Next in our blog series on racism and mental health: Max Maddox's interview with Dr. Juliana Deans.
Juliana received her Ph.D. in Marriage and Family Therapy from Nova Southeastern University in South Florida, along with a Master of Science in both Marriage and Family Therapy and Mental Health counseling from Palm Beach Atlantic University. She is a Licensed Professional Counselor, a Licensed Mental Health Counselor, and a National Certified Counselor. She runs her own private practice while serving as adjunct professor at a Colorado Springs university, a mental health evaluator at a local hospital, and a counselor for military families. Juliana is a transracial adoptee with a special interest in diversity and family dynamics.
Max: What does mental health look like today, and how do you approach the challenges of mental health in 2020? How well do you feel enabled and supported as a provider, and how does color play into this?
Juliana: Mental health right now, for me, is about going through these struggles personally because of what happened to George Floyd. I’m an interracial adoptee, so my adoptive parents are white and I’m Black. And what happened with George Floyd, which has never happened in any previous situations that I’ve witnessed, is the intensity of it all. He didn’t have a gun; he wasn’t a threat.
I have a son, so it really hit home, and for the first time ever I found myself participating in protest. I consumed my world with that. I kind of exhausted myself mentally, and because of the pandemic and protests, the tools that I would have enjoyed before I couldn’t use.
So one of the things I started doing is gardening, for the first time ever. And one time when I was gardening, it just hit me; I re-realized I really needed to do mind work.
With gardening, it's so frustrating: I would have a plant and I would say, “What’s going on? You’re dying.” So I would move the plant, try to figure out how to fix it. “How do I revive you?” Then I would put it in a pot, and it wasn’t doing well, and I would plant it somewhere else. And then I said, “Wait a minute, I have to change and transform the way I think. I have to transplant myself.” What worked pre-pandemic and pre-protests no longer works. So now, what does that look like? I had to become my own therapist. I had to look internally, as far as how, really, George Floyd affected me.
Now, you mentioned support. I didn't feel supported by my adopted family as it relates to this racial historical movement. I’m saying “Black Lives Matter”; my parents are saying, “All lives matter.” My parents want to stay in the safe zone. My parents and I don’t address conflict very well, and if you don’t have the support you need to deal with conflict in a healthy, productive way, it exacerbates so many symptoms.
One of the things I often do for myself at this time is, when I wake up, I apply what I call “solution-focused therapy.” So if I feel funky, I just ask myself, “What needs to change now, so you can be where you want to be?”
Max: How do you feel supported professionally? How do you feel about mental health and its relationship to Black Lives Matter?
Juliana: Well, anxiety and depression has risen since the pandemic began, and especially for those who are African American and people of color. With the George Floyd movement, we don’t know who’s for us and who’s not for us. We don’t know when people reach out to us: Is it out of flattery? Are you really fighting on our behalf?
This situation has really drawn a line that I didn’t even know existed. I hear from my Black friends, “Now is the time to reclaim your story.” But with my family it has created a dent in our relationship, from an emotional point of view.
Just like the plants, you need things to help you grow. You can put marigolds anywhere, and they will encourage growth. That’s mental health: You want to be around people that will help you grow. Speaking of, if you look at the way peas grow along the trellises, they have little curls and they hold hands, but loosely. So whoever you are growing with, you don’t want an enmeshed relationship, you want support to be nice and loose.
My parents couldn’t teach me what it was like to be Black in America. I’ve had to become my own therapist, and I’ve learned the art of reframing because not everything is Black-versus-white, or racist. People go into this field to heal themselves. For me, I do a daily check-in and make sure I am food for someone else’s soul. In every interaction, I want to be that difference that makes the difference.
Max: There’s always the potential for self-doubt when you feel affronted by someone, or encounter prejudice. How do you avoid that internalization? I see Black people overcoming that doubt. To be able to say what happened to you — that’s huge within NAMI, that you “own” a core set of experiences that can’t be challenged or doubted.
Juliana: That’s one thing I love about NAMI, and that I encourage my clients to do — for them to tell their story, and [know] their story is their truth. I don’t have self-doubt now, but it took me 36 years to get to that point. My issue right now is that I want myself and others that look like me to feel like they belong, and I also want that for people with mental illnesses, because of that stigma that’s out there...
For me, I’m searching for belonging in the United States of America. I know I’m enough. I can’t keep on beating myself up. My clients, when they come to me, they are enough, exactly where they are. Some people will say they're broken. “That’s beautiful,” I say, then add, “I love the fact that you’re broken, because you know what I can do? I can create this beautiful table and I can use you as a mosaic. So you’re enough now, and you’ll be enough when we’re done with therapy.”
'For me, I'm searching for belonging
in the United States of America.'
