Mental health on the margins
Finding mental health care that fits an individual’s needs is often a difficult and time-consuming task, but it can be particularly frustrating for Black people and other people of color. A study published in the International Journal of Health Services revealed that Black adults are 20% more likely to experience mental health issues than the rest of the population. They are also more likely to witness or be victims of serious violent crime, which increases the risk of developing a mental health condition such as post-traumatic stress disorder, depression, or anxiety. So far, mainstream mental health apps haven’t been up to the task of addressing those unique stressors.
“A lot of mainstream mental health apps are not educated on subjects such as racial trauma, race gaslighting, mental impacts after viral police brutality in the media, colorism, microaggression,” said Jasmin Pierre, a Black mental health advocate. Pierre is the creator of The Safe Place app, a free mental health app that caters to Black users with Black mental health statistics, inspirational quotes, self-care tips for coping with police brutality, recorded meditations, and breathing technique tutorials.
Given how institutional racism in the mental health industry shapes traditional treatment approaches and perspectives, it isn’t surprising that mainstream apps lack programs and approaches that cater to communities of color. Despite the “racial reckonings” taking place after the summer of 2020, several mainstream health apps have yet to offer any specific programs and resources that directly address the needs of BIPOC users. (Prism contacted the Calm app for comment about the diversity pledges they made last year, but received no response.)
This leaves a troubling lack of accessible and culturally relevant mental health care and resources. Dr Bisma Anwar, whose work centers around normalizing mental health care for people of color, says tailored approaches to mental health for minority groups can make a huge difference in processes of recovery. Trauma in particular plays a large role in the mental health care needs of BIPOC, LGBTQ+, and other underserved communities. But while “cultural competence” training has been a key aspect of psychological treatment for around 50 years, it’s unclear how many therapists are trained to understand diverse cultural specificities.
“The world of psychology is really westernized,” Pierre said. “A lot of those textbooks [mental health professionals] read and studied in college were written by white people.”
Additionally, funding for culturally competent training and mental health treatment development is scarce.
Bringing relevant lived experiences into mental health
Mental health apps’ dearth of programs and treatment that reflect BIPOC lived experiences reflects a larger representation issue within the mental health care industry: Only 6.2% of psychologists and 21.3% of psychiatrists are members of minority groups, according to the American Psychiatric Association. And statistics published by the National Association on Mental Illness (NAMI) reveal that only 3.7% of members in the American Psychiatric Association and 1.5% of members in the American Psychological Association are Black.
The lack of BIPOC in mental health spaces and services is a problem that Shine, a self-care focused app that centers BIPOC populations and whose staff is majority BIPOC, is trying to address. The Shine app offers a meditation library, personalized tools and content based on the user’s needs, and support from an inclusive community and mental health experts. The app offers tools like space for guided journaling, and public forums to share experiences and ask questions about mental health. Shine reviews all of its audio meditations and Sleep Stories through a “privilege checklist” to ensure they’re not “preachy, pricey, or presumptuous.” This means that a guided meditation recording won’t assume anything about the listeners’ race, gender, sexuality, and class, which are assumptions that can sometimes alienate users. The Shine app also has most of their content voiced and created by women of color, said Shine co-founder Naomi Hirabayashi.
However, Dr. Anwar warns that while minority-specific approaches can offer validation and understanding to people of color who are struggling with mental illness, sometimes the search for specific care can hinder recovery.
“There’s a level of growth that can come from having someone understand and validate your experience, because you don’t have to explain that piece to them,” she said. “But at the same time, I think that there are some things that can actually be talked about and translated [in therapy]. At the end of the day, you need a good therapist who knows what they’re doing.”
Navigating barriers to mental health care
Despite a demonstrated need for mental health support and care among Black and other marginalized populations, there are also cultural barriers that can hamper access. According to a study by the American Psychology Association, up to 85% of Black Americans describe themselves as “fairly religious” or “religious,” and they commonly use prayer as a way to handle stress. Pierre’s Safe Space app also addresses this issue through offering specific coping tips to deal with mental health in religious settings, but mainstream apps do not.
“Many Black families are taught that strength and prayer are the only answer, or that therapy is just for white people,” Pierre said. “This way of thinking has stopped many in the Black community from receiving help. The app is helping to normalize seeking mental health support, and in a culturally competent way.”
