Black, Indigenous and People of Color (BIPOC) are at risk of experiencing trauma due to mental and emotional injury from a variety of causes.

If you have experienced such trauma, you may find that your relationships are impacted. Consider these strategies to protect and manage your closest relationships and all that are important to you.

Recognize triggers

We can be triggered by and experience racism.

The impacts can go beyond our own emotional pain and psychological distress to affect our relationships. When we feel triggered, it’s important to:

• Identify your emotions—Are we feeling surprise, fear, sadness, disgust, anger? It can be helpful to name to our emotions so we can use our knowledge about how to deal with them and seek help if necessary.
• Recognize the validity of your emotions—We are right to feel the way we do, and we don’t need to waste our energy questioning that. It’s important to take the time to understand how we are feeling.
• Manage your emotions—When we know what we are feeling, we are in a better place to be in control of how to approach and react to people and situations. This can have beneficial impacts for our relationships.

Set boundaries

With family members and friends, co-workers and even strangers, we must feel safe to be ourselves and feel respected. Setting and sticking to personal boundaries can help. Here’s how you can do it:

• Prioritize needs—Take the time to think through where you stand, what you can and cannot tolerate, and what makes you feel happy or uncomfortable.
• Anticipate resistance—Expect that others may not easily understand your boundaries, especially if they have different backgrounds or personalities.
• Communicate boundaries—Clearly and directly let others know of your boundaries and reiterate them if you feel they are being overstepped.
• Distance yourself if necessary—If you feel disrespected or have your boundaries crossed repeatedly, it may be time to cut off further interactions to protect your emotional wellbeing.

Practice self-care

We are our own best advocates. It is vitally important that we take time to do the things that make us happy, keep us healthy and give us an outlet from negativity. Not only will our wellbeing improve, but our relationships will also benefit. Try these:

• Try a delicious new recipe—Taking time to enjoy cooking or baking can be relaxing and fruitful when it’s time to eat!
• Enjoy quiet time to rest or nap—Sometimes it can be hard to take a break. Take the opportunities as they arise and enjoy every moment!
• Catch up for a visit or phone call with a loved one—Connecting with others can increase your sense of safety, belonging and security.
• Read a book or start a hobby—Keep your mind active and engaged in activities that bring you joy.
• Volunteer—Giving of yourself to help others can improve your confidence, self-esteem and life satisfaction.
• Get outside for fresh air and exercise—Sunshine and nature have been proven to boost mood.

Additional emotional support resources

For more on BIPOC mental health, visit our website for July BIPOC Mental Health Awareness Month, MagellanHealthcare.com/BIPOC-MH, and be sure to check out the BIPOC mental health tip sheets and awareness campaign toolkit.

You can also check out a recording from our webinar, “BIPOC mental health and relationships.”

Discussions about mental health in the Black community shouldn’t be limited to Black History Month in February and BIPOC Mental Health Awareness Month in July. The conversations and action steps geared toward providing education, support, and resources require a year-round effort.

A recent article published by the Kaiser Family Foundation, shares that although Black people have made great contributions and achievements in the United States, “they continue to face many health disparities that adversely impact their overall health and well-being,” which have been “exacerbated by impacts of the COVID-pandemic, ongoing racism and discrimination, and police violence against and killings of Black people.”

What impact do these factors have on the mental health of individuals in the BIPOC community? Magellan’s medical director Rakel Beall-Wilkins, M.D., MPH shares her perspectives on depression and suggestions on ways to be supportive.

What is depression and what are some signs or symptoms?

Dr. Beall-Wilkins: Depression is a clinical illness characterized by:

• Prolonged periods of low or sad mood.
• Loss of interest or pleasure in activities.
• Changes in appetite, sleep or energy levels.
• Feelings of worthlessness or hopelessness.
• Thoughts of death or suicide.

Depression can be caused by medical illness, substance abuse, and stressful social, academic, or occupational situations, but it can also develop more readily in individuals who have a family history of depression or other mental health conditions.

Other signs of depression may include:

• Withdrawing from social activities, relationships, or hobbies.
• Escalating drug or alcohol use.
• Declining self-care in the form of poor personal hygiene and grooming.
• Expressing feelings of hopelessness, worthlessness, and/or helplessness.
• Neglecting to attend to chronic medical conditions or maintain follow-up with healthcare providers.

How does depression impact individuals in the Black community?

Dr. Beall-Wilkins: As of 2020, the National Survey on Drug Use and Health found that 6% of Black American adults and 12.9% of Black American adolescents experienced a major depressive episode within the last year. Despite increasing levels of depression within the Black community, studies also show that Black Americans are less likely than their White counterparts to receive psychotherapy or medications for their depressive symptoms. This disparity is largely attributed to limited access to healthcare coverage and culturally competent behavioral health providers, as well as pervasive cultural stigma.

Is it possible for someone to experience depression that is triggered by external factors and societal issues, such as violence, police brutality, political unrest, and racism? If so, how?

Dr. Beall-Wilkins: Yes, it is possible for depression to develop as a result of exposure to sociopolitical strife. In fact, during the week following the highly publicized death of George Floyd in May 2020, rates of depression and anxiety spiked from 36 to 41% among Black American respondents to the Census Bureau’s 2020 Household Pulse Survey.

