Mental Health is a primary area of concern in the United States. Moreover, recent data suggests that depression is on the rise for Americans as a whole. In 2018, the Blue Cross Blue Shield Association released a study on the overall impact of major depressive disorder (MDD) on Americans’ mental health. The findings revealed that more than nine million insured American (4.4 percent) had been formally diagnosed with major depression. Furthermore, certain groups, like women, who are diagnosed at rates double that of men, millennials, who had a 47 percent increase in diagnosis, and adolescents, who had a 63 percent increase, all experienced a dramatic increase in major depressive diagnoses.

There are many adverse health outcomes associated with major depression. Increased likelihood of suicide, reduced quality of overall health, and a shorter life expectancy are all examples. However, MDD is just one of many mental health conditions that impact Americans.

Thankfully, more researchers have begun looking at the impact of depression on certain groups based on their demographic factors, like gender, age, sexual orientation, and ability status. By aggregating specific data about the people who have depression, mental health professionals can compare experiences and tailor resources to meet specific needs.

For example, one demographic factor that is often overlooked is that of race and ethnicity. Many people of color (POC)  move through life without having discussions about mental health or the way daily experiences with racism and bias can have a long-term impact on mental health. The stress that accompanies living life along the margins is negatively affecting people of color in the United States. However, the impact of a racialized identity is often overlooked when discussing the obstacles to obtaining adequate access to mental health services.

Data suggests:

• The Health and Human Services Office of Minority Health indicates that Black Americans have a 20% increased likelihood of mental health issues compared to the general population.
• Asian American women have the highest suicide rate for women over 65.
• Suicide attempts for Hispanic girls (9-12 grade) were 70 percent higher than white girls of the same age.
• In 2014, suicide was the second leading cause of death for the American Indian/Alaska Natives population.

Despite, more intracommunity dialogue (the slow increase in mental health conversations taking place in communities of color) and researchers and organizations taking race into consideration, there are still many obstacles to obtaining quality mental health care.  

Dr. Erlanger Turner, Ph.D., assistant professor at the University of Houston-Downtown and faculty affiliate with the Center for Critical Race Studies has spent a great deal of time familiarizing himself with the unique struggles impacting people of color seeking mental health treatment.

“Some of the primary challenges are locating providers in proximity to their homes, accessing services through their health insurance, and locating providers of color. Although providers may be available, some do not accept health insurance, which causes a dilemma for many families,” he explains.

Other components are a bit more complicated to solve. For example, people of color often find themselves uncomfortable with speaking to mental health providers who lack cultural context or lack a solid understanding of the ways provider bias in mental health can impact the mental health professional-client relationship.

Unfortunately, neither mental health professionals nor clients of color are immune to the subliminal messages we are sent through entertainment media like television.

Media portrayals and social scripts often center conversations about mental health around white characters. Since many people of color don’t have these conversations in their homes, this can lead to feelings of isolation in the larger context of depression and other mental health conditions.

According to Sahra Ali, a former nonprofit mental health and addiction service worker, the portrayal of mental health as a “white people thing” has left many people of color further marginalized in the discipline and reluctant to seek mental health services.

“Generally speaking, the stigma on mental illness is greater in the minority, POC population in part because they receive it from both sides. People of color are not only discouraged by the general public but also by their own culture. I recall this being one of the hardest, most persistent deterrents for POC when they came to inquire about treatment,” Ali explains.

The lack of representation of POC in the mainstream, as well as inner community, mental health dialogue can also leave them uncomfortable with seeking treatment. Similarly, many mental health providers have internalized bias from these same mainstream, social scripts. The result is people of color are further discouraged from seeking help.

“Based on the research and the work that I have been doing, POC often are reluctant to work with providers that don’t look like them for fear of being misunderstood,” Turner explains.

Ali also notes that for many people of color, mental health treatment comes with dual marginalization. “Most White people do not have to think about the cultural stigma when they seek treatment. To be fair, there are two stigmas we are talking about here—the overall stigma of having a possible mental illness or issue and the stigma of seeking treatment as a member of an already ‘othered’ group,” she explains.

