“The System isn’t Set up for Us”: Stories of young Black women’s mental health journey

Abstract

Background:

Black women are too often overlooked and underserved by the mental health system, resulting in disparities in their access to care and services provided. Little attention has been given to understanding the mental health experiences of Black women or to the development of culturally responsive, effective interventions that promote equitable access and services for these women.

Objectives:

This study provides an opportunity to understand the lived experiences of young Black women with mental health challenges and their engagement with mental health services.

Design:

A descriptive phenomenological approach was used to understand the lived experiences of young Black women with mental health challenges and their engagement with mental health services.

Methods:

Using a descriptive phenomenological approach, loosely structured interviews with 15 Black women, ages 18–30 years, experiencing mental health challenges were conducted.

Results:

A thematic analysis revealed five overarching themes: (1) the “Strong Black Woman” persona as a barrier to seeking care, (2) impact of mental health stigma in the Black community, (3) intergenerational mental health trauma among Black women, (4) lack of culturally responsive practitioners, and (5) the impact of COVID-19 on mental health.

Conclusion:

The findings suggest practitioners need to consider the intersecting identities of Black women when developing culturally responsive interventions. Additionally, concepts such as identity shifting, identity centrality, and radical healing should be considered when addressing the unique experiences of young Black women.

Keywords

Strong Black Woman mental health identity shifting COVID-19 stigma

Introduction

Black women encounter distinct challenges due to their double minoritized status of being female and Black. They are more exposed to and harmed by the socio-historical and political climate of interconnected violence and power, which shape their experiences of inequalities, placing them at a higher risk for mental health concerns.^1
–3 Additionally, Black women face a distinct type of racial discrimination called misogynoir.⁴ The term misogynoir describes the form of oppression Black women endure at the intersection of racism and sexism. Misogynoir merges misogyny, the hatred toward women,⁵ with racial discrimination, resulting in a unique type of discrimination that mainly targets Black women.⁴ The exposure of Black women to this type of discrimination often results in the internalization of their emotions.⁶ The internalization process, alongside other factors like elevated stress levels, can give rise to psychological issues such as low self-esteem and depression.^7,8 Furthermore, Black women who are constantly exposed to racism, sexism, and the continuous battle against societal pressures often lead to hopelessness and despair,⁹ which can contribute to the development of severe mental health symptoms and a cultural pathway for a heightened risk for suicidal behaviors.^9,10

Despite the plethora of stressors that Black women face, they often avoid seeking professional help or delay treatment until their symptoms become incredibly severe.^11,12 Moreover, when they do seek mental healthcare, they are less likely to receive adequate treatment due to implicit bias and lack of cultural competency.^13,14 The consequence of historical trauma has made it difficult for some Black women to acknowledge and address their mental health challenges. With the numerous historical examples of attempts to control the behaviors of Black folx, especially Black women, their difficulties and uncertainties are not unwarranted.¹⁵ Few studies have attempted to investigate the mental health journey of young Black women, including their struggles and mental well-being. In this study, we center the voices of young Black women between the ages of 18 and 30 to understand their lived experiences with mental health challenges and engagement with mental health services.

The myth of the “Strong Black Woman”

The “Strong Black Woman” (SBW) persona, a prevalent coping mechanism among Black women, is both a testament to their resilience and a burden that significantly contributes to the risk of psychiatric disorders due to the dual pressures of fulfilling traditional roles and combating systemic adversities. The SBW persona mandates them to bear the weight of both gender-specific expectations and the broader struggle against the sociopolitical injustices that undermine their communities, often sacrificing their physical and mental health in the process.^16
–18

The relentless pursuit to uphold this persona can predispose some Black women to various psychiatric conditions, including post-traumatic stress disorder (PTSD), depression, anxiety, eating disorders, and substance abuse.^19,20 The pervasive myth of the SBW not only shapes the socialization of Black females from an early age but also significantly influences their attitudes toward mental health, often resulting in a reluctance to seek professional help due to the internalization of ideals emphasizing strength, self-reliance, and emotional stoicism in the face of adversity.²⁰ This reluctance is compounded by the significant racial disparities in mental health services, characterized by inadequate care, higher misdiagnosis rates of psychotic disorders, and prevalent cultural mistrust.^13,21

This socialized upbringing, which often involves suppressing negative emotions to avoid appearing weak or inadequate, is rooted in historical narratives that cast Black women as the indefatigable pillars of their families and communities, capable of achieving success with limited resources despite the enduring legacy of slavery.^22
–24 The SBW persona is also paradoxical in portraying Black women as both infallible and deeply flawed as aggressive actors in white spaces.²⁵ Thus, it is logical that the enduring myth of the SBW would have tangible psychological repercussions, which contribute to a range of mental health issues, including depression, sadness, hostility, self-hatred, and self-destructive behaviors.^26,27

As stated above, despite the prevalence of these mental health issues, Black women are statistically less likely to seek professional treatment compared to their white counterparts.^11,28,29 This disparity can be attributed to the cultural stigma surrounding mental illness and an ingrained belief in the expectation to remain “strong” and “in control.”²² Additionally, mistrust of healthcare professionals, cultural differences, and limited awareness about available services or the presence of inaccessible services further exacerbate the underutilization of mental health services by Black women.^30
–33 For those who do seek help, a preference for informal support networks such as family, friends, or church communities over professional mental health services is often observed, highlighting the stigmatization associated with seeking professional help within the context of their racialized, gendered identity.^34
–36

Demystifying the myth of the SBW and addressing the systemic and cultural barriers to mental healthcare are crucial steps in improving mental health outcomes for Black women. Addressing these challenges requires a nuanced understanding of the persona’s sociohistorical context, relationship with controlling images,³⁷ and subsequent impacts, along with a concerted effort to mitigate the systemic barriers to adequate mental healthcare.

