The last year has been one marked by collective trauma.
Covid-19 brought on a wave of loss, anxiety, stress, fear, economic instability and isolation across the country, creating, within the pandemic, a mental health crisis. Images of Black people shot and killed by police, mass protests, the shock of the Capitol riot and the opening up of the deep, systemic wounds of racism have brought on another level of trauma.
Through it all, Black therapists, who are disproportionately underrepresented in their field, have been in high demand.
One morning psychiatrist Danielle Hairston treated three Black patients at Howard University Hospital in Washington, D.C., who had attempted to kill themselves. In Atlanta, psychotherapist Laura Morse had clients who expressed tremendous fear for their safety after the riot at the Capitol in January. Carol Binta Nadeem, a Maryland psychotherapist, advised her clients who she treats for trauma to avoid watching videos of police killings.
As people seek help, it’s not unusual to find a Black therapist only to learn they are unable to accept new clients. As of 2019, only 3 percent of the psychology workforce in the U.S. is Black, yet many people are specifically seeking a Black therapist.
"When you are exhausted and seeking help and maybe you waited until a crisis, you don’t want to take time to find out whether a therapist who is white will understand you," said Morse, a professional counselor in Atlanta. "People came wanting and needing immediate connections.
"From March of last year until now has been my most lucrative year," Morse said. "It’s wonderful, but it’s not wonderful."
While the total impact of the pandemic can’t be known yet, June data from the Centers for Disease Control and Prevention showed 15 percent of Black respondents seriously considered suicide in the previous month, compared to 8 percent of white respondents and 10.7 percent overall.
Even before the pandemic, an article in the medical journal The Lancet collected data that showed police killings of unarmed Black people “were associated with worse mental health among other black Americans in the general US population.”
Black therapists say they have seen evidence that Black clients are suffering from increased mental stress, having more incidents of suicidal ideation and more drug addiction relapses.
“At Howard University Hospital in one day, I had back-to-back suicide attempts,” said Hairston, who is the psychiatry residency training director at Howard University College of Medicine. “That day I had three suicides — one a young mother, two males, all between 20 and 50 years old. I had never seen so many suicide attempts in such a short period.”
By last fall, she said people were showing up at the emergency room because they didn’t have access to the internet for virtual appointments and they simply wanted to see a doctor.
"That’s where you see there is a great digital divide, for those lower economic patients or older patients who don’t have a smartphone or trust Zoom or other platforms," Hairston said. "I don’t think any of us expected that."
There were other surprises. Hairston said many patients asked for letters recommending they receive emotional support animals. Morse said she did not realize how much the Jan. 6 riot at the Capitol would impact some of her clients.
“Watching the insurrection made some people think everything was eroding, that they could not take basic safety for granted,” Morse said. “It was a huge boundary violation. And there was the perception that after the election things would get better. It shook some people to the core.”
Morse was already counseling couples who found “some cracks in their foundation” after being forced “to stay under one another for a whole year because of the pandemic.” Then, she said, “the killing of George Floyd and other African Americans by police shifted the intensity at which people needed support. The racial reawakening made everything feel layered. You might have someone dealing with losing a family member because of Covid, but then they are also afraid for their son because of the deaths of Black men at the hands of police.”
Jaleel Brabham, a mental/behavioral health therapist in the Philadelphia area, has noticed an increase in the number of his Black clients who are “self-medicating with drugs.”
Brabham, who specializes in treating people with substance abuse and mental health disorders, believes some of the reported “attempts” at suicide are accidental. “Maybe they quit drugs and have been clean for a while and when they relapse, they mistakenly overdose,” he offered.
Sarah Y. Vinson has a private practice and treats clients at a county clinic in Atlanta.
“In my private practice, I have more Black professionals who work in corporate America and have more day-to-day interaction with white people,” she explained.
She said her professional clients are stressed by new commitments to diversity and change by their companies that have assigned them to lead the charge while not providing adequate personnel assistance or financial support.
“They were also invited to engage in more conversations about race with people who wanted to play devil’s advocate and see it just as academic conversation,” Vinson said.
She said those clients more recently expressed feeling “very alone and frustrated. They felt white colleagues were paying little attention to the [Derek] Chauvin trial. They felt the rest of the world has gone back to the norm. They are questioning: Did you really care or were you just stuck at home, so you had to pay attention” to the aftermath of Floyd’s killing.
In her practice at the public clinic, Vinson works with Black clients concerned about economic insecurity and the ways that instability affects their children. Those kids, she said, “have very little contact with whites but are more affected by structural racism that affects their schools.”
“They live in underfinanced school districts where there is no good Wi-Fi in the area,” she said. “I saw the juxtaposition of what it’s like when everybody has devices and good Wi-Fi and then some of the families I work with had kids trying to do schoolwork on a phone.”
LeRoy Reese, a pediatric psychologist in Atlanta, primarily works with Black teen boys and young Black men. His waitlist is three months long.
“The intersection of the pandemic and its toll, with the real-time occurrence of the public assassination of Black men, creates a toxic algorithm that can only compromise one’s psychological well-being,” said Reese, who is also a faculty member at Morehouse School of Medicine. “I have young people who are worried about their parents’ jobs and then seeing the series of public violence committed against people who look like them, it has resulted in fear and rage. How do you maintain sanity in a place that so clearly says it does not value you?”
Nevertheless, Reese has seen some encouraging signs coming from experiences in the past year, such as the increase in the number of Black people seeking help through therapy.
"The other thing I saw was faith communities say, 'Hey, we have to get people in front of our congregants to say this is how you take care of yourself,'" Reese said. The pastor of his own church, Ray of Hope Christian Church, gave up a Sunday service and instead held a mental health education program for the congregation.
He said he’s also seen fraternities, sororities and other social groups do the same.
“One of the things I’m hoping that comes out of this is a normalization of good mental hygiene, that we know we do not have to suffer in silence,” Reese said.
Carol Binta Nadeem, of Silver Spring, Maryland, primarily counsels regular clients with pre-existing trauma. She finds that for them, the police killings of unarmed Black people “trigger that feeling of being victimized.”
She said they were also re-traumatized by the Jan. 6 riot at the Capitol, miles from Nadeem’s practice.
"They kept saying, 'As a Black person, I don’t feel safe.' They knew that many of those involved were white supremacists. That created more anxiety," she said. "My phone was jumping off the hook that week. Especially for those living in the D.C. area, people were afraid to go out of their houses."
Black therapists spend hours listening to the pain of other Black people even as they experience pain from some of the same events and issues. It’s important to practice self-care, said Nadeem, who referred to herself and her Black peers as “wounded healers.”
“I have seen a lot of colleagues get burned out,” said Brabham, who has a support group made up of friends. “Even family and friends will come to you for help, but we have to make sure we set boundaries.”
“During the summer, after Rayshard Brooks was killed, I was feeling overwhelmed myself,” Morse said. “I thought I’d get a break when my white clients came in, but they were so impacted by it too — hurting and feeling guilt. We are all experiencing this collectively. But I have to detach from my own emotions in order to validate and support my clients.”
If you or someone you know is in crisis, call the National Suicide Prevention Lifeline at 800-273-8255, text HOME to 741741 or visit SpeakingOfSuicide.com/resources for additional resources.