So it's not about self-doubt for me. I belong here, so stop putting these conditions on me. Self-doubt puts the pressure on me. It's not me who needs to change, it's not other Black people that need to change, it’s society that needs to change. It’s the same thing with mental health: It's not someone with ADHD or schizophrenia that needs to change, it's society.
Max: Do you feel hopeful that even a movement that started with racial oppression could be powerful enough to broach the problems of mental health — going down the line with all the social movements alongside Black Lives Matter, especially as it concerns the police and their treatment of Black people and those living with mental illness alike?
Juliana: There is so much education that’s needed. The police need more classes, hands-on classes, on racial equality. I see the value in police officers guiding us, but it’s the lack of awareness, it's the lack of understanding of their own prejudices and biases. I think it goes back to the training and the exposure. We all need exposure.
I used to be terrified of people with schizophrenia. I didn’t understand those symptoms until I got in the field with them. It’s about meeting the clients where they are. I don’t challenge some of those ideas. I use them. “Who else is on that train ride with us? What are we doing here?” Everything comes down to context. Get to know whoever is in front of you, their story. Don’t just look at the way they’re behaving.
When I’m in the hospitals, and there are patients who are coming in because they are unstable and off their medications, I can tell the police officers who have had training with individuals with mental illnesses and which ones have not. These patients, if you get to know their context, they might be more than willing to go along with the officers. If you put some of the patients in handcuffs, that could be added trauma from their original mental illness symptoms.
When you first get that label of a diagnosis, you feel stripped of what normalcy is. We throw away that person’s life and everything they’ve built. We need to get to know that story instead of stamping it like a red scarlet letter everywhere they go.
Max: How does racism come into play in the clinical setting? There’s the clients, for the first time under the professional gaze of a Black woman maybe, and how you navigate what I assume is a very white setting. Do you feel burdened on a daily basis by race?
Juliana: Research has shown that most mental health clients that reach out are white, and all my clients right now are white. Three Black individuals have reached out to me recently, and there are more Black people reaching out for mental health services than ever before. Now Black therapists are being sought out.
At one of my jobs, I’m the only Black therapist among about 15 of us. We have such a great respect for each other, and we admire each other as people. We’re not competing with each other. I think we have a great balance. But after George Floyd, you could sense that people didn’t know what to say. “Should I bring it up, should I not bring it up?” But it's not the responsibility of Black people to teach you about Black Lives Matter.
I explained to them, “I’m learning. I’m adopted to a white family, I grew up ‘white,’ my school was white, my church was white. I am still seeking out what this means to me today. What do I agree with or what do I not agree with?”
There are people who have been affected more than me. I work with a white woman whose husband is a Black police officer. There are people at that table who are homosexuals, and they’re dealing with their own issues with how they have felt oppressed. This is greater than just Black. When we’re talking about healing, changing, a revolution ... so many people didn’t realize they’ve been suffering from PTSD this whole time until the George Floyd movement.
Max: Where are there adjustments needed in mental health, and where do we need to address stigma in the Black community? How do providers embrace Black people?
Juliana: My husband is Black American and I’m from Haiti. We get into this so often — my “whiteness,” even though I’m Black, versus his “Blackness.” One of the things he was taught is that “what happens in the home stays in the home.” So how do you get rid of that mindset, that whatever goes on here stays here?
As Black people, we keep talking about how people need to be woke, but we ourselves need to be woke, to understand the services and to break down some of our own barriers that prevent us from asking for help.
I think a lot of it is that we don’t want to ask for help, especially of somebody from another race. There are only a few of us that will humble ourselves and say, “It doesn’t matter, and I’ll take the help.” Why are we willing to go to a doctor that’s white, a dentist that’s white, but when it comes to mental health professionals, we halt ourselves? That's really unfortunate. We need to accomplish this together. We all must do the work. NAMI is a great organization. The more we can get people there to understand it, the more likely we’re able to reduce stigma and get rid of it. Be solutions-focused, do more of what works — and if it doesn’t work, then change it. …
'We need to accomplish this together.
We all must do the work.'
The other problem is affordability. Are you going to pay for a therapist, especially if it's against your norms where you grew up, or would you rather save to pay for something else? …
It goes back to availability and cost. I think if it were available to them, they would take it. All the research shows that the higher the degree of education, the more likely that someone who is Black will seek out mental health services. Not only for Black people, but for everybody. It's the language that we use. I tell my students that one of the greatest gifts you can learn is the gift of adaptability. If you can adapt through life, you can make so many changes, and you can allow other people’s experiences to also change you, your thoughts, your views. That’s what I’m asking for from everybody.
You might not agree with everyone’s point of view in the movement, but try to see if there is one view that will help you adapt your thinking and the way you’re seeing the situation. We’re not asking for people to write a dissertation, or people to riot or anything like that. We’re just asking for people to listen and be empathetic to the message.