Hesitancy to seek mental health treatment is also rooted in a history of medical racism and violence in the U.S. Discrimination, mistreatment in health care, misdiagnosis, and racial bias from medical staff are really discouraging to mentally ill Black people who need affirming spaces for healing. Communities that include refugees, asyleees, and undocumented people also struggle with reluctance to seek mental health treatment due to a lack of culturally appropriate care and accessibility in languages other than English. The high costs of mental health care are also a considerable deterrent, even for those who have health insurance—therapy, psychiatric treatment, medication, clinic visits, and other forms of care can quickly add up, especially for those who require life-long treatment. Poverty can cause or worsen mental illness and in turn, mental illness can worsen financial status.
Mental health apps offer potential alternatives that lack the history of trauma from medical mistreatment for BIPOC and other marginalized people, so it’s important for those apps to address their needs to encourage use. It’s especially essential for those apps to provide care that recognizes how racialization and generational trauma might affect users’ mental health.
”It’s about addressing the mental health issue, but also recognizing [how the everyday] underlying experience that comes from being a person of color or from another minority group [includes a] sense of being either discriminated against or singled out, or not getting enough opportunities due to their racial background or class or some other part of their identity,” Anwar said.
The absence of recognition for those everyday experiences and their effects in most mental health apps is what inspired Hirabayashi to co-found the Shine app with Marah Lidey.
“As two women of color, [co-founder] Marah and I both struggled to see our intersectionality addressed in an inclusive way across meditation apps, in media, etc.,” said Hirabayashi, who is biracial Japanese; her co-founder Lidey is Black. “Everything from our skin tone, our family dynamics, our financial background, it all felt otherized. Everything ‘wellness’ felt like it was created with one archetype in mind. And that wasn’t us.”
Mental health care still costs money
There are advantages for users finding mental health care and resources through apps—flexibility, no need to travel, going at your own pace, tailoring programs to your specific needs—but as with traditional areas of mental health care, managing mental illness through apps still comes at a cost. While some apps like The Safe Place rely on donations to maintain operations, most offer only a small portion of their resources for free; full access to their content requires a paid subscription. Some mental health apps like BetterHelp offer sliding scales for online therapy services, but the lowest price stands at $240 a month, which is almost 20% of the monthly minimum wage.
It’s also often unclear how apps that offer therapy vet their mental health care providers. For example, BetterHelp’s online therapy service was a source of controversy in October 2018, when users found small print on the app’s website that read: “We do not control the quality of the Counselor Services and we do not determine whether any Counselor is qualified to provide any specific service. . . We do not represent to verify, and do not guarantee the verification of, the skills, degrees, qualifications, licensure, certification, credentials, competence or background of any Counselor.” Along with others that provide online therapy services, BetterHelp has been overwhelmed by people looking for treatment during the pandemic—but the question of whether online therapy works as it should is difficult to answer.
The high cost of some of these apps is something Hirabayashi wants the Shine app to address as well, as she believes everyone should have access to tools that help them support their mental health. And putting accessibility at the heart of Shine’s messaging has everything to do with how Black and Latinx people are more likely to live in poverty than the overall American population.
“Accessibility is core to Shine’s mission,” Hirabayashi said. “We intentionally have a free and premium version of the Shine app to make sure everyone has access to Shine content, no matter their disposable income.”
Free access to Shine includes weekday motivational messages and research-backed articles, and daily meditations, including three short meditations for the morning, midday, and evening that users can access at any time. But if users want to take advantage of Shine’s entire meditation library, personalized tools, community, and mental health experts, it costs $64.99 a year.
Ultimately, mental health apps made by BIPOC for BIPOC can help marginalized people find more of the support and resources that they need. But mainstream mental health apps are still relying on BIPOC to create programs that address their lived experiences instead of putting the work into their own platforms to help close that gap. Further, it reinforces the idea that the mental health of those who aren’t white and and can’t afford care should be treated as an afterthought, rather than an area of need that must be addressed. While the burden shouldn’t always be on BIPOC to make up for the deficiencies in any industry, Pierre said, the frustrating reality is that if BIPOC don’t, nobody else will.
“That’s the problem,” she said. “Why do we always have to exhaust ourselves for the sake of the community, while others watch from the sidelines and do nothing?”
Nicole Froio is a writer and researcher currently based in Florida. She is working on a PhD on masculinity, sexual violence, and the media. She writes about gender in pop culture, as well as Global South and Latinx feminisms and many other topics.
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