Detroiters benefit in many ways from living in one of the Blackest U.S. cities. Finding a mental health provider who shares their cultural background apparently isn’t one of them.
This cultural disconnect is one reason people of color in the city receive mental healthcare at disproportionately low rates and often don’t seek help at all.
Studies over the last 20 years consistently found Black people’s struggles with mental health are similar to those of white people, but only about half of Black people with serious mental illness have received treatment. McLean Hospital, a mental health facility that is part of the Mass General Brigham system, reports that 25% of Black people seek mental health treatment when needed, as compared to 40% of white people. Rates of seeking help were similar for Latinx people and Asian Americans, and the gap hasn’t narrowed since 2012.
At least 78% of the people living in Detroit are Black, 8% are Latinx and 2% are Asian American.
Marginalized groups, especially Black Americans, have faced mistreatment and substandard care when they enter the mental health system, and that may be one reason these patients are skeptical of seeking help.
Anna Niforos, an Asian American therapist who works for Hope and Thrive Counseling in Ferndale, said the benefits of therapy transcend any cultural differences.
“The unconditional support, objective outlook and approaches are designed to help people with anything — ranging from mental disorders, identity, trauma, stress or even day to day living,” Niforos said.
Do therapists need to have the same background as their clients?
Black clients looking for a therapist generally prefer to see one of the same race. However, the research on whether seeing a therapist of your same race improves mental health is not clear-cut. A 2011 review found Black patients were more likely to stick with therapy and had just slightly better overall outcomes when paired with Black therapists. Latinx people experienced no appreciable advantage across 18 studies.
Before Amalia Miralrío started her practice, Amity Detroit Counseling, she was one of very few Latinx students in her graduate program. She never had a Latinx role model or mentor to look up to.
When she worked at a nonprofit in her early career, she said she faced a lot of microaggressions from a predominantly white clientele, something she discussed with her mentor, an Asian American male counselor.
“He really helped me contextualize (the microaggressions) I was experiencing at my full time job and planted the seeds of how I might want to do things differently when I’m on my own,” Miralrío said.
Now, Miralrío says Amity Detroit’s client base is 60% women of color between the ages of 25 and 50. Miralrío’s practice primarily focuses on issues of relationships and dating, body image and racial identity.
“I’ve spent so much time thinking about my own identity and how it shapes my world,” Miralrío said. “I know the way in which my clients experience the world is multifaceted and cannot be reduced to a stereotype.”
Sabrina Black runs Abundant Life Counseling in Detroit. She said knowing about and being able to address the historical generational trauma of people of color is necessary.
Abundant Life focuses on marriage, grief, gambling addiction and racial identity issues. Black uses a religious approach to connect with her clients, including LGBTQ+ people.
“Like everyone else, these communities want to be loved and understood, not dismissed and judged,” Black said. “My goal is to help everyone live their best life and address the issues and concerns they present.”
‘Bursting at the seams’
Many people of color are skipping therapy — and its benefits — entirely.
Even though only a fraction of people of color who could benefit from mental health care are getting it, the few counselors of color in Detroit are still struggling to keep up with the demand.
“From a behavioral health standpoint, we’re bursting at the seams,” said Dr. Felix Valbuena, medical director of the Community Health and Social Services (CHASS) Center in Detroit. “It’s a travesty when we have a patient that needs (urgent) ongoing support and we can’t meet it.”
Valbuena said the counselors there must be Latinx and bilingual in order to do their jobs well. He said about 73% of patients at CHASS prefer to speak in Spanish, and this makes it difficult for the center to keep up with the demand for its behavioral health services.
While the field of mental health care is diversifying, as of 2018, 84% of the U.S. psychology workforce is white. Black and Latinx people are starkly underrepresented in the field compared to their share of the national population.
Therapists agree that racial compatibility alone shouldn’t deter potential clients. Instead, Miralrío said potential clients should research a therapist’s theoretical orientation — or what strategies a therapist uses with their clients — to see if they are a good fit. Black also said a person’s willingness to engage in therapy actively is an indicator of whether the counseling will be successful.
Anna Niforos of Hope and Thrive Counseling said while she was never able to find an Asian American therapist in her youth, she had great personal experiences with therapists who didn’t look like her. Many of her therapists were women of color.
“I had gone through my own identity struggles growing up,” Niforos said. “Even if I didn’t have someone who specifically (looked) like me, I was still appreciative of the therapeutic help.”
She said other obstacles often stand between people of color and getting the help they need.
Insurance inequities are one of these obstacles. The average price of mental health services is about $165 a session in Michigan, a cost that is unaffordable for many people without health insurance picking up some of the cost. People of color are less likely to be insured nationwide, but Michigan has a lower uninsured rate among Black Americans due to expanded Medicaid availability.
“Mental health is so important,” Niforos said. “We’re trying to get the affordable piece … Not everyone knows that you don’t have to pay a top rate for therapy.”
Cultural pressures can be a roadblock for people of color seeking therapy. Many Asian Americans are pressured to associate mental illness with social or moral failings, and refuse to get care, although about 15% percent of Asian Americans reported having a mental illness in 2021.
Time poverty is another issue affecting people of color being able to access therapy. The availability of virtual therapy increased during the COVID-19 pandemic and has made it easier for many people to fit therapy into a busy schedule.
“There’s always the time crunch of trying to keep a job and manage everything,” Nicole Cannonier, founder of Hope and Thrive Counseling, said. “With a virtual platform, a lot of people can come into the therapy journey because they can log in anywhere — some clients (even) have families in other rooms during their sessions.”
Hope and Thrive’s primary clientele is women of color, and it uses a sliding scale to make appointments affordable to more people. The practice also regularly hires students in master’s programs as interns to take on clients who can’t afford market price therapy.
Sometimes, Niforos and her partners can offer therapy for free through partnerships with foundations such as Therapy for Black Girls, Black Girls Smile, the Loveland Foundation and Open Path Collective. These foundations also have free support groups to bridge the gap for those who need therapy but might not be ready or still find it unaffordable.
Detroit residents looking for therapists can use Psychology Today’s database and filter by race, gender, insurance, location and more. The Detroit Wayne Integrated Health Network also offers a comprehensive list of providers.