African Americans across the state have concerns that their mental health assessment and diagnoses are inadequate, according to a state-commissioned report issued today.

These inaccurate psychiatric assessments are a “part of the problem that leads to disparate outcomes,” the report said.

“People felt like they did not have a good assessment (from their provider) to understand what their particular issues are,” said V. Diane Woods,the founding president of the African American Health Institute of San Bernardino County and primary author of the study. “And if you are not getting a good assessment, you are not getting a good plan or care, and it increases the probability that you will be placed on the wrong medication.”

This is an issue of concern for mental health professionals nationwide.

“Due to lack of cultural understanding, some clinicians may misdiagnose African American patients,” Annelle Primm, the American Psychiatric Association’s deputy medical director and director of its Office of Minority and National Affairs, wrote in an email. “For instance, it is well documented in the literature that African Americans have been overdiagnosed with schizophrenia and underdiagnosed with illnesses like major depression and bipolar disorder. Expressing ‘healthy paranoia,’ regarded as a survival skill among African Americans, may prompt an uninformed clinician unfamiliar with African American culture to consider this as a symptom of schizophrenia or psychosis.”

Based on 35 focus groups, 45 individual interviews, 635 surveys, and 10 public forums and meetings with residents and mental health professionals from across the state, the report aimed to provide a more complete picture of the African American community’s experience with the state’s mental and behavioral health system, Woods said.

“Black people across the state wanted the population report to ‘tell the entire story’ so others could understand the lived experiences with and related to mental health issues,” said Woods, who is also an assistant research psychologist at UC Riverside.

Among the barriers to accessing mental health care described by study participants is a lack of culturally proficient practitioners and providers.

“I should have been in counseling a long time ago,’’ Helen B. Rucker, a Monterey County resident who is African American, told researchers.  “I wish I had access to talk to someone about how I feel. But, there has never been anyone I could talk to who understood what I was going through.”

Karen D. Lincoln, an associate professor of social work at the University of Southern California, said that this dynamic can contribute to disparities in treatment and diagnosis. “There is a white norm around symptom presentation,” Lincoln wrote in an email. “If you aren’t looking for the right symptoms or if the language being used to describe the symptoms is unfamiliar to you, you can have disparities in diagnosis.”

Community distrust is another barrier to accessing mental health care, said Thomas A. Parham, a past president of the National Association of Black Psychologists. 

“Historically, what has happened is African Americans are given more institutionalization and drugs as the treatment of choice as opposed to therapy,” said Parham, who also serves as vice chancellor for student affairs and an adjunct faculty member at UC Irvine. “You tend to have misdiagnosis because clinicians are not culturally competent. It diminishes confidence in the mental health system. It’s not all a function of the mental health system being unavailable; people also make deliberate decisions not to access it because they don’t trust them.”