Minnesota struggles to catch up as minority mental health needs grow

Gregory Clark Jr. entered the University of Minnesota with scholarships and promise. He seemed to make the transition easily from Minneapolis North Community High School to the U.

But after two years, life at college began to unravel due to a mental illness. He'd become unmoored and unmotivated, dropping out of college, and then life.

"I just stopped doing the things that were important to me — the things I loved," Clark said. "I didn't know how to get my focus back."

It would take six more years for Clark to find a therapist who understood his struggles and could help him find a path forward. Clark said it made a difference that the therapist was an African-American man like him and could shape the treatment with an important window onto his life.

"Just having somebody who has navigated and experienced the challenges of being a black man really helped shed light on my issues," Clark said. "He's able to better help me in dealing with them."

Experts say Clark was lucky to make that kind of connection in Minnesota.

Despite the state's growing racial and ethnic diversity and a yawning need for mental health services among people of color, Minnesota's health professions remain overwhelmingly white and seemingly walled off to diverse clients hoping to talk to providers who look like them.

Whites are overrepresented as patients as well. State data show less than 10 percent of whites have symptoms of serious mental illness but more than 70 percent of whites received mental health treatment. Meanwhile, communities of color with the highest rates of mental illness continue to be underserved by providers.

Minnesota and mental health officials don't deny there's a problem and say they're working on efforts to increase diversity, from exposing students of color to mental health careers to expanding college loan forgiveness program for providers who open practices in urban areas.

But it's a long road. Other efforts, including a recommendation to make cultural competency training a state licensure requirement, have stalled.

It's complicated, too, observers say, because some white professionals don't believe race matters when it comes to treatment.

But counselors of color say it's vital the industry do more to reflect the diversity of its patients and clients in Minnesota.

"We need a lot more providers of color serving communities of color in the cities. Period," said Juneau Hill, an African-American licensed clinical social worker who recently moved her one-year-old Brooklyn Park practice to a bigger office because of rising demand.

Only 1 percent of Minnesota's licensed social workers — the state's most common behavioral health profession — identified as Latino and 2 percent as black in a 2015 study on the state's mental health workforce.

One in five people suffer from a mental illness, but communities of color face more risk factors, including poverty, said Sue Abderholden, executive director of National Alliance on Mental Illness Minnesota.

Many factors contribute to the lopsided treatment outcomes — from deep-seated stigma to lack of insurance. But counselors of color say overall the workforce failure to offer culturally adapted services have been a barrier to treatment for diverse communities.

"It really has always been a problem" said Willie Garrett, president of the Minnesota Association of Black Psychologists. "There's never been enough mental health providers overall, whether you're white or black, but there's a huge shortage when it comes to providers of color — a huge shortage."

But in the absence of workforce diversity, cultural competence training should be a priority, he said.

However, he also believes some of his white colleagues may have a blind spot about the role race plays in therapy or don't realize white cultural norms define American identity.

"This is what a white therapist brings to therapy, it's this narrow definition. It's based on white standards and that's what considered normal and everything else is abnormal."

But providers of color are filling the void with culturally specific practices with pronounced emphasis on trauma, located in diverse neighborhoods. They're also incorporating traditional healing methods found in communities of color with talk therapy. Counselors say that marriage makes treatment relevant. And it also helps to erode deep-seated stigma.

Scars of genocide, racism

Trauma — historical, generational, institutional and present-day — has been identified as a major contributor of mental illness in communities of color. Researchers have found traumatic incidents change DNA and that alteration is passed down through generations.

That realization has reshaped approaches to treatment in recent years for a growing number of providers of color.

As a Hmong-American, Alyssa Vang, a psychologist and cultural competency trainer, knew oppression, persecution and genocide dominated Hmong history.

As a mental health provider, she also knew the psychological and emotional scars lingered from that suffering.

"It was a superficial understanding," she admitted. "Yeah, my people, they were in the Vietnam War, but I didn't really understand the intricacies of that, and, sadly, my clients didn't either."

