By Wendy Todd
Mental health has eclipsed gun violence as the top public health concern among Black St. Louisans, according to new polling — a striking shift in a city where fears about shootings have long dominated.
But while more are acknowledging the problem, several barriers prevent them from getting help. Persistent stigma, the shortage of Black mental health providers, long waitlists, transportation challenges and high out-of-pocket costs all stand in the way.
Some residents don’t recognize their symptoms as mental health issues, while others fear being judged if they admit they’re struggling. Ebony Smith, a licensed counselor with BJC Behavioral Health, has heard her Black clients express a “fear-based mindset.”
“Like, ‘Oh, I don’t need that,’ or ‘I’m too messed up to navigate therapy or counseling,’ or ‘They’re going to dig deep in my past. It’s going to make me seem like I’m crazy,’” recalled Smith, founder of The Therapy Desk, which provides virtual mental health care services.
A recent survey by iHeard St. Louis, a health information response system that collects public health data through weekly surveys and annual polls, found that while gun violence remains the top public health concern for all St. Louisans, mental health is rising sharply, particularly among Black residents, who made up 49% of respondents.
During the COVID-19 pandemic, which began in 2020, the Black community nationally experienced higher rates of infection, hospitalization and death, resulting in increased grief, trauma and stress. In St. Louis, the devastating tornado on May 16 added to these mental health challenges.
“The proportion of Black St. Louisans who said mental health is the number one health problem in St. Louis has increased from 9% in 2023, to 12% in 2024, to 22% in this year’s survey,” said Matthew Kreuter, the founder of iHeard St. Louis and a public health professor at Washington University in Saint Louis. “There was a strong sentiment among Black respondents in our survey that many St. Louisans either don’t realize that they have mental health issues or don’t seek help for it.”
Data from the Kaiser Family Foundation, the National Alliance on Mental Health and other organizations show that rising mental health concerns are centered on racial disparities and distress, or “complex trauma,” as behavioral health executive Tiffany Lacy Clark calls it.
“The repercussions of violence, strained relationships both intimate and familial, as well as social and civil unrest contribute to this complex trauma,” said Clark, president and CEO of Behavioral Health Response, a St. Louis nonprofit that provides 24-hour crisis line counseling. She also noted that natural disasters, such as the tornado, adds to distress.
“Disparities in access to employment and economic opportunities and discriminatory treatment” are other factors in mental health issues in the Black community, she said. Insurance coverage disparities are another.
In 2023, 9.7% of Black Americans were uninsured compared to 6.5% of white Americans. Federal cuts to Medicaid and Medicare are projected to leave 10.5 million people without coverage by 2034. Upcoming eligibility changes — including work requirements and more frequent re-certifications — could push some off the rolls much sooner. Even for those with insurance, many mental health providers do not accept it, leaving patients to shoulder unaffordable out-of-pocket costs.
Finding a provider with a cultural connection to the Black community is another challenge. According to the American Psychological Association, only 4% of the U.S. psychology workforce is African American. This shortage makes it harder for patients seeking a Black provider to find one.
Cultural stigma around mental health also persists. Smith believes more Black individuals are seeking help, but often not the full scope of care they might need. “They’re not seeking wraparound care, like seeing a psychiatrist, getting psychological testing, and other assessments that can lead to the most appropriate treatment,” she said.
Other persistent issues such as lack of access to specialized treatments, transportation and long waitlists prevent some from accessing mental health care.
“Mental health services can feel like a mirage in a desert when access is limited,” Clark said. “The best illustration I can give is of a person dragging their depression through a desert looking for help and realizing once they reach the waterspout there’s a three-month wait for water. It can be the difference between life and death in a very real way.”
If you or someone you know is in a mental health crisis, call or text 988 to reach the Suicide & Crisis Lifeline. Free, confidential help is available 24/7. In an emergency, call 911.
Wendy Todd is a member of Report for America, which supports local journalists who report on under-covered issues and communities.
This post appeared first on The St. Louis American.