Abstract
Mental Health Among African Americans: Innovations in Research and Practice, written by Erlanger A. Turner, offers the reader an honest look into innovative thought around understanding and attending to the mental health concerns of African Americans. Turner makes a case for the intentional incorporation of African American cultural values into psychological practices, acknowledging that the relationship between the helping professions and African Americans has frequently been destructive. In this concise yet compelling book, Turner not only reminds us to recognize the much-repressed history of racism within the helping professions but he also provides tools to develop and use while working with and adapting to the needs of African American clients and populations.
Turner begins by offering historical context around the relationship between mental health practitioners and African Americans. While noting the history of unethical behavior toward African Americans, Turner demands psychologists evolve beyond a standard grasp of professional ethical standards. Instead, he underscores the importance of infusing African American values, such as collectivism, spirituality/religiosity, and cultural perspectives on time, expressive communication, and orality, into the understanding of professional ethics (Turner, 2019, p. 57). To support his call for increased cultural competence, he provides a wealth of information about helping African Americans navigate any ethical concerns in research and clinical settings.
The introduction of the Model Treatment Initiative for African Americans (MTI), a conceptual model of help-seeking, provides a theoretical basis to better aid psychologists in understanding factors that often contribute to the treatment adherence of African Americans. The MTI captures the complexity with help-seeking among African Americans, noting influences such as accessibility, availability, acceptability, and appropriateness of treatment; or “The 4 As of Treatment Initiation” (Turner et al., 2016). In posing the MTI, Turner encourages us to explore, ask, and learn more about the complicated relationship between racism and mental health for African Americans. Anecdotes of the author’s research and clinical experiences do well to assist practitioners in this effort as well as to highlight his use of this emerging model.
Turner’s accessibility factors include structural barriers such as cost of treatment, the proximity of mental health providers, and fear of mistreatment. In elucidating a historical analysis of the unethical treatment of African Americans, Turner reminds us to explore a multitude of barriers to treatment for African Americans.
Availability factors include preferring a provider who is either African American or one who explicitly expresses cultural sensitivity. Acknowledging the dearth of African American psychologists in the field, Turner stresses the importance of all psychologists to have cultural competency, noting, “It is particularly necessary that providers recognize that many African American clients have expectations for therapists to discuss sensitive cultural issues and be open to navigating issues around race during treatment” (p. 51). The reluctance to discuss cultural issues, Turner contends, may further decrease mental health help-seeking among African Americans.
Acceptability factors are those that either lead a client to seek treatment or factors that contribute toward the apprehension around seeking mental health treatment for African Americans. In explaining these factors, Turner connects the historical experience of racism to the perception of mental health as a family matter and the justifiably healthy cultural mistrust of the mental health industry.
Appropriateness factors relate to the perception of whether or not concerns are severe enough to warrant mental health treatment. Turner reminds providers to be mindful of African American values, precisely the value of spirituality and religiosity. He further explains that providers need not exclude topics of religion and spirituality from treatment; instead, providers need to explore with African American clients the importance of this value.
Turner ends with a reminder that we all have more work to do in order better to meet the mental health needs of African Americans. He calls on researchers and practitioners to acknowledge how racism has influenced the help-seeking behaviors of African Americans. Turner clarifies by stating, “In an ideal world, discrimination and various forms of racism would be nonexistent. Sadly, history has taught us that it is difficult to undo a system of oppression that was created with the formation of the United States” (p. 24). If psychologists can acknowledge the enmeshment of racial oppression within the very fabric of society, then surely there should be widespread interest in a model grounded within African American cultural values that recognize the impact of historical racism on the help-seeking behaviors of African Americans.
Mental Health Among African Americans is an excellent starting point for developing better competence when working with African Americans. While supporting the notion that race-related stress is a dire mental health concern for African Americans, despite lacking recognition as a mental health disorder, this expertly crafted book will be useful for students, practitioners, researchers, and educators who wish to begin the journey to developing a greater understanding of the nuances of treatment among African Americans.
