Stigma, barriers, and discrimination

Male depression has been labelled a mental health crisis, with men accounting for around 80% of suicides worldwide¹.

For black men, and particularly young black men, this gender gap and the male stigma around mental health is compounded by cultural barriers and experiences of racism. This has made black men the most likely group to develop mental health problems².

There are lots of complex reasons for this, and every person's circumstances are unique. But there are some overarching factors that help explain how both race and gender inequalities and barriers have led to this crisis. We explore these factors, with help from mental health expert and counsellor Matthew Schubert.

The concept of intergenerational trauma may help explain some of the mental health challenges faced by black men. This is the idea that you can feel the effects of trauma experienced by your family members in previous generations⁴, as Schubert explains:

"Much like the inheritance of genes, life experiences are transmitted across generations. When trauma, oppression, and socio-economic adversities affect a parent or grandparent, their impact often carries forward through their children."

Black communities have experienced more trauma than other racial groups, due to a long history of racism and discrimination⁴. Children learn how to respond to their surroundings in a similar way as their parents responded to theirs. Consequently, it's thought that the burden of inherited trauma explains why more black people experience Posttraumatische Belastungsstörung (PTBS) than other ethnicities⁵.

Fatherless household epidemic

But are there intergenerational traumas that might affect black men in particular? Schubert believes so: "the fatherless household epidemic is more common in the black communities. When boys don't have a father figure in the home to model the behaviour of a loving male adult, they have a harder time becoming a loving male adult themselves - and this can mean bottling up emotions."

In a 2019 survey of England and Wales, 63% of children in Black Caribbean families were found to live in single-parent households - this compares to the lowest ratio of 6% of children in UK Indian families⁶. This can also be seen in the US, where 58% of black children are raised in a fatherless home, compared to 21% in the white community⁷.

Black men also have to battle with a set of unhealthy and harmful standards that set out what it means to be masculine. This so-called toxic masculinity has existed as a cultural pressure for decades, for men across all ethnicities.

One notion of toxic masculinity is toughness. Expressions such as 'take it like a man' or 'boys don't cry', build the dangerous and unrealistic idea that men should not express emotions that make them look vulnerable, such as being sad or anxious.

Yet, bottling up emotions and following the masculine norms of self-reliance make men more likely to develop Depressionen⁸, more likely to consider Suizid⁹, and less likely to seek support for their mental health¹⁰.

For black men, this is compounded by intergenerational trauma. Historically, black men have opted into toxic masculinity to provide for and protect their families - beginning with slavery and lasting through social structures that have ultimately favoured wealthy white men above everyone else¹¹.

Black masculinity

Experts argue that black masculinity has been a way for black men to form their own culture of dominance, building a barrier between them and racist discrimination.

Counsellor Schubert agrees that the behaviours passed down from father to son are important here. "Again, we can use the example of fatherless households. If there is no positive adult male role model in the home, boys will have a difficult time becoming emotionally mature men."

Outside the family home, the image of black masculinity has seeped into our films and TV shows, sending a clear message to some black men that displays of emotion are frowned upon¹².

These influences leave black men more vulnerable to mental health problems like isolation, Einsamkeit, trauma-related mental conditions, depression, and Angstzustände. It also makes them less likely to ask for help. For those that do, they may experience some barriers and shortcomings in the care they receive.

An analysis of 66 studies on ethnic inequalities in UK mental healthcare found¹³:

• A lack of socially relevant knowledge in medical training and services, which becomes a barrier when treating mental illnesses linked to experiences of complex trauma, systemic racism, and migration.

• Many patients avoid mental healthcare due to fears of racist care and concerns around unsuitable treatment.

• Direct experiences of discrimination.

• A lack of progress in tackling ethnic inequalities, due to many services not adopting community recommendations.

Ongoing education

Schubert says that for mental health professionals working with marginalised or oppressed communities, ongoing education about cultural and racial diversities is crucial. "By understanding people's diverse backgrounds, professionals can significantly enhance their ability to empathise with, comprehend, and effectively support their clients."

These types of programmes offer valuable blueprints for the future of black mental health support. A report sharing what has been learnt from Shifting the Dial has called for the UK government to tackle all forms of discrimination, including in schools, employment, policing, and healthcare.

It also asks charitable bodies to ensure black-led organisations get fair access to funding, so that these types of programmes can continue to improve black men's mental health support.

1. Heads Up Guys: Stats on suicide in men.

2. Mind: Mind's work with young Black men.

3. NHS Survey: Adult psychiatric morbidity survey: England.

4. Lee et al: Addressing intergenerational trauma in Black families: Trauma-informed socioculturally attuned family therapy.

5. Sibrava et al: Posttraumatic stress disorder in African American and Latino adults: clinical course and the role of racial and ethnic discrimination.

6. Office for National Statistics: Proportion of children in lone parent families by ethnic group, England and Wales, 2019.

7. US Census Bureau: America’s families and living arrangements.

8. Iwamoto etal: Masculinity and depression: a longitudinal investigation of multidimensional masculine norms among college men.

9. King et al: Expressions of masculinity and associations with suicidal ideation among young males.

10. Yousaf et al: An investigation of masculinity attitudes, gender, and attitudes toward psychological help-seeking.

11. Johnson and Norwitt: African American masculinity.

12. Goodwill et al: Media representations of popular culture figures and the construction of Black masculinities.

13. Bansal et al: Understanding ethnic inequalities in mental healthcare in the UK: A meta-ethnography.