This article is part of State of Health, a series about how Michigan communities are rising to address health challenges. It is made possible with funding from the Michigan Health Endowment Fund.

COVID-19 has taken a toll on mental health in Michigan and across the world, but new Wayne State University (WSU) research shows that burden has been heaviest for people of color.

WSU researchers Dr. Peter Lichtenberg and Dr. Wassim Tarraf are examining how race, employment, and socioeconomic status intersect with pandemic-related stress, depression, and anxiety. They've used U.S. census data to identify individuals to poll every two weeks about how their mental health has changed throughout the pandemic.

"The findings that we have are pretty concerning," Tarraf says. "What we see through the data is a large percent of individuals who do report that they have mental health issues. What’s also concerning is these rates of mental health issues have remained stable over time. … People are not adapting and there are not enough tools for helping them reduce that level of stress. It is worth mentioning that rates are higher for people of color than those reported among whites."

Lichtenberg and Tarraf also took stock of the social determinants of health that are affecting their subjects' mental health.

Peter Lichtenberg.

"Food insecurity and job loss really stood out to us," Lichtenberg says. "65% of people with food insecurity had mental health issues. The numbers were similar for job loss in the household during the time of COVID-19."

Other Michigan mental health practitioners are seeing the same trends.

"There are so many factors contributing to this," says Kevin Fischer, executive director of the National Alliance on Mental Illness-Michigan (NAMI). "Mistrusting the medical system, unemployment, being laid off — economic conditions are really difficult. African-Americans, unfortunately, have lower wages. Having children home and doing homeschooling is additional pressure. There are so many widespread ramifications due to COVID right now."

Kevin Fischer.

Rebecca Spann, a licensed professional counselor in Grand Rapids, concurs.

"Various factors due to COVID-19 have caused people of color to experience a higher level of stress and anxiety," Spann says, citing both housing and food as major issues. "... When you think of children who went to school and were fed two or three meals a day, they are now eating meals at home. In my practice, I have seen the stress that mothers and single parents endure with children being home, learning virtually, while parents are working from home."

Since the pandemic began, Fischer says calls to the NAMI national and state help lines have increased 80%. Spann notes that social distancing takes away one major coping mechanism for those experiencing anxiety and depression: spending time with family members and friends.

"You have this pandemic in place and so many are in a space where they feel lonely or don’t have that connection they once had," she says.

Stigma adds challenges

Stigma about mental illness prevents many in African-American and Latinx communities from seeking help for anxiety, depression, substance abuse, and other mental health concerns. Some of the hesitation to engage with mental health care is based in very rational concerns. Implicit bias and outright prejudice have long impacted the quality of care people of color receive in the U.S. health system. Incidents of medical experimentation on people of color, as recent as the '90s, have fostered a pervasive mistrust. Many of Michigan’s Latinx residents fear reprisals from immigrations officials, either for themselves or for family members.

"The stigma associated with getting mental health care in the African-American community really makes it even harder," Fischer says. "Many simply won’t reach out for the help they need."

"When you think of mental health care, our families have taught us that to keep us safe, we keep what’s going on with us and to us," Spann says. "We don’t want to be further exploited."

Rebecca Spann.

When people of color do reach out for help, more often than not, their therapists neither look like them nor have the same cultural experiences.

"There are not as many options for help," Fischer says. "First of all, having access to care — beyond the stigma — or being aware of care is much more challenging. Then there’s the much larger issue of cultural competency. Overall, there is a tremendous shortage of behavioral health professionals. When you add the context of wanting someone who looks like you, it gets even worse."

A focus on solutions

To address this barrier, Spann has launched a Grand Rapids nonprofit, Mental Health Clinicians of Color, to connect Grand Rapids-area people of color with vetted counselors and psychiatrists who look like them. Fischer also encourages people of color to seek help even if the only therapists available are white.

"You can get competent care, even culturally competent care, from a person who is not the same color or gender as you," Fischer says. "I am trying to encourage people of color to not let that be a determining factor, a barrier."

Fischer notes that care can be difficult to find because of the strain COVID-19 has put on the health care system. On the flip side, the continuum of care for people with Medicaid is often better than for people with private insurance. Because the public behavioral health system focuses on social determinants of health, it also focuses on patients’ issues with employment, education, and relationships in community.

"In Michigan, we know we don’t have enough resources, but we do have resources. We really do have some very good providers in the public systems of care. They provide … all these things that make people feel better about who they are and which encourage them to continue with their treatment plan and recovery," Fischer says. "For a lot of people, it’s really just having someone to listen to them, not heavy counseling and medications. A lot of people dealing with COVID just need to be heard, to know that they are not alone."

Tarraf and Lichtenberg hope their findings inform new policies that deal with the root causes of mental illness in income-challenged communities and communities of color. They believe that as long as our communities fail to meet people’s basic needs for healthy food, adequate housing, a living wage, and culturally competent health care, issues with mental health will continue to disrupt, and often destroy, Michiganders' lives.

Wassim Tarraf.

"This [research] should hopefully inform some policy recommendations on how to target whatever aid is going to come, how to be better prepared in the future, how to really find where the need is within these communities, and how to help them so they can be more resilient," Tarraf says. "When COVID-19 ends, the lives of these individuals are going to continue to exist within the confines of food insecurity and poverty. The real work is how to maintain help for these individuals and communities when COVID-19 is behind us."

"The better we can fulfill these needs, the better our communities will be," adds Lichtenberg. "The suffering that is going on is quite palpable through this data. For these communities, it’s such a high-touch endeavor. It’s about getting basic needs met out there: food and income."

Meanwhile, Spann and Fischer encourage people of color experiencing symptoms of anxiety, depression, substance abuse, or other mental health concerns to find the help they need today. As a first step, NAMI has created a free guide, "The Effects of COVID-19-Related Social Isolation on the Mental Health of Racialized Communities."

"People of color, as with anyone, should seek help with behavioral health care if they feel overwhelmed or isolated," Fischer says. "Don’t allow the stigma to stop you from seeking help. You are not the only one feeling this way and there are resources available."

A freelance writer and editor, Estelle Slootmaker is happiest writing about social justice, wellness, and the arts. She is development news editor for Rapid Growth Media, communications manager for Our Kitchen Table, and chairs The Tree Amigos, City of Wyoming Tree Commission. Her finest accomplishment is her five amazing adult children. You can contact Estelle at Estelle.Slootmaker@gmail.com or www.constellations.biz.

Wassim Tarraf and Peter Lichtenberg photos by Nick Hagen. Kevin Fischer photo by Doug Coombe. Rebecca Spann photo courtesy of Rebecca Spann.