While the freedom to exist outside of the expectations of one’s community is a privilege that many white people take for granted, people of color have to consider both how they will be perceived as an individual, as well as, a representative of their racial group.

Thankfully, many mental health professionals are actively researching ways to improve mental health-related experiences for people of color.

One of the most effective ways to buffer people of color from real as well as perceived bias is by connecting them with providers who understand racial differences.

“When they are connected with a provider that looks like them or that is culturally sensitive they feel more open to treatment. The research also supports that when providers are culturally competent, it increases the client-therapist relationship and improves treatment outcomes,” Turner continues.

Research has shown positive outcomes for people of color when seeking treatment with those who have a cultural understanding. However, those providers can be hard to find due to shortages of cultural education as well as limited professionals of color.

“In general, it seems that perceptions about mental health treatment are improving among POC. However, the field still needs to improve its representation of diverse providers to meet the needs of communities of color,” concludes Dr. Turner.

The importance of culturally competent care is severely underemphasized in mental health improvement dialogue. To combat this, Ali suggests that we need to move beyond accommodating cultural difference and more towards expecting it. She reminds us of the extreme vulnerability involved in seeking out mental health services and discusses the ways the fear of being misunderstood can further complicate the process.

“Mental health is a very personal thing. Patients are more likely to seek and continue treatment if they feel they are understood and seen…With that said, it is essential for us to recognize the various challenges that POC face in this arena…plan for it and expect it and most of all, respect their varying experiences,” she states.  

Ironically, the cultural shift to openly discuss mental health conditions like anxiety and depression doesn’t always yield immediate benefits. For example, it isn’t uncommon for individuals of color to hold on to cultural frameworks that emphasize prayer, spirituality, and persistence as a tool for survival through struggles. As a result, transparency about seeking mental health resources might have the accompanying internalized stigma of “weakness.”

“For POC, it is even more difficult. You are perceived as weak and not in control of your life. For Black Americans with a history of slavery or even those from Somalia or other war-torn countries; anxiety and depression are just not talked about. It is not [seen as a] feasible means of survival. It is the same with PTSD which often coincides with anxiety and can enable prolonged depression,” she explains.

One way to alleviate the discomfort surrounding mental health treatment is to increase representation of people of color in the mainstream mental health dialogue.

We owe it to all patients to ensure mental health professionals have received training that is comprehensive and has components of culture education.

Lastly, both Turner and Ali emphasize the importance of the impact of financial class as an isolating factor limiting people of color seeking assistance. Segregated areas with Black and brown people are significantly less likely to have access to quality care. Also, even when care is available, there are often other limitations like trouble receiving time off work or finding childcare.

Targeted campaigns (like National Minority Mental Health Awareness Month, which takes place in July) aim to look at the unique needs of people of color, but there is still work to do.

Being a person of color comes with many challenges. The mental health industry can improve outcomes by making sure mental health professionals of color, as well as patients of color, have the freedom to customize care and spearhead the dialogue about what best benefits those communities.   

This article was first published on ProHealth.com on September 15, 2018 and was updated on June 17, 2021.

Rochaun Meadows-Fernandez is a diversity content specialist whose work can be seen in The Washington Post, InStyle, The Guardian, and many other places.  

By Sarah Ann Shockley

So many caring people are anxious to help their friends, relatives, and co-workers who are living with chronic pain that they are quick to offer recommendations and words of advice. But is more advice what people in pain really need?

I would suggest, most respectfully, that it is not.

Chronic pain is a complex condition that is not easily remedied by typical treatments, supplements, or exercise routines. While we appreciate everyone’s sincere desire to help, what we require usually isn’t more advice. To support us in our healing, here’s what we would ask for:

1. Respect

Please understand that everyone in chronic pain is doing our utmost to heal. We are not malingering or making it up or exaggerating. We are not lazy, or melodramatic, or trying to get more attention by being ill. In fact, most of us understate our situation in order not to make others around us feel bad. And please respect our intelligence and tenacity. If we have been in pain for any length of time, believe me, we’ve tried most of the treatments, both alternative and traditional, that you have ever heard of. And then some.