Likewise, a 2018 study published in The Lancet found that police killings of unarmed Black Americans resulted in an increase in poor mental health days among Black American respondents. Though they may not know the victims of these circumstances personally, it is very common for Black Americans to collectively internalize the trauma of these events and feel despair over the possibility that a similar fate could befall them or their close family members and friends. Moreover, the repeated nature of these events can elicit sadness, hopelessness, and fear that things will never change.

What are tips for an individual that recognizes they are showing signs of depression?

Dr. Beall-Wilkins:

• Visit your doctor and seek treatment: Regularly follow up with a primary care provider to ensure there are no untreated or undertreated medical conditions that may contribute to the development or worsening of depressive symptoms.
• Stay connected: Stay connected to close friends, family, and spiritual community for support.
• Diet and exercise play a role: Eat a balanced diet and engage in physical activity for at least 30 minutes a day, three times per week.

Resources:

• National Alliance on Mental Illness’s (NAMI) cultural dimensions website for BIPOC/AAPI communities.
• DSM-5 (American Psychiatric Publishing, Copyright 2013 (American Psychiatric Association) 
• Stanford University 
• Anxiety and Depression Association of America 

For July Black, Indigenous and People of Color (BIPOC) Mental Health Awareness Month, we are pleased to share our e-interview with Dr. Tonicia Freeman-Foster, Ed.D, CDP, CHES®, PMP, co-founder and principal consultant at Kusudi Consulting Group, and change specialist at Change Matrix, on mental health for Black people and African Americans

Magellan: What are some sources of stigma related to mental health treatment in Black communities?

Dr. Freeman-Foster: One source of stigma stems from slavery where Blacks and African Americans were deemed to be strong so that they could do the work. There were adverse consequences, including death, for those who were deemed to be weak. Because of this, in so many ways we have internalized strength to mean that you have to be able to do the work. You must be able to always put on a smile, even when you are sad or not feeling well. We have internalized this to the point of when we are not feeling well, we feel the judgment of it as a weakness or being lazy. This is why the message “it’s okay not to be okay” is critical, and it’s critical that we as Blacks and African Americans say it, practice it, and live it. Mental health is health too.

Another huge factor is the intersection between mental wellness and faith. There is some belief that if you are feeling sad, then you probably did not pray enough, or you do not believe in God enough, or that you do not have enough faith. The belief that overall, you are weak spiritually. No one wants to be seen as weak, and so as a result we do not seek help. It’s important that we understand that we can do both simultaneously. We can seek earthly help for our mental wellness AND we can pray too.

Magellan: Tell us about your presentation Equity as an Expectation on August 30th at 2:00 p.m. ET.

Dr. Freeman-Foster: With Equity as an Expectation (information and free registration under Upcoming Events here), we will explore strategies to create an environment where people, no matter their demographics or life experiences, can expect that they will receive culturally responsive services in an equitable manner and have equitable outcomes.

The reason that equity is missing in a lot of our programs and services is because it has been allowed to be optional. I compare it to a grocery store. You have young adult services on aisle five, HIV services on aisle six, mental health services on aisle seven, substance use services on aisle eight, physical health on aisle nine, and then equity on aisle three. If we truly want to make a positive impact in all our interactions, then equity must be the shopping cart. It must be the first thing that you come in the door with, and the thing that everything builds on top of. It is about interweaving equity practices into everything that we do, versus having equity as an optional standalone practice. There must also be accountability measures in place for all team members, and a consistent process for reviewing progress, outcomes measures, and follow-up actions.

Dr. Tonicia Freeman-Foster has over 20 years of experience in cultivating hope, resiliency, and wellness through her work with underserved persons and marginalized communities. She is passionate about her work in assisting organizations and leaders in understanding how their beliefs and actions impact diversity, equity, inclusion, belonging, and justice for staff, clients, and communities. Dr. Freeman-Foster possesses extensive experience in matters related to mental health, substance use, child welfare, HIV/AIDS, and LGBTQ+, youth and young adult, women, Black, Indigenous, and People of color (BIPOC) populations. 

Dr. Freeman-Foster is the co-founder and principal consultant at Kusudi Consulting Group, and she also currently serves as a change specialist at Change Matrix. In these roles, she provides training, technical assistance, and coaching to individuals, communities, and organizations throughout the nation. In her previous role, Dr. Freeman-Foster served as project director of the Florida Healthy Transitions program and led the development of an innovative peer-to-peer behavioral health model for youth and young adults. Dr. Freeman-Foster possesses a Bachelor’s degree in Health Science Education (Community Health) from the University of Florida, a Master’s degree in Human Services (Organizational Management and Leadership) from Springfield College, and a Doctorate degree in Education (Organizational Leadership) from Argosy University. Dr. Freeman-Foster is a Certified Diversity Professional, Certified Health Education Specialist, Certified Courageous Conversations About Race™ Practitioner, and Certified Project Management Professional.

This is an excerpt from the Magellan Healthcare eMpowered for Wellness July 2021 newsletter. To read the full article, go here. For more information and resources to support BIPOC mental health, and to register for Dr. Freeman-Foster’s continuing education credits-eligible webinar, visit MagellanHealthcare.com/BIPOC-MH