Cedric Weatherspoon, Clark Jr.'s therapist, started his practice in 2008. But it was only three years ago when he began tying maladaptive behaviors in his clients to the historical damage done by slavery, segregation and systemic racism.

"We grew into the historical trauma piece through studying and personal development," he said. "As a therapist, you have to grow. I can't tell you how to heal if I can't heal myself."

Hill, a licensed social worker, identifies slavery as the root of the destabilization of the black family.

"If you don't think African-Americans have experienced generational trauma, there's a problem," said Hill. "We're experiencing trauma right now. Just look around the country. We're getting murdered."

She added: "If you don't have training in trauma, I don't think you should be working with this population, honestly."

Working through the stigma

It can be hard for anyone to accept that they need mental health help, but it's especially hard in communities of color, providers say.

"Oftentimes, they have this preconceived notion that if you go see a psychologist that means you're crazy or you're not right in the head," said Vang.

In the case of African-Americans, there's a heightened distrust given the history of medical experimentation on black people.

While efforts to bridge that gap — placing mental health ministries in black churches, for instance — are normalizing and making treatment accessible, providers say resilience, stemming from a history of normalizing pain and suffering, is still a default response to mental illness.

"There's this thing about being strong and sucking it up in the black community," Hill said.

"We've learned as a people how to survive very well, almost to our detriment," she added. "You couldn't have anxiety or depression as a slave — You think the master's going to care that you're traumatized because your brother just got sold? — so you had to be strong and not have any feelings."

The ability to overcome is a source of pride for many people of color, but it's also a major roadblock to mental health treatment.

Vang said suppressed emotions are contributing being released and manifesting in rise in domestic violence, suicides and homicides in the Hmong community. "The way Hmong approach the world and problem solve is very crisis-like because they don't know any other way."

Trauma doesn't just happen to the psyche, said Anissa Keyes. "It gets stored in your body and we need to have physical ways of working through it," said Keys, who plans to open a healing center in north Minneapolis, where she was born and raised.

She started her practice in 2012 and has offices in St. Paul and Brooklyn Center. But the north Minneapolis center will go beyond traditional talk therapy with offerings that include yoga, tai chi, drumming and root medicine.

"It's not for recreation or self-care," she noted. "It will be for people diagnosed with mental illness."

Vang, a Woodbury resident, set up shop there six years ago, but she saw enough demand she opened a second location last year in St. Paul's Frogtown neighborhood; that also made her eligible for the state's loan forgiveness program.

Does the profession see a problem?

The Legislature in 2013 called on the Minnesota State Colleges and Universities system to come up with plans to boost the number of counselors of color.

That led to changes, including a program that exposes diverse students to mental health careers, and expanded college loan forgiveness for counselors who open practices in designated high need areas.

Abderholden, who serves on the Minnesota State-led panel, believes the state is making progress. She noted the Legislature recently passed the panel's recommendation to drop the high school diploma requirement for peer specialists in order to boost the number of immigrants and refugees in the career program.

However, the recommendation to make cultural competence a requirement of all licensure and certifications across discipline didn't advance, said Garrett, who is also a member of the state panel.

That suggests white professionals may not see the issue the same way.

In a 2015 survey commissioned by the committee, 72 percent of diverse counselors identified cultural competency as the biggest shortcoming of the state's workforce but only 38 percent of white respondents did.

Vang said she sees the disconnect in the racial makeup of the people who register for her training sessions. Attendees are largely diverse counselors, she said. "Very few come from the dominant white culture, so that's very disheartening and it's discouraging."

She believes that some white counselors do have a sufficient grasp of cultural issues in treatment, "but they don't recognize there are lot of factors that play into how communities of color look at health and healing. It's just not part of many providers' world view."

There are opportunities around the Twin Cities for providers to learn on their own if they chose.

