Dr. Salvatore J. Giorgianni, Jr. PharmD. Senior Science Advisor,
Men’s Health Network
Special to The Truth
Over two and a half years ago, in the article “African-American
Boys and Men in America Are Killing Themselves and No One Seems to
Care,” I wrote about the national disgrace that is the heavier toll
of suicide facing African-American boys and men.
I said that in minority communities, people often misunderstand what a mental health condition is, and therefore, discussing the subject is uncommon. A
lack of understanding leads many to believe that a mental health
condition is a personal weakness or a form of punishment.
African Americans are also more likely to be exposed to factors that
increase the risk for developing a mental health condition, such as
discrimination, social isolation, homelessness, and exposure to
violence.
What has changed – for better and for worse – since then? Do
African-American men and boys continue to have a higher death rate
from suicide and violence than others? Is the male suicide rate in
the United States still far higher than women? Is suicide still a
leading cause of death for minority males? Are African-Americans
still more likely to experience serious mental health problems than
the general population? Sadly, the answer to all of these questions
remains yes.
What has gotten worse? As I’ve said previously, African-American
youth who are exposed to violence have a 25 percent higher risk of
developing PTSD than non-Black youth. Violent crime rates in US
cities have only increased since 2019.2 This is especially true
amongst young African-American men. These two facts seem inextricably
tied together: violence leads to PTSD; PTSD leads to violence, over
and over again.
Minority access to mental health-related diagnoses and care is
impeded by barriers and challenges that are also experienced by
minorities who need addiction and recovery support and resources.
There also seems a strong correlation between mental health issues
and overdose rates. A recent JAMA study suggests that during the
COVID epidemic, specifically from January 2019 through mid-2020,
opioid overdoses decreased 24 percent among whites in Philadelphia.
Conversely, opioid overdoses actually increased amongst Black
Philadelphians by over 50 percent.
According to the U. S. Health and Human Services Office of Minority Health, only one third of Black adults diagnosed with mental illness receive treatment. According to the American Psychiatric Association’s “Mental Health Facts for African-Americans” guide, Black adults are less likely to be
included in research and receive quality care, while being more
likely to use an emergency room as primary care.
I recently spoke with Dr. Jean Bonhomme, founder of the National
Black Men’s Health Network, who relayed to me some other startling
recent statistics. In 2020, African Americans made up about 13.5 percent of
the U.S. population, while they also made up over 55 percent of homicide
victims, with a more than a 65 percent increase in homicides relative to
2019. Other stark figures that Dr. Bonhomme shared were from a recent
CDC study.
In the same period–2019 through 2020–drug overdose death rates for
non-Hispanic Black persons increased by 44 percent, while for non-Hispanic
American Indian or Alaska Native (AI/AN) persons the drug overdose
death rates increased by 39 percent.
Other numbers that jump out include the 2020 death rate from overdose among Black males aged ≥ 65 years (52.6 per 100,000) as being nearly seven times that of non-Hispanic white males of a similar age. Meanwhile, treatment for substance use was at the lowest for Black persons (at 8.3 percent).
One factor in the mental health crisis disproportionally facing the Black community is shown in data from the National Association of State Mental Health Program Directors. This data indicates that the number of people
admitted to psychiatric hospitals (and other residential facilities)
in the US declined from 471,000 in 1970 to 170,000 in 2014.7
This reduction in the availability of a potential intervention opportunity
appears to have led to growth in incarceration and similar
non-therapeutic interventions, which, in the absence of these other
options, take the place of actual psychiatric help. We must also
consider that the life circumstances of young black men must also be
the driver of many of these differences and disparities. Out of
decency alone, the US needs to find a way to identify and target
systemic changes to benefit these populations, which have the most
urgent need.
Data like this can seem overwhelming, but this only highlights how
disparities tend to cascade through any system, like an engine with
one worn part eventually damaging another. The United States has
deferred system-wide maintenance in the places that have needed them
most for far too long: the health and mental health care systems. The
outcome is predictable, yet we remain shocked when the situation
worsens.
Are there any positives the can impact minority mental health?