Hear more on Facebook from Juliana, and learn more about interracial adoptees with other adoptees at the United States Foundation for the Children of Haiti.
While talking recently with a colleague from NAMI Colorado, Array Parity project leader Max Maddox was introduced to Dr. Melba Arnold (left), a retired college professor and active occupational therapist in mental health and cognitive behavior. Melba’s work has spanned the practices of psychiatry, pediatrics, school-based practice, gerontology, and long-term physical rehabilitation.
Given her decades of experience working with clients of various backgrounds, Max asked Melba to share some thoughts on the mental health impacts of systemic inadequacies and racism. Here’s a conversation excerpt, which followed Max’s reference to “the insurance-doctor-client mental health pipeline, now the prison system.”
Melba: The change in how healthcare is provided is thought to have been influenced over time by cost-cutting measures. Many individuals with mental illness are housed in prison systems secondary to the loss of public health care that was available at least 20 years ago. The point you made about the prisons appearing to become the mental health units is a concern expressed by others as well. There is concern about the increased privatization of mental healthcare and pricing the disenfranchised out of the opportunity to receive necessary treatment.
You’ve also mentioned African-Americans as clients in mental healthcare. In many ways, this is quite a complex topic. When you consider the economic and social disenfranchisement of the African-American community for hundreds of years to present time; the systemic racial disenfranchisement in society, including healthcare, income; merely to exist and struggle with everyday discriminative challenges ... these are major factors that influence decisions about trusting hospitalization and healthcare equity.
Additionally, there is a paucity of information about mental health treatment options and recovery. While there has been some noticeable progress in this area, the impact has been very minimal.
The lack of and difficulty in accessing mental health services is a nationwide health care problem that unfortunately affects the minority communities far more than it should. The need for greater funding and education at the national and community level cannot be overemphasized.
Personally, I am engaged in start-up efforts to develop a mental health ministry through my local church. I would like to do more to expose disenfranchised communities, especially African-Americans, to the benefits of mental health intervention; to reveal the health benefits and eliminate the myths and stereotypes associated with seeking mental health services. It would be great to help eliminate the perspective of mental illness being viewed as “another strike against oneself” because of ethnicity or socio-economic status.
"The goal is to influence all of society, especially people of color,
to perceive mental health as a 'user-friendly,' treatable illness."
Having lived through generations of oppressive discrimination because of race, and with society’s seemingly negative attitude toward mental health … having a mental illness becomes an additional struggle for Black Americans and other people of color. The goal is to influence all of society, especially people of color, to perceive mental health as a “user-friendly,” treatable illness that is not to be treated as something to fear any more than hyper-tension, diabetes or cancer.
The unfortunate reality and true difficulty is, among African-Americans the lack of equity is real in our society and in health care delivery. For generations, it has been a painful experience for many. So African-Americans face the challenge of having to deal with the potential mistreatment secondary to race and a diagnosis of mental illness.
Max: How do mental health professionals broaden their scope? How do we advocate effectively when there is so much stigma assigned to Black communities?
Melba: When society at large can truly embrace equity … that is my altruistic goal. If I had the answer to that question, I could change the world.
Aside from greater funding for mental healthcare, how professionals are trained at classroom and clinical level is critical. Educating the public about the stigma assigned to mental health is also critical. Add these two factors to treating clients who happen to be African-American, Latino-American, Asian-American. …
How do we effectively advocate for everyone, when there is so much stigma being assigned to the clients? Ethics, moral decency, healthcare justice, integrity, a sense of equity and fairness, eradication of the “isms” (systemic racism, religion, gender, sexual orientation, age discrimination) society has been working at equity among these for centuries … how far do you think we have come thus far?
If your life involves discrimination for at least two of these, the intensity of treatment and the quality of the healthcare provider are paramount to the client’s success.
In 2004, having seen depression affect their lives and communities, Tracey Robinson says she and her friend Stephanie Green wanted “people who look like us to have a place to come in and talk about it.” So they started Another Life Foundation, a 501c3 devoted to helping people of color battle mental illness and suicidal behaviors.
Sixteen years later, they’re still at it: Stephanie continues to serve as executive director, and Tracey as board president. Through the years, Another Life Foundation has provided various services to people of color living with mental illness, from mentoring relationships to culturally competent counseling referrals to help accessing Social Security, Medicaid and Medicare benefits.
During COVID-19, the foundation has created a Virtual Counseling Support Program and gone online with its Black Men’s Project. With support from NAMI Colorado Springs and other community entities, the Project brings conversations about mental health and wellness into barbershops and salons frequented by men and boys of color. Juaquin Mobley’s Community Barbershop hosted the Project’s first Wellness Summit back in January.