2. A Free Pass

Just being in pain is hugely exhausting, and we are using most of our available energy and personal resources just to get by. Getting out of bed in the morning and lurching through another day may be all we can manage. The fact that we found the energy and wherewithal to make one important phone call or fill out a necessary medical form may be a major triumph for that day.

3. Understanding That We Can’t Be Normal

Most of us are sleep deprived and under a great deal of stress trying to handle work and parenting and relationships and self-care and medical demands while in pain. We don’t have any reserves left over to participate in life at normal levels. We are not being selfish or acting like victims if we have to say no to a lot of things. We are not doing this to make you angry or to get attention. Just having a conversation may take all our available energy. Imagine having pain in your body and the flu and jet lag and severe sleep deprivation all at once. It can be like that most of the time for us.

4. Allowances for Our Cylinders Not Firing

People in pain simply don’t have the brainpower that we normally would. All our available stamina is going into healing and into living with pain. There doesn’t seem to be a lot left over for our noggins to draw on. We forget things easily, we can’t find the right words sometimes, and sometimes our brains go offline for a few moments and we simply blank out. We have trouble focusing and we may not be able to make sense of complicated instructions. Actually, we may not be able to follow any instructions. Just imagine finals week at college. You know, the last day, after not sleeping all week? Remember how brain dead you felt? Some of us feel that way every day.

5. Compassion and Trust

What we really need from you is compassion, understanding and trust that we are already doing our best and to refrain from asking us to hurry up and get out of pain. We need you to not be so scared of your own pain that you refuse to allow us to experience ours or feel like we have to hide it and not speak of it. For whatever reason, we are still in it for the time being and, even if we wanted to, we can’t move out of it to make you feel better. Believe us, we certainly would if we could. We wish we could be more available to you and to our own lives, but we can’t at this time.

Instead of trying to help us by offering methods for healing, we are in need of you simply being with us, being there for us when you can, and trusting us to find our own individual path through pain. We will let you know if we need more than that. We appreciate your loving-kindness, your gentleness and your compassion most of all, and these, really, more than any words of advice, are the most healing things you can offer anyone in pain.

This article was first published on ProHealth.com on July 6, 2018 and was updated on June 13, 2021.

A native of Connecticut, Sarah Anne Shockley is a multiple award winning producer and director of educational films, including Dancing From the Inside Out, a highly acclaimed documentary on disabled dance. She holds an MBA in International Marketing and has worked in high-tech management, as a corporate trainer, and teaching undergraduate and graduate business administration. As the result of a work related injury in the Fall of 2007, Sarah contracted Thoracic Outlet Syndrome (TOS) and has lived with debilitating nerve pain since then. She has been a columnist for Pain News Network, is a regular contributor to The Mighty. She is the author of The Pain Companion: Everyday Wisdom for Living with and Moving Beyond Chronic Pain and other books on living with pain, and currently resides in the San Francisco Bay Area.

By Scott Olson

When you have an upset stomach, gas, bloating, pain, or really any digestive complaint, there’s often an herb that can help.

While many people reach for a prescription or over-the-counter remedy, these often are not very helpful. Herbs and herbal combinations have been handed down through generations and are foods for the gut that nourish, protect, and improve the functioning of the entire digestive system.

Let’s take a look at some of the more powerful herbal aids that are used whenever you have a digestive complaint.

LICORICE

When you think of licorice, most people imagine a red candy snack you eat in the movie theater. Real licorice, the root of the Glycyrrhiza glabra plant, is a much healthier thing to put in your mouth. Licorice has been used as traditional medicine for thousands of years; it is high in sterols, flavonoids, isoflavonoids, coumarins, quercetin, magnesium, manganese, silicon, zinc, and many other nutrients. It is both a nutritive to the digestive system and a healing aid for damaged tissues.

Traditionally, licorice has been added to herbal formulas to help colds/flu and fatigue, as an expectorant, and as a way to sweeten bitter medicine. Modern science has discovered that licorice acts to reduce inflammation, supports healthy immune function, protects the heart and liver, and exhibits antiviral and antibacterial properties.(1)

Licorice really shines, though, as a beneficial aid for gastrointestinal conditions.

