Running head: HELP-SEEKING IN BLACK MALE STUDENT POPULATIONS

Help-Seeking in Black Male Student Populations

Jade Pearson

California State University, Northridge

HELP-SEEKING IN BLACK MALE STUDENT POPULATIONS

Introduction

Help-seeking is a precursor to many students receiving the mental health services they

need on campus. Students generally pay a mandatory student services fee for the services offered

on campus, and they must receive the professional help they require to graduate successfully.

Help-seeking behaviors are limited amongst college students, especially among African

American and Black men (Robinson et al., 2018). This markedly low help-seeking behavior

leads to an underutilization of services on the college campus. The literature reviews effective

ways to encourage Black male student populations’ help-seeking behaviors to promote mental

health and student services on campus.

Help-seeking behaviors can look different across student populations but are a precursor

to receiving the help they need. College students overall underuse needed professional

psychological help (Blanco et al., 2008). Although degree attainment among minorities has

increased over the past two decades, Black males still have the lowest college degree attainment

rate, according to the National Center for Education Statistics (NCES, 2019). Many Black adults

in the United States experience significant mental health problems in their lives yet are reluctant

to seek professional psychological help. There are many reasons that literature has found for this

reluctance, including stigma, masculinity, and mistrust of healthcare systems (Cheng, Kwan, &

Sevig, 2013; Powell et al., 2016; Hammond, 2010). The United States is not known to provide

equal health service opportunities for the different racial and ethnic groups. This lack of

equitable opportunities presents a challenge for Black men to seek mental health services.

Although African Americans seek formal help for their mental illness, such as

depression, it is at significantly lower rates than White Americans (Robinson et al., 2018). In

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fact, in comparison with females of most ethnic or racial groups and White males, African

American males significantly have the least likelihood to seek help for health-related issues

(Robinson et al., 2018). This is unfortunate because Black males also have some of the highest

infant mortality rates, high school dropout, incarceration, homelessness, unemployment,

cardiovascular disease, cancer, HIV, depression, substance abuse, homicide. These factors lead to

poor health outcomes and the lowest life expectancy of any other race or gender (Robinson et al.,

2018).

Black Identity Development

Like the larger African American population, Racial and ethnic minority college students

were found to underuse mental health service even more than nonminority students and tended to

hold less favorable attitudes toward seeking professional psychological help (Cheng et al., 2013).

Black identity development may affect help-seeking behaviors in Black men across their

lifespan. Ethnic identity represents an individual’s awareness and knowledge of the history and

values, affective attachment, sense of pride, and cultural practices related to their ethnicity

(Phinney & Ong, 2007). An effective way to understand this particular population is to look at

the identity development that typically describes Black males.

Cross (2001) describes five stages of Black identification. Pre-encounter (stage 1) depicts

the identity to be changed; Encounter (stage 2) isolates the point at which the person feels

compelled to change; Immersion/Emersion (stage 3) describes the vortex of identity change; and

Internalization and Internalization-Commitment (stages 4 and 5) describe the habituation and

internalization of the new identity. Higher ethnic identity predicted lower self-stigma associated

with seeking psychological help for African American college students. This implies that being

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anchored in one’s ethnic group may provide a secure psychological foundation (Cheng et al.,

2013). Black students who are in the immersion-emersion stage of racial identity may prefer

counselors of the same race and may be more likely to utilize counseling services when there is

Black staff (Cross, 2001).

Amongst Black men, higher ethnic identity predicted lower self-stigma associated with

seeking psychological help for African American college students (Cheng et al., 2013). This

implies that being anchored in one’s ethnic group may provide a secure psychological

foundation. Cheng et al. (2013) found that a confident sense of oneself is related to an achieved

ethnic identity for Black college students. They may have fewer concerns about being

stigmatized by others and less self-stigma for seeking professional psychological help because of

the identity foundation and psychological security they have developed (Chang et al., 2013). Yet,

there is still an overwhelming amount of Black males who do not seek mental health services.

Barriers to Help-Seeking

Simply being Black in America has been shown to harm Black mental health (Cannon &

Locke, 1977). However, this population is still among the lowest percentages in seeking mental

health services, regardless of socioeconomic status (Duncan, 2003). A significant factor of

help-seeking behavior is that certain cultures hold different perceptions and beliefs about mental

health problems—the cultural values within the Black community conflict with the available

mental health services.