Absolutely! The new nation-wide 988 crisis number launch went live
July 16th of this year, and text-based services will be included.
Studies suggest that over 75 percent of those using text on existing crisis
services are under 25.8 Minority populations in the USA have a higher
percentage of people in younger age groups than whites. Therefore,
better serving an underserved community is an outcome that is a clear
improvement on the current situation.
Post-pandemic societal trauma, proper focusing on framing gender
equity, gender identification, and gender expression are all areas of
special concern within minority communities. For example, a Black
teen in a city school district might not find the same resources and
support as a white teen in the suburbs. This can trigger high mental
stress that may follow them into and throughout adulthood. Issues
like these, and the struggle to keep issues relevant to mainstream
media, are just the tip of the iceberg of challenges facing any
effort to improve the existing situation surrounding minority
men’s’ mental health.
What can be done? The ACA (Affordable Care Act, also known as
Obamacare), as passed by Congress, does not provide for Well-Man
visits. I continue to urge insurance companies and other payers to
include adequately-reimbursed Well-Man medical visits similar to the
yearly Well-Woman Visits available under the ACA.
Men’s Health Network redoubles its recommendation that those
charged with the health and social welfare of boys and men consider
the following:
1. Acknowledge the heterogeneity of boys and men and the unique needs
of diverse populations
2. Develop culturally appropriate male-focused screening tools
3. Develop guidelines that recognize the need to regularly and
routinely screen boys and men for both physical and mental health
issues
4. Address the poor reimbursement for behavioral health clinical
services
5. Establish culturally and gender-appropriate programs to identify,
interrupt, triage, and manage mental health issues in
African-American boys and men, providing education and training for
those in the community who interact with boys and men.
With this said, Men’s Health Network, Healthy Men, Inc., the
National Black Men’s Health Network, and the Men’s Health Caucus,
have launched a public awareness campaign, “You OK, Bro?”
https://cts.vresp.com/c/?MensHealthNetwork/ff5ca8b8c0/bab110333e/17c13d87b5 and will be hosting a workshop summit on Thursday, October 13th, 2022
at the National Press Club in Washington, DC to build awareness of
the mental health crisis now erupting in the male population of the
US. This important event will be live-streamed. The goal of the
summit is to examine and return recommendations to help reverse the
recent increase in mental health crises. Behavioral experts from
multiple organizations will share research, trends and discoveries,
and supply information to men, boys, and their loved ones to help
them identify the signs of mental distress, and recommend ways to
improve mental and emotional fitness.
“You OK, Bro?” is the beginning of a dialog that can start with
those words, whether between just two men, or at a national scale. We
hope “You OK, Bro?” can change the way the US sees and talks
about men’s mental health.
MEN’S HEALTH NETWORK
Men’s Health Network (MHN) is a national non-profit organization
whose mission is to reach men, boys, and their families where they
live, work, play, and pray with health awareness and disease
prevention messages and tools, screening programs, educational
materials, advocacy opportunities, and patient navigation.
Salvatore Giorgianni is an expert in men’s health, is Senior Science Advisor to Men’s Health Network, and is a registered pharmacist. He is a recognized expert in drug regulatory and US pharmaceutical policy as well as in organizational reputation management and strategic alliance development. He has authored, co-authored or presented some 200 works in health care, industry regulation and business. He is an advisor and board member to several health advocacy associations including: Men’s Health Network; American Osteopathic Medical Foundation; Kappa Psi Scholarship Foundation; Nurse Practitioner Health Care Foundation and the National Association for Continence.
He is a founding member of the Dialogue on Men’s Health, a presenter at the White House conference on Men’s Health, and a contributor to the SAGE publication, American Journal of Men’s Health. Dr. Giorgianni had a 26 year career with Pfizer Inc, where he held positions in the medical, regulatory, training, public policy, business planning, sales and marketing groups. Most recently he served as Pfizer’s Director, External Relations. He also directed several publications, including the Pfizer Careers In Health Care series and The Pfizer Journal: Perspectives in Health Care and Biomedical Research.