Mental health challenges are part of the human experience. Most people will go through periods of grief, sadness and fear. However, when those feelings turn into depression, anxiety, hopelessness and suicidal ideation, it’s time to seek help.

Yet, many individuals, especially minorities, struggle to access the support necessary to overcome mental health issues, leaving them with few healthy coping mechanisms.

July is Minority Mental Health Awareness Month, and we connected with Rosanna De La Rosa, a Latin American woman and WakeMed’s Virtual Behavioral Health Supervisor, as well as Jeremy Gilmore, an African American man and WakeMed’s Director of Spiritual Care, for insight into the challenges minorities face and what can be done to turn the tide.

Starting with Spirituality

The first line of defense for mental health among many minorities is often spiritual care. A pastor, rabbi, priest or imam are generally the starting point when there is a crisis. And, minorities are not alone in utilizing this resource. Spirituality matters for most people in the world. Data shows that more than 80% of people practice religion and feel that spirituality is important in their lives. In most minority communities and countries, religion is integrated into the culture. The Pew Research Center shows that the vast majority of African American (87%), Latinx/Hispanic (73%), and Asian American (81%) populations report religious affiliations.

Spirituality is a gateway to exploring mental health issues because, within the context of religion, there is typically established trust. The religious authority offers support before there is an emotional crisis through teaching, preaching, serving and praying, so people will often go to their religious leader for support before seeking a psychologist. Some members of the Latino community, for example, might be nervous to go to a White/Caucasian therapist if there is an immigration concern, cultural difference or language barrier but would feel comfortable going to their religious counselor/leader.

In fact, a lot of what Jeremy Gilmore and team do in WakeMed Spiritual Care is pastoral counseling. They listen and offer support to people as they navigate grief, anxiety, family concerns and emotional crises.

Spirituality is an embedded and proactive protectant from despair and can be a vehicle for celebration. It helps people make meaning out of the trials they go through and helps them endure difficult moments.

For example, data shows that religious cancer patients are able to withstand more aggressive treatments and for longer periods. It is clear that spirituality offers emotional regulation, psychological integration and hope.

An awareness and appreciation of a person’s spirituality can be an important first step in building the trust needed to create a therapeutic relationship. With this in mind, there is a point at which spirituality and mental health therapy intersect, yet some minorities may be hard-pressed to afford and trust other sources of mental health support.

Addressing Financial Hurdles

Rosanna was inspired to join WakeMed partly because in her previous position, she found that many minorities would struggle with the practical aspects of receiving therapy. For example, therapy was not an option for them if they could not afford the insurance co-pays or had no insurance at all. These financial constraints meant these patients would fall through the cracks and be left to navigate mental breakdowns without adequate support.

This was heartbreaking for Rosanna, so what caught her attention about WakeMed’s Virtual Behavioral Health Program was the commitment to support patients. Patients who are referred to her program can receive between six and eight free sessions (if they qualify) while awaiting an assignment to another therapist appropriate for their needs. At WakeMed, she also has the resources to connect referred patients to other behavioral health programs that may have a sliding fee scale. This is great for patients who lack knowledge in how best to access supportive resources and lack financial means to pay top dollar for the help they need.

Banishing the Stigma

Another hurdle for minorities is the stigma around the meaning of mental health issues. Some believe that mental health support is for “crazy” people. Others argue that it violates their culture of family secrecy.

As for patients in the pediatric setting, they often have a hard time telling their parents that they are anxious or depressed. As for the patient’s parents, a barrier is the parents’ suspiciousness of medication administration or confidential therapeutic treatment. These concerns may stem from a hard and fast belief that addressing mental health issues is in violation of the family culture.

Telling Your Truth

A lot of people within the minority community may struggle with opening up. This may stem from having previously informed a family member about trauma they experienced, and then not being believed or — as mentioned previously — being told to keep quiet to protect the family’s name.

Because they could not discuss it and had no caregiver available to help carry them through the trauma, their brains were not able to fully process those traumatic experiences. As a result, they lived in a state of fight or flight with quite a bit of guilt and shame. This led them to engage in substance use or other harmful addictions or thought patterns, numbing them, so they could cope with what was not being processed.

Patients will say, “I just don’t discuss it,” so they have a lot being repressed through subterfuge, building up toxic emotions without a mental health provider to share with.

These issues are the same in both the majority and minority population with one exception: the minority population struggles with accessing the help they need.

As a result, they get used to living in a depressed or anxious mode. It is all they know, and they may not realize that it is a serious problem until it starts affecting their daily functioning.

Accessing Life’s Basics

Another challenge is that many minority populations grapple with meeting daily needs as a result of poverty, immigration status, housing instability, lack of education, lack of access to health care and more.

Institutionalized discrimination — which is responsible for many of these disparities — means that if they also have mental health issues, they lack the ability to access the treatment they need.

Providers who can see them without insurance often have significant fees. It can also be hard for them to get to a treatment session because they cannot take time off of work since many work hourly jobs without paid time off.

Those experiencing homelessness may be couch surfing from friend to friend or family member to family member in need of permanent shelter. For these patients, it is difficult to be stable enough to go to a regularly scheduled therapy session. Many also don’t have a consistent phone connection to contact the provider and explain challenges as they arise.

What’s more, a lifestyle of instability can, itself, be at the root of mental health issues — triggering worry, anxiety and depression.