Licorice soothes and strengthens mucus membranes – and since the entire digestive tract is lined with mucous membranes, it can benefit a wide variety of conditions. Licorice works well for ulcers(2) and even canker sores(3) in the mouth. Taking licorice in a chewable form is often the best, as mixing it with saliva activates the herb. Licorice is also helpful for gastritis, reflux, indigestion, heart burn and other conditions.(4)

Licorice contains glycyrrhiza, which can increase blood pressure in some people, so using a deglycyrrhizinated type of licorice is recommended.

PEPPERMINT

The leaves of the peppermint plant (Mentha piperita) have long been cultivated and used in traditional medicine, and it is now one of the most widely used herbal plants in the world. Sure, peppermint tastes great, but its popularity is based more on the benefits it brings to the digestive system than on how our taste buds feel about it.

The leaves of the peppermint plant contain flavonoids, beta-carotene, magnesium, potassium, selenium, zinc, and many vitamins. It has been shown through scientific study to have strong antibacterial and antiviral activity, acts as a powerful antioxidant, can support healthy immune function, and has cancer preventing properties.(5)

What peppermint really excels at is calming nerves; this is especially true of the nerves of the digestive system. Scientists call peppermint an antispasmodic because of the calming activity it has on the entire digestive system. Peppermint has been shown in animal studies to have a relaxing effect on the gastrointestinal tissue and reduces pain associated with gas and bloating.(6) Peppermint improves the entire digestion process. Peppermint oil has been shown to be helpful in reducing the symptoms of irritable bowel syndrome (IBS).(7)

People with reflux should use peppermint with caution because it can make the condition worse.

GINGER

Ginger is better known as a spice, but scientists have been surprised at just how many conditions this herbal powerhouse can benefit. To date, more than 1,000 medical studies have been done on the root of this plant known as Zingiber officinalis. All the attention ginger is receiving is for good reason:

• It is packed full of powerful antioxidants, minerals, vitamins and phytonutrients. It has been shown in laboratory tests to be a powerful anti-inflammatory and cancer preventive and to help reduce pain.(8)
• Ginger has long been known to fight nausea, which is why people drink ginger ale when they feel sick while traveling. This anti-nausea ability has been backed up scientifically by multiple studies. Ginger has proven effective for pregnancy-related nausea, chemotherapy induced nausea, and motion sickness.(9,10)
• Ginger also is a powerful antimicrobial and is being studied for reducing H. pylori infections, which have been shown to cause ulcers.(11)
• Ginger helps most symptoms of indigestion and has also been studied for use in people with ulcerative colitis.(12)

Overall, ginger is one of the best herbs you can use to relieve nausea and improve the functioning of the entire digestive tract.

TRIPHALA

Triphala, which means “three fruits,” is a health and digestive tonic from traditional Indian, or Ayurvedic, medicine. It is made from the fruits of three trees, the amalaki fruit (Embelica officinalis), bibhitaki fruit (Terminalia belerica), and haritaki fruit (Terminalia chebula).

These fruits are high in vitamins and antioxidants. Triphala has been used for thousands of years – often for people who are suffering from digestive complaints. It works especially well for the elderly and people with sensitive stomachs.

Triphala has many properties that make it desirable as a digestive tonic. It works as a gentle laxative and improves assimilation of food for people with weak digestion. It improves the function of the entire digestive system. It reduces gas and can help to improve appetite.

Note: This information has not been evaluated by the FDA. It is generic and is not meant to prevent, diagnose, treat or cure any disease. It is very important that you make no change in your healthcare plan or health support regimen without researching and discussing it in collaboration with your professional healthcare team.

This article was first published on ProHealth.com on June 27, 2018 and was updated on June 9, 2021.

About the Author: As a Naturopathic Doctor, Scott Olson is trained as a primary care physician with an added emphasis on science supporting the healing powers of nature. He has an expert knowledge of natural medicine, including nutrition and botanicals, and is a much-published medical writer. He is the author of Sugarettes, a book about the addictive qualities of sugar.