Again, Who Gets to Help Us?

The Difference Between Accountability and Gatekeeping (Part I)

Right now, the question of who gets to help Black communities is answered through licensing, trust, access, history, and who gets recognized as credible.

Professional standards matter. People deserve ethical, safe, and accountable care. Licensing helps protect people from harm, especially when it comes to diagnosis, treatment, crisis care, and specialized mental health support. But we also have to be honest about this: many of the institutions that created those standards also abused us, excluded us, misread us, and failed to understand our ways of healing, learning, surviving, grieving, and making meaning.

In Part I, I referenced the American Psychological Association’s apology to people of color for psychology’s role in promoting and failing to challenge racism and racial hierarchy (American Psychological Association, 2021). The entire field itself has acknowledged harm. So when we talk about standards, we also have to ask who those standards protected, who they excluded, and who they left underrepresented or mismanaged.

This is not an argument against credentials. It is an argument against making credentials the only form of credibility.

Black communities have always had helpers: elders, aunties, teachers, pastors, mentors, barbers, stylists, coaches, organizers, artists, doulas, strategists, and truth-tellers. Some of that help has been imperfect. Some of it has been life-saving. Not every helper can do every kind of work. The point is that help has never lived in only one place.

Representation makes this even more urgent. The American Psychological Association reported that in 2015, 86% of psychologists in the U.S. workforce were White, while only 4% were Black (American Psychological Association, 2018). The Association of Black Psychologists also notes limited Black representation across other mental health fields, including psychiatry, counseling, and marriage and family therapy (Association of Black Psychologists, n.d.). When Black people are barely represented among the professionals defining, diagnosing, and treating distress, cultural misunderstanding is not an isolated issue. It seeps into every part of the care environment.

That misunderstanding can be dangerous. Research on racial disparities in bipolar disorder treatment found that Black and Hispanic individuals with bipolar disorder were more likely than White individuals to have previously been misdiagnosed with schizophrenia (Akinhanmi et al., 2018). Rutgers University also reported that African Americans with severe depression were more likely to be misdiagnosed with schizophrenia, partly because clinicians emphasized psychotic symptoms over depressive symptoms when evaluating Black patients (Rutgers University, 2019). And don’t me started on theory about the overdiagnosis of bi-polar disorder in Black people and untamed double consciousness.

This is why the conversation has to be bigger than who has permission to help. We also have to ask whether the people offering help understand the lives, histories, spiritual traditions, family systems, cultural language, and survival strategies of the people they are trying to support. Without that context, pain can be mislabeled. Strength can be misunderstood. Distrust can be mistaken for resistance. Survival can be mistaken for dysfunction.

The solution is not either-or. It is both-and.

We need licensed professionals and culturally rooted community support. We need clinical care and personal development. We need research and lived experience. We need ethics and spiritual wisdom. We need diagnosis when diagnosis is necessary, and discernment when racialized stress is being mistaken for pathology. We need the best from the material world and the spiritual world working together to create better outcomes for us.

If we want better outcomes, we have to include us. Our language. Our learning styles. Our spiritual traditions. Our family systems. Our histories. Our discomfort with institutions. Our need for warmth before vulnerability. Our need to be believed before we are assessed.

We need better pathways and fewer standards. We need helpers who know their scope, professionals who understand our context, and communities that can tell the difference between safe help and harmful help. 

Healing is not only clinical. 

Sometimes it is educational. 

Sometimes it is spiritual. 

Sometimes it is relational. 

Sometimes it is strategic. 

And sometimes, it begins when someone finally gives you language for what you have been carrying.

References

Akinhanmi, M. O., Biernacka, J. M., Strakowski, S. M., McElroy, S. L., Balls Berry, J. E., Merikangas, K. R., Assari, S., McInnis, M. G., Schulze, T. G., LeBoyer, M., Tamminga, C., Patten, C. A., Frye, M. A., & Bobo, W. V. (2018). Racial disparities in bipolar disorder treatment and research: A call to action. Bipolar Disorders, 20(6), 506–514.

American Psychological Association. (2018). Datapoint: How diverse is the psychology workforce? https://www.apa.org/monitor/2018/02/datapoint

American Psychological Association. (2021). Apology to people of color for APA’s role in promoting, perpetuating, and failing to challenge racism, racial discrimination, and human hierarchy in U.S. https://www.apa.org/about/policy/racism-apology

Association of Black Psychologists. (n.d.). Black mental health workforce. https://abpsi.org/blackmhworkforce/

Rutgers University. (2019). African Americans more likely to be misdiagnosed with schizophrenia, Rutgers study finds. https://www.rutgers.edu/news/african-americans-more-likely-be-misdiagnosed-schizophrenia-rutgers-study-finds