The Mental Health for Everyone Project seeks to understand the impact of racial discrimination on the lives and health of racialized people, improve the mental health resources available for them, and share anti-racist clinical tools to assist in their effective treatment.

by Andrew Duffy

March 24, 2022  

Professor Jude Cenat

When a 34-year-old patient, a Black man, presented himself in the clinic of Ottawa psychologist Dr. Jude Mary Cénat, he described himself as “sad and tired.”

Cénat, a clinician and psychology professor at the University of Ottawa, had heard similar confessions of distress from other young Black fathers.

His new patient, a Canadian-born man of Caribbean descent, was an accomplished professional and the father of two children. But he described to Cénat a life weighed down by racism and discrimination.

He talked about a teacher who called him “Kirikou, the Black genius” (based on a character in an animated French-language film), about repeatedly doing group projects alone in university, about being forced to constantly “justify” his management position, about watching teachers treat his children “as I was treated as a kid.”

“I am not weak,” the man told Cénat. “I am sad, I am tired, and I think I’m going to explode.”

Cénat ultimately diagnosed the patient with severe depressive and anxiety symptoms, and with a PTSD-like disorder related to his racial trauma. In subsequent therapy sessions, Cénat further explored the patient’s experience with discrimination.

University of Ottawa psychology Prof. Jude Mary Cénat. (Photo courtesy of uOttawa)  “I addressed his racist experiences, unlike a clinical psychologist or psychiatrist who sees victims of racial discrimination as suffering from paranoia — an attitude that is deeply racist or at best constitutes a racial microaggression,” Cénat wrote in a recent commentary in The Lancet Psychiatry journal in which he described his clinical approach to racial trauma.

“In reality, psychiatrists and psychologists are poorly trained to deal with racial trauma,” he said. “At best they avoid it, at worst they pull out the paranoia card.”

Cénat is on a mission to change how racial trauma is treated in Canada. Among other things, he wants to alter this country’s “colour blind” approach to mental health care.

He wants clinicians not to treat Black people like all other patients, but to actively address the psychological harm caused to them by the discrimination, racial profiling and microaggressions that so often mark the lives of people of colour.

Only that kind of proactive mental health care, he says, can address the psychological burdens of skin colour and the trauma of racism.*

After joining uOttawa’s Faculty of Social Sciences in 2018, Cénat met with members of the local Black community to understand their concerns.

Many complained about a mental health system ill-suited to their needs, particularly those of Black youth. In response, Cénat helped launch the Mental Health for Everyone Project.

The initiative seeks to understand the impact of racial discrimination on the lives and health of racialized people, improve the mental health resources available for them, and share anti-racist clinical tools to assist in their effective treatment.

“There are ways to address racial trauma and help patients get better,” Cénat insists.

Through his research, Cénat has established a strong link between racism and the mental health of its victims.

He recently published a study that found Black people who experience high levels of racial discrimination are 36 times more at risk of suffering severe depressive symptoms than those who experience low levels of discrimination.

Another of his studies found that four out of 10 Black Canadians experience casual racism at least once a week. The study surveyed 845 Black Canadians between the ages of 15 and 40.

More than half of participants said they had experienced major episodes of racial discrimination at least once in their lives related to job hiring (61.5 per cent), education (60.5 per cent), policing (55.5 per cent) and health services (53.1 per cent).

Cénat’s research echoed the findings of the first Black Canadian National Survey, conducted last year by York University’s Institute for Social Research and the Canadian Race Relations Foundation. Seventy per cent of the 5,000 Black Canadians who responded to that survey said they experienced racism “regularly or from time to time.” Almost half (47 per cent) said they were treated unfairly by an employer in the previous year.

Such pervasive discrimination, Cénat said, has consequences.

Those who experience it can suffer from emotional distress, PTSD, depression, anxiety, low self-esteem and substance use.

In the United States, one meta-analysis of 293 previous studies found that experiences with discrimination were “consistently related” to poor mental health, including elevated levels of anxiety, depression and psychosis among people of colour.

Although studies suggest the connection between racial discrimination and PTSD is strong, racial trauma is still not included in the American Psychiatric Association’s authoritative diagnostic manual, the DSM-5. The manual now recognizes racism as trauma only when it flows from a single racist event, such as an assault.

Dr. Monnica T. Williams, the Canada Research Chair in Mental Health Disparities at the University of Ottawa, is among those who have called for racial trauma to be included in the diagnostic manual. “Many people of color experience cumulative experiences of racism as traumatic, with perhaps a minor event acting as ‘the last straw’ in triggering trauma reactions,” she wrote in Psychology Today.

Dr. Myrna Lashley, a psychologist and professor at McGill University’s department of psychiatry, said the everyday Black experience is such that overt racism can aggravate scar tissue collected over many years.

OCTOBER 20, 2020Dr. Myrna Lashley, a professor in McGill University’s department of psychiatry, outside her home in Montreal. PHOTO BY JOHN MAHONEY /Montreal Gazette

She tells a personal story to highlight her point. Walking down a street in downtown Montreal, Lashley said, she was stopped by a dishevelled panhandler who asked for change. As was her habit, Lashley offered to buy him something to eat. He again demanded money. Lashley said she would give him food, not money.

He swore at her using a racial epithet.

Lashley said her anger flashed not least because of the societal message he had delivered: “We have put certain people automatically — by dint of their pigmentation and regardless of their socio-economic status — as being better than others placed below the line.”

The man was living on the street, but saw himself as superior, Lashley said, and the experience had an outsized impact on her sense of well-being.