Organizers at a recent African mental health conference in St. Paul said 60 percent of attendees were white.

U social work grad student Brianna Chamberlain said she gained insight into the culture of the East African clients she works with. And the cultural competence training put the on focus clients' needs, not the providers. Chamberlain said the takeaway from the two days of training was the importance of finding treatment methods that resonate with diverse clients.

"If that's incorporating traditional forms of healing and therapy then we need to validate that for the client," Chamberlain said, adding could be mean introducing methods white providers are uncomfortable or unfamiliar with. "Then that means bringing in somebody that is can help inform us. There are other ways of healing that have been done for thousands of years. Just because it's not the western way, it's still something to be taken into consideration."

For Africans, the drum is one of those ways.

Master drummer Samba Fall extolled its healing qualities to a drum circle of providers at the conference, encouraging them to merge traditional with mainstream.

Chamberlain attended the workshop.

"Thinking of a drum circle as a way of healing and incorporating spirituality was really interesting. That's not something I've ever done before."

Therapy divide

Providers of color say they're able to understand physical cues and other subtleties in their racially diverse clients that white providers can miss because of who they are and how they've been trained.

The divide fosters a cultural gap that can inhibit full disclosure in therapy.

"Often African-Americans present verbal and nonverbal behaviors that are perceived in a negative way by white middle class culture," said Garrett.

For example, he said some blacks may tend to look away twice as much as whites when listening in a conversation. Their pauses in speech, too, are double the rate of whites.

The western concept of mental health is at odds with the Hmong's spiritual outlook, adds Vang.

"When you talk about mental health, you're talking about the mind and that isn't something the Hmong focus on, in terms of healing," she said. "So, when you want to talk about mental health and healing, you really want to talk about the heart and the soul."

Language can be a barrier, too.

The Hmong word commonly used by therapists for depression covers many conditions, including stress, Vang said. But she prefers a term more specific and accessible for her patients.

"It translates to services for those whose heart and soul are suffering or whose heart and soul have been damaged, because the Hmong look at soul as being the center of it all."

Vang honors and validates traditional practices and in her otherwise conventional, western practice.

"I've been very open about talking about their spiritual beliefs, whether it's Hmong spirituality or converted Christianity," she said. "I ask them what have they tried from a traditional perspective and then I add my piece as a complement to that."

Weatherspoon, Clark Jr.'s therapist, said one of the six counselors at his practice is also a minister.

"The church has always been a staple in the community," he said. "When prayer and holy water doesn't work, we can offer an alternative. It's about forming strong partnerships with already developed systems that support community members."

Weatherspoon, who plans to add more counselors this summer, wants his agency to occupy the status of the "lady across the street ... she's the woman your mom goes to when she's stressed to vent, get advice and comfort."

In Weatherspoon, Clark, who lives in north Minneapolis, found familiarity.

Weatherspoon, whose mother battled mental illness, also had to overcome the social ills young black men in north Minneapolis face.

"There weren't a lot of Ph.D.s around me when I was growing," Weatherspoon said. "When I sit down next to somebody who says my brother went to prison, I can relate to that story."

He avoids clinical language. "I've learned to use the language of the community to be able to uplift the community," he said.

'I stuck to the plan'

In three years of seeing Weatherspoon, Clark returned and graduated from college. He's also back in the recording studio, singing and rapping.

"Cedric gave me the life skills I needed to work through so many challenges in my life," said Clark, now 33.

"His therapy is more interactive; it builds you up, so you can move forward and overcome your challenges. It's not your traditional therapy where you sit on the couch and they take notes."

The first day Clark met Weatherspoon, they created a practical and attainable plan.

"He had a sheet and we brainstormed my three-month, year-, three-year and 10-year goals," Clark recalled. "It helped me envision what I wanted to do with my life."

That plan, Clark said, led him back to school.

"I graduated with my bachelors because I stuck to that plan."

Three years later, the sheet is still tucked in his wallet.