens through which to view medicine. And the more I zoomed out and added in that context, the more I realized that there needed to be a focus that wasn’t focused around these people. There’s something going on with them. There’s something wrong with them, and we need to help them. And more so, “Oh, these people are not being served in a number of different ways and we need to improve the services that we offer.”
So now I was very much focused on, “Okay. How do I take my education and my training and all the value in that and then kind of weed out the stuff that’s not useful?” And then I have to fill it in with something else, because if I see a healthcare professional, I want to have a different experience. I want my mom to, etc., etc. So I realized that there’s not a lot of people in this specific area focusing in this space. And now it’s 1 or 2 percent of psychiatrists who are Black. You know, [if] we’re not going to do it, who else will? So in that 2 percent, most of us are thinking about and focused on, how do we serve our own communities? […] We’ve experienced our training and we see how there’s shortcomings in how, as a collective, psychiatrists and other mental health professionals practice. So it’s kind of impossible not to focus our attention on our own community. For all of those reasons, there’s just a lot of work to do.
In short, the descriptive landscape of mental health among Black women is a poignant blend of resilience and despair. It is a painting filled with shadows and light, where the hues of suffering and strength mingle. The complexity of this landscape is not a mere academic pursuit, but a call to action. We must turn our eyes toward solutions, toward a world where mental health is not an isolated island but an integrated part of well-being. We must cultivate understanding, empathy, and compassion for ourselves. Our communities must forge pathways that lead not only to treatment but also to prevention, to a future where mental health is not a privilege but a right. In the dance between pain and healing, between darkness and light, lies a path to a better future. For Black women and for our community as a whole, we must have the courage to walk this path together. Only then will the echoes of despair transform into a symphony of hope.
journaling questions 
1.How do you perceive the impact of generational trauma on your mental health and emotional well-being? How have you addressed or started to heal this form of trauma in your life?
2.In what ways do you feel racism has impacted your psyche and mental health? How do you work toward acknowledging and addressing these impacts?
3.How do you understand the intersection of race and mental health disorders like major depressive disorder (MDD) and post-traumatic stress disorder (PTSD)? How has this understanding shaped your approach to mental health care?
4.How has the “Strong Black Woman” schema affected your perception of your mental health needs? What steps can you take to dismantle this harmful narrative?
5.How does the concept of “Linked Fate” impact your mental health, particularly in terms of hypervigilance and fear? How can you address these impacts in a healing and nurturing way?
6.What structural barriers have you faced in seeking mental health support? How have these barriers influenced your journey toward emotional well-being?
7.How has your experience been in finding representative, culturally sensitive mental health care? How important is this aspect of care to you, and why?
8.Have you encountered stigma or negative judgments associated with seeking mental health care? How do you navigate or challenge these stigmas?
9.How have socioeconomic factors impacted your access to mental health care? How do you navigate these challenges?
10.How can community support and self-advocacy play a role in overcoming structural barriers and stigma related to mental health care? How can you encourage these supportive systems in your own life and within your community?
affirmations 
1.I acknowledge the generational trauma in my lineage, and I am committed to healing and breaking the cycle for myself and future generations.
2.I recognize the deep-seated effects of racism on my psyche, and I am actively working toward healing these wounds.
3.I acknowledge the racial components in mental health disorders, and I am actively seeking understanding and healing in a way that respects my unique experiences as a Black woman.
4.I release the burden of the “Strong Black Woman” schema, acknowledging my right to vulnerability, support, and care.
5.I am aware of the impact of Linked Fate on my mental well-being. I am cultivating resilience, safety, and peace in the face of this collective experience.
6.Despite the structural barriers I face, I am determined to seek and obtain the mental health support I deserve.
7.I deserve mental health care that is culturally sensitive and representative. I will strive to find it and advocate for it.
8.I stand against the stigma of seeking mental health care. My journey to healing is valid and necessary.
9.Despite socioeconomic challenges, I am resourceful and determined to seek access to the mental health care I need.
10.I am worthy of healing, care, and peace. I will advocate for myself and my mental health needs, knowing that I am deserving of wellness and joy.
7.Yucel, Aylin, Swarnava Sanyal, Ekere James Essien, Osaro Mgbere, Rajender R. Aparasu, Vinod S. Bhatara, Joy Alonzo et al., 2019. “Racial/ethnic Differences In Treatment Quality Among Youth With Primary Care Provider‐initiated Versus Mental Health Specialist‐initiated Care For Major Depressive Disorders,” Child and Adolescent Mental Health (25), 1:28–35. doi.org/10.1111/camh.12359.