It’s an example of the psychological burden faced by those in the Black community, where parents regularly remind their children to obtain store receipts, and warn their teenagers to keep their hands on the steering wheel if stopped by police.

“(American writer) James Baldwin said that to be born Black is to be born angry,” said Lashley, “because there are so many structural things in place that make it difficult for you to operate on an even keel. You’re constantly having to carry that.

“It’s part of the stress of constantly being on your guard, and having to pose that question: Did that happen because of my race?”

All of which means, she said, that improving mental health care for Black patients is critical since so many live with exceptional psychological burdens.

“That clinician you’re seeing needs to understand the historical nature of some of the stress you’re undergoing, that this is endemic,” Lashley said.*

Papa Ladjiké Diouf, a registered psychotherapist and co-chair of the Ottawa Black Mental Health Coalition, said he sees signs of racial trauma among many of his Black clients.

“Every single day that I have a client from our community, I realize that there is that piece of racial trauma in how they were treated by the system, the barriers they’ve faced,” said Diouf, who helped launch the coalition in an attempt to improve access to quality mental health services for people in Ottawa’s African, Caribbean and Black (ACB) communities.

Oftentimes, he said, racial trauma starts in school where young Black students do not see Black history or Black people accurately reflected in classes. Their self-image, he said, can be distorted through mirrors held by those in the white majority.

“I see a lot parents from the ACB community who face children saying, ‘I don’t like my skin,’ ‘I don’t like my hair.’ It’s the first step in reproducing racial trauma.”

At Ottawa psychologist Dr. Buuma Maisha’s practice, about one quarter of his clients are Black. Maisha, an assistant professor in the school of counselling, psychotherapy and spirituality at Saint Paul University, said he remains attentive to each client’s cultural background and life experiences.

“Some of those experiences can be difficult because of perceived or experienced discrimination,” he said. “Unfortunately, it’s a very common experience.”

Such incidents can lead to depression, anxiety or trauma, he said, but also to general malaise, self-doubt, and a sense of “not belonging” to society. “Belonging is very important, and when they don’t feel like they belong, it affects their identity,” he said.

It means, Maisha said, that therapists have to be good listeners and be “guided by the client’s experience, not just the textbook.”

Lashley expressed the same idea in a different way. She called it “cultural humility.”

“It means you accept that you don’t bloody well know,” she said.

A 2018 survey of U.S. psychologists found 71 per cent had worked with clients who reported race-based trauma. But only a fraction (18.9 per cent) of the 106 counsellors surveyed said they had received training to treat race-based trauma.

Perhaps it’s not surprising then, Cénat said, that U.S. research also shows more than 50 per cent of people from the Black community leave psychological treatment before it’s complete.

“I think this is what’s wrong with the colour blind approach to care,” he said. “If you are in the office of a psychologist or psychiatrist, and you cannot talk about your racial trauma because you’re afraid people will blame or ignore you, then you don’t talk about it.

“And if you feel you’re not welcome to talk about something this important, then you stop going.”

The Mental Health for Everyone project offers a detailed set of guidelines for clinicians who want to offer better care to Black patients.

Dr. Buuma Maisha is a psychologist and assistant professor of counselling, psychotherapy and spirituality at Saint Paul University. Friday, March 18, 2022. PHOTO BY ERROL MCGIHON /ERROL MCGIHON

Among other things, the project’s anti-racist mental health care guidelines advise clinicians to be aware of racial issues and not to be blind to their clients’ skin colour.

Clinicians are advised to educate themselves on the social and cultural determinants of health, such as income levels, housing conditions, food insecurity, unemployment, childhood development and social networks, and to understand that racism can also be an important determinant of health.

They’re asked to remember “that Black communities are not culturally homogenous,” and to take the time to learn about the ethnic identity, religious beliefs and cultural values of their patients.

Clinicians need to address the effects of racism, the guidelines say, and analyze a patient’s hypervigilance, anxiety and depressive symptoms in relation to institutional and systemic racism. They also encourage clinicians not to over-prescribe and to carefully explain the purpose of any medication.

Lashley said the approach means taking race into account for the state of a patient’s mental health rather than ignoring it. The same is true for Indigenous and Asian-Canadian patients, she said.

“If you’re telling me you’re colour blind, that means you’re not seeing me,” she said. “That part of who I am involves how people see me as a Black woman, and how I see myself situated in this society.

“Telling me you’re colour blind means you’re not cognizant of, nor do you want to be cognizant of, what my everyday life is like.”

She tells her psychology students: “Close your eyes, hear with your feelings, not only with your cognition.”*

The “sad and tired” 34-year-old father that Cénat treated ultimately improved.

The man managed to taper and halt his medication after about eight months; he regained his zest for his life, relationships and hobbies. Cénat celebrated the man’s resilience with him.

Outside his clinic, Cénat has used the patient as a case study to highlight the importance of a thoughtful, proactive approach to the treatment of racial trauma.

“It is true that Black men may have difficulties seeking help, consulting psychologists and psychiatrists because mental health problems, and specifically depression, are still taboo in many communities. Seeking help is often perceived as weakness,” Cénat wrote in The Lancet.

“But I realize through my own experiences as a Black clinical psychologist that many more Black men would consult psychologists and psychiatrists if their experiences were understood, their anger was heard, the very act of talking about racism did not make professionals themselves uncomfortable, the care provided was culturally appropriate and anti-racist, and they were treated with humanity, respect and dignity.”

Source: Ottawa Citizen