Many need help with resources to work through challenges causing situational anxiety or depression — first. Once they have income and safe, stable housing, they can be ready to work with a mental health therapist to deal with underlying issues that may have led to this state of crisis.

Understanding the Symptoms

Yet another issue is recognizing the signs of mental health breakdowns. They include:

• Isolation from friends and family
• Lack of enjoyment in activities that were once a source of pleasure
• Avoidance of phone calls
• Sleep disturbances
• Lack of or low self-esteem and confidence
• Negative thinking
• Emotional withdrawal
• Irritability
• Increased or decreased appetite

Recognizing these symptoms for what they are may bring on shame. Clinicians have an opportunity to help patients break through this barrier, so they can get help.

Letting Go of Shame

Shame may be evidenced by a person who refuses to admit there is a problem or an individual who sees a therapist but has trouble warming up. It is often triggered by past trauma and a lack of safety/trust in people in positions of power. Once patients are able to let their guard down, they can discuss the root cause of their shame and what this means to them.

It is at that point that clinicians can provide psychoeducation to show patients that they deserve mental health therapy.

Just as the body needs care, the brain also needs care. This is normal and nothing to be ashamed of. Therapy can be beneficial to patients and their loved one — even if the loved one is the person who is against therapy.

Reframing unhealthy thought patterns that trigger shame is important to help move past it and rewire the brain to think more healthfully. This process takes time, so a trusting relationship is necessary for the patient to begin to heal.

Finding Therapeutic Support

Do you want mental health support?

For those with insurance, a good starting point is with your Primary Care provider. This provider can connect you with therapeutic clinicians in the community.

For those with or without insurance and in need of immediate support with a mental health or substance use crisis with no medical issues, the following community providers specialize in urgent and ongoing mental health care:

• Alliance Health: 800-510-9132
• National Suicide Prevention Hotline: 800-273-8255
• Monarch BH Urgent Care: 319 Chapanoke Road, Suite 120, Raleigh, NC 27603 | 919-703-2845
• Carolina Outreach BHUC: 2670 Durham-Chapel Hill Blvd., Durham, North Carolina 27707 | 919-251-9009
• Mobile Crisis Services with Alliance Health: 800-510-9132 | Relay: 711 or 800-735-2962

Healing Within Yourself

Beyond the support of a spiritual leader and a psychologist or psychiatrist, there are measures you can take to support your own mental well-being.

• Exercise — Physical fitness helps to release feel-good endorphins and helps you maintain good health.
• Eat healthy — Food is truly nourishment for the soul. A diet rich in vitamins and nutrients contributes to a stronger sense of well-being.
• Take lots of walks — Exploring nature is a way to reconnect with yourself and renew your inner peace.
• Get sufficient sleep — If your body isn’t resting, your brain isn’t resting. A sleep routine is critical. Look up calming apps and sounds to help with sleep.
• Attend a support group — Connecting with others who are dealing with similar life circumstances helps understand that you are not alone, that your situation is not completely alien to others and that there is hope for a brighter day ahead.
• Spend quality time with emotionally healthy family and friends — Time spent with emotionally healthy people lessens time spent in isolation — which is fodder for negative and ruminating thoughts.
• Take time for meditation practices and breathing exercises — These have been proven to decrease blood pressure, reduce anxiety, help you live in the moment and even navigate a challenging relationship. Studies show that for bipolar disorder meditation has been shown that meditation is the most common alternative and highly effective treatment.
• Pray — Jeremy Gilmore shared that at WakeMed the team would pray with a patient and the person’s blood pressure would drop. Prayer would stop, and blood pressure would go back up. The patient would again request Spiritual Care, and during prayer, the blood pressure would again go back down. Remember, you are not just a physical being. You are metaphysical being. Emotions and spirituality are all connected.

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About Rosanna De La Rosa

Rosanna De La Rosa, LCMHC, has served for three years as the WakeMed Virtual Behavioral Health Supervisor and also has her own counseling caseload to support children and adults. As the only Spanish-speaking member of the team, she serves an important accessibility role for patients who speak Spanish. She accepts referrals from WakeMed Pediatric and Adult Primary Care and OB-GYN (for expecting mothers and those who struggle with postpartum depression).

About Jeremy Gilmore

Reverend Jeremy Gilmore, MA, MDiv, joined WakeMed as the Director of Spiritual Care in 2020. Previously, he served at UNC REX Healthcare in Raleigh, NC; Carolinas NorthEast in Concord, NC; and the Durham VA Medical Center in Durham, NC. Before working in health care, he was the Assistant Director of Diversity Initiatives for the Kelley School of Business at Indiana University. He has earned degrees at Indiana University and Duke University and is currently a PhD candidate at North Carolina State University. His latest article, “Caring for the African American ‘S.E.L.F.’ in CPE Supervision during Two Pandemics: COVID-19 and Police Brutality,” was featured in the Journal for Reflective Practice in 2021.

Additional Source:

Koenig, H. G. (2009). Research on religion, spirituality, and mental health: A review. Canadian Journal of Psychiatry, 54(5), 283-91. Retrieved from https://proxying.lib.ncsu.edu/index.php/login?url=https://www.proquest.com/scholarly-journals/research-on-religion-spirituality-mental-health/docview/222845928/se-2