The upcoming virtual summit, featuring five local speakers, will take place on Saturday, July 18, between 1 and 3 p.m. Registration is free, and attendees will have the chance to win prizes.
As part of our ongoing blog series about the intersection of race and mental illness, we talked earlier this week with Tracey, a longtime health care professional, about what the foundation is working for — and against.
NAMI: You were exposed to depression as a child, with two parents living with depression. How did that impact you personally, and specifically as a child of color?
Tracey: Both of my parents were educated, and I came up as a middle-class child. So what do you do if you have parents who have good jobs and you look the part? No one's supposed to know [about mental illness in the family].
Because through history, there were the Jim Crow laws and segregation, and parents having to deal with the trauma of not being able to be Black. You wouldn't be hired if you had an Afro or things of that nature. So you don't add [other potential issues]. You have depression? What's that? What's that look like? It doesn't. It doesn't look like anything within the Black community, because you're taught to suck it up. You're not taught how to have coping skills.
So that's the reason why we have Another Life Foundation: to let people know that it's OK to have a degree, to be educated, to be Black, and to have mental health [issues]. But you need to have coping skills, which are not given to you in the Black home.
In Black homes, maybe you're not as fortunate to have parents who have good jobs. Maybe your parents are on welfare or you have a single parent, or they struggle. Then that looks different — maybe it's kind of the hip-hop culture. You deal with [illness] by “manning up,” you go get a tattoo, you pour out, you turn up, you drink liquor, you know what I'm saying? Then your coping mechanism is more destructive than productive.
NAMI: You've mentioned a couple of the barriers you see standing between Black communities and mental health care. Are there others that you want to make sure people understand exist, that maybe they don't think of right away?
Tracey: I think people at large do not think that trauma is a barrier between the Black community and mental health awareness and mental health access. Because when we process the trauma in our lives — seeing it in our homes — when we don't have the coping skills, we learn behavior. You saw Mom or you saw Grandma, but you don't know if they have schizophrenia or bipolar or whatnot.
The resilience of the community of Black people on the whole is, "We march on." We've got to just keep standing, and keep marching. It's not OK to cry. And even if one does cry, that might be their only healthy way of dealing with what's going on.
NAMI: Can you name some of the systemic problems that contribute to this dynamic?
Tracey: If I'm performing at a level that's acceptable to my counterparts in white society, you don't see that I'm suffering from anxiety and depression, because of the resilience that I put up — the front. That's a problem.
Feeding that back into the Black Men's Project, this is big in the Black men's community, because their anger and aggression from depression — that's the way it's manifested, by popping off. So then they have a higher risk of having police encounters. And in those encounters, it’s not, "Hey, are you OK?" You know, police aren't asking Black men if they have mental health issues, or if maybe they're having a bad day.
It's just the buildup of the trauma over the years, of not knowing how to deal with it. Not having a mentor, not having someone you can go to talk to, not having the proper coping skills — and not seeing that there's anything wrong. Not having the avenues to say, "I need help," escalates you to other problems in your life.
'It's just the buildup of the trauma over the years,
of not knowing how to deal with it.'
NAMI: What you're describing goes beyond stigma. It's not just that people don't want to talk about their mental health issues, or that they’re feeling bad, it's that maybe they don't even recognize that the way they're feeling or reacting isn't healthy.
Tracey: Exactly. Because your mom or your dad — again, most of every behavior is a learned behavior, and from birth until the age of 7, all you're doing is downloading and processing how to respond. That’s how you’re trained to respond. No one said, "Hey, it's OK for you to cry." You didn't see your dad cry; you saw him go and hit your mom. So now you think that's the appropriate response. Or you didn't see your mom go and ask for help; she went and turned to a pipe.
So, again, it begins to systematically become a cycle of abuse in the community.
I did grow up with good things. Both my parents have degrees; my mother has a master's, my father had a bachelor's. My father also ran his own business. But he suffered. He had a sickness, and he didn't know how to deal with it. Therefore, he died at an early age, because he had cirrhosis of the liver, because he just drank.
There's a better way. We don't want our young men to grow up thinking that the only alternative is to join the gangs, or the only alternative is to go and steal, or the only alternative is to go to jail.
NAMI: What you're talking about is a whole lot of education and opening up conversation. Is there anything else that you feel is just essential to making positive change, making some headway toward getting mental health help to the Black community?
Tracey: Let's just say that once we start opening the doors and it becomes OK to have a conversation, be patient. Because I've noticed that even within the community of mental health, it takes about 10 years, maybe longer in the Black community, to even come to grips that there is mental illness and to do the work and get the counseling. So patience and awareness is key.
For more information on Another Life Foundation, visit anotherlifefoundation.com. For links to and information about additional resources dedicated to communities of color, see this page of our website.