Fear of stigmatization is the most mentioned reason for not seeking professional

psychological help (Cheng et al., 2013). The stigma associated with mental illness is the most

daunting obstacle to the progress and advancement of mental health within the Black community

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(Cheng et al., 2013). Stigma impedes the search for mental health treatment and hinders

following up with continued care. Many college students underuse professional psychological

help for mental health difficulties. The stigma associated with seeking such help appears to be

one reason for this underuse (Cheng et al., 2013). Black men have been historically stigmatized

as deficient, weak, problematic, or dangerous and were found to be more likely to be diagnosed

as having more serious mental illnesses and given lower quality of mental health care (e.g.,

reduced clinician adherence to treatment guidelines) compared with White American clients

(Cheng et al., 2013). Black culture sees seeking such treatment as bringing shame to their ethnic

groups or reinforcing negative stereotypes directed toward their communities.

Masculinity

Cultural expectations about male behavior such as emotional toughness, pride,

autonomous coping, and maintaining self-control despite the presence of mental illness tend to

encourage males to avoid help-seeking (Robinson et al., 2018). Black culture has beliefs such as

depression is not a mental illness, is a sign of weakness or depression is not a Black man’s

disease and is something that does not need medical intervention but can be dealt with alone,

have been found to be common in African American culture (Campbell and Long 2014).

Additionally, African Americans’ spiritual culture has historically been rooted in the church,

which has asserted that mental illness is not a physical issue, but a spiritual one.

Powell et al. (2016) conducted a quantitative study among 458 African American men.

They found that men who were exposed to frequent racial discrimination in their daily lives

reported more barriers to help-seeking. The study also found that masculinity norms also

mitigated African American men’s help-seeking. Masculine role identity shapes the tone of

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interactions with healthcare professionals, including mental health professionals, in ways that

impede the trust-building processes (Hammond, 2010). The study found that the more central

traditional masculine values were to African American men’s male role identity, the more

mistrustful healthcare organizations were (Hammond, 2010).

Mistrust

Medical mistrust among African Americans and the healthcare system in America

impacts help-seeking behavior. Historically, Blacks were mistreated in the healthcare system,

putting their lives and health at risk. For example, the Tuskegee Study of Untreated Syphilis in

the Negro Male (TSUS), which took place between 1932 and 1972, remains the most frequently

attributed source of medical mistrust for African Americans (Gamble 1997). Since African

American men were the primary subjects of The TSUS, it is plausible that they have an increased

awareness of the potential for healthcare organizations to do harm (Hammond, 2010).

Age may also play a factor in help-seeking behavior. Older chronological age may place

African American men closer to when well-known historical incidents of medical malice

occurred, negatively influencing outcome expectations. Other studies show that Black men

between the ages of 18 and 24 were less likely to seek help than were older adults (Neighbors

1991), suggesting a relationship between Black help-seeking behavior and age. Younger men,

such as traditional college age, may experience generational trauma from their ancestors who

endured mistreatment at the White-preferenced institutions’ hands. These men may have also

encountered their own form of racism in their lifetimes.

Perceived racism in healthcare was the most robust correlate of medical mistrust

(Hammond, 2010). Distrust of healthcare organizations and health professionals, including

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mental health professionals, has been associated with less care satisfaction, treatment adherence,

and healthcare services utilization (Musa et al., 2009). African American men who reported

experiencing racial discrimination in the social environment more frequently, discrimination

experiences elicit perceptions of discrimination in healthcare that lead African American men to

have more medical mistrust (Hammond, 2010). Duncan (2003) found that Black men with higher

cultural mistrust reported less positive attitudes about seeking professional help.

The harmful effects of the stigma associated with mental illness and psychological

help-seeking may be amplified by membership in other socially stigmatized categories, including

racial/ethnic and sexual orientation minorities, due to the social differentiation between groups

(Cheng, Kwan, & Sevig, 2013). For example, Black male help-seeking behavior in LGBTQIA+

communities may look different than straight Black males. There has been historical

mistreatment of Black transgender males who perceive stigma at a higher rate than their White

counterparts. High-achieving Black males, such as those with an advanced degree, may also have

different help-seeking behaviors than those from lower-income communities. Duncan (2003)

found that Black male students who are older and of lower SES have a more positive attitude

toward counseling. Due to education, these men may see mental health as a necessary part of

their overall health and may be more likely to seek mental health services.

Effective strategies

The World Health Organization (WHO) defines mental health as a state of well-being in

which every individual realizes their potential, can cope with the everyday stresses of life, can

work productively and fruitfully, and can contribute to her or his community (WHO, 2012).

Increased investment is required to promote help-seeking behaviors, including mental health

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awareness, to endorse understanding and reduce stigma. Efforts are also needed to increase

access to quality mental health care and effective treatments (WHO, 2012). For college students,

in particular, the responsibility will be with counseling and student affairs professionals.

Maslow (1964) endorsed religion and spirituality in his hierarchal construct to human

self-actualization (Maslow 1964). Research studies that juxtaposed religion, spirituality, and

health in the Black community viewed religion or spirituality as a de-stressor (Newlin et al.

2008). There is an underutilization of professional psychological services and a preference for

non-mental health professionals such as clergy and family members among the Black community

(Robinson et al., 2018). This may mean that counseling and student affairs professionals should

educate themselves on religious and cultural practices or jargon to build rapport and increase

trust with college students.

Creating a space that encourages ethnic identity development may promote help-seeking

behaviors in Black males (Cheng, Kwan, & Sevig, 2013). Historically Black Colleges and

Universities, for example, provide a great environment to do s. For predominantly white

institutions, reaching out to the community by creating services that target the population and

destigmatizing mental health may be an effective way to change mental health attitudes. The

more Black students are concerned with stigmatization by others for seeking psychological help,

the more likely they may stigmatize themselves for seeking psychological help (Cheng et al.,

2013). Professionals working with Black male college students need to demonstrate sensitivity

and the initiative to explore experiences of discrimination and potential concerns about how their

social support system views psychological help-seeking (Cheng, Kwan, & Sevig, 2013). This

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will foster rapport and increase positive interactions with student service and mental health

providers.

Conversely, students of color who were more open toward other cultures and felt more

connected with people from different groups held less negative views toward themselves if they

sought professional help (Cheng et al., 2013). Individuals with higher other-group orientation

may have more positive regards toward themselves and may be less likely to stigmatize

themselves for seeking psychological help. As characterized by a positive intergroup approach

and appreciation of different worldviews, other-group orientation is an asset that is related to

more openness to diverse ways of dealing with difficulties, including reduced self-stigma of

seeking psychological help (Cheng at al., 2013).

Representation amongst leaders, student affairs, and mental health professionals may

increase help-seeking behaviors (Duncan, 2003). Nickerson et al. (1994) found that those Blacks

who reported high levels of mistrust toward Whites had a more negative attitude about seeking

psychological help if a clinic was staffed primarily by Whites. Additionally, Fyffe (2000) found

that people perceived Black counselors as more cross-culturally competent by study respondents.

Conclusion

Predisposed attitudes have an impact on if a person seeks mental health services.

Counselors should be wary of adopting a stereotypical view of an oppositional Black male as this

may not be an accurate portrayal of all Black men on college campuses. Black men visit college

counseling centers at a rate that is significantly lower than White students. Duncan (2003)

reasons that a positive attitude toward counseling may not be enough to motivate Black males

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students to seek services; some Black men may hold a private opinion about counseling services

that may not be readily apparent.

Black males may have attitudes that are multifarious and depended on a variety of

factors. Counselors and student affairs professionals should avoid categorizing all Black men as

resistant to counseling. Within their work, counselors should act as advocates to address barriers

to help-seeking behaviors. Additionally, mental health and university counseling centers will

have to focus on reaching out to Black men where they live and establishing programs relevant

to their life situations (Duncan, 2003). Future research of this student population should involve

examining within-group variables that influence attitudes toward counseling. These variables

include age, socioeconomic status, sexual orientation, and education.

Lastly, representation amongst leaders, student affairs, and mental health professionals

may increase help-seeking behaviors (Duncan, 2003). Nickerson et al. (1994) found that Blacks

who reported high levels of mistrust toward Whites had a more negative attitude about seeking

psychological help if a clinic was staffed primarily by Whites. Equitable hiring practices should

be followed by higher education administrative leaders, leading to representation among this

group. To promote equity and inclusion principles, counselors and student affairs professionals

should be aware of the unique variables that affect help-seeking behaviors of Black men. If

colleges want to see this student population thrive and persist, proactivity must be the course of

action.

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