Identity shifting and identity centrality

Within the societal roles expected of them, Black women navigate complex identity dynamics, often resorting to identity shifting as a strategy to conform to the dominant cultural norms in professional and social settings, which, while serving as a short-term coping mechanism, may contribute to adverse long-term mental health outcomes. Identity shifting involves linguistic adaptations, such as code-switching, and behavioral modifications to align with the prevailing cultural expectations to mitigate discrimination.^8,38 The socio-historical context positions Black women as family matriarchs and caregivers, roles that extend into their professional lives in predominantly white spaces (i.e., as seen in controlling image archetypes like “the mammy”).³⁷ This dual existence necessitates a constant negotiation of identity, where cultural prescriptions regarding appearance and demeanor compel Black women to mask their authentic selves.^39,40 For example, Black women are discouraged from wearing their natural hair in some settings because it would be considered “unprofessional,” or they may have to alter how they speak to reflect the “tone” and language of their White peers.^40,41

The media’s portrayal of Black women through stereotypical and negative lenses (e.g., exotic, sexually provocative, disheveled, welfare queens, on drugs, etc.) amplifies the pressure to engage in identity shifting, further entrenching the need to navigate societal perceptions cautiously.^37,42 This external validation is mirrored throughout the literature, which often emphasizes “deviant” narratives at the expense of exploring the broader spectrum of Black women’s holistic experiences.^43,44 The cumulative effect of these societal and personal stressors, exacerbated by the demands of maintaining a façade of strength and control, correlates with diminished mental health outcomes for Black women.⁴⁵ Despite these challenges, Black women derive resilience from their strong connection to their racial identity, a phenomenon known as racial centrality—the connection or importance one ascribes to their race, which can offer a buffer against some stressors.^46,47 However, the delicate balance between identity shifting and a strong racial identity can, paradoxically, exacerbate mental health issues when the internal conflict between these identities becomes too great, leading to potential consequences of de-identification or cognitive dissonance.^8,48

The practice of identity shifting among Black women, rooted in the historical and societal expectations of strength and resilience, presents a complex interplay between cultural conformity and the preservation of the authentic self. While it may serve as an immediate adaptive strategy, its long-term implications on mental health underscore the need for more culturally competent mental health support tailored to the unique experiences of Black women. This is especially pertinent in the face of national and global challenges and changes.

COVID-19 pandemic impact on Black communities

The study was conducted in early 2022 after the COVID-19 lockdown and before the full post-COVID integration into society. The COVID-19 pandemic had a profound effect on the mental health of populations globally, instituting a “new normal” characterized by social isolation and economic instability, with Black communities in the United States facing exacerbated challenges due to pre-existing racial disparities in healthcare and mental health support systems.⁴⁹ The rapid spread of COVID-19 led governments to enforce unprecedented public health measures, such as the widespread implementation of social distancing measures, including stay-at-home orders and the closure of schools and places of worship, which contributed to isolation, job loss, and significant mental health challenges.⁵⁰ Black communities were disproportionately affected by these measures, exacerbating pre-existing disparities and contributing to an increase in the wealth gap and disproportionate fatal outcomes.^51,52 Although the long-term impact of COVID-19 on mental health is yet to be determined, public health measures, while necessary to curb the virus’s spread, resulted in significant short-term mental health repercussions, including increased rates of anxiety, depression, and other psychological stressors. Studies indicate that Black adults experienced higher rates of anxiety and depressive disorders compared to their White counterparts during the pandemic.⁵³ For Black women, the pandemic intensified gender health disparities, leading to increased levels of psychological distress, depression, anxiety, and suicidal behaviors.^54,55 This disparity is attributed to longstanding inequalities within the healthcare system, as well as the heightened exposure of Black individuals to the virus, particularly among Black women employed in “essential” sectors^50,56 with roles such as cashiers, childcare workers, and healthcare professionals, further elevating their risk of contracting COVID-19.^57,58 These essential roles, often lacking adequate workplace protections and benefits even before COVID-19, placed Black women at an increased risk of both COVID-19 infection and financial instability, further compounding the mental health challenges faced during this period.^57,58 These circumstances are significant, compounding the difficulties faced by Black women, who are often the sole providers for their families.^22,59

The pandemic underscored and intensified gender-specific health disparities among Black women, who were already navigating a complex intersection of racial and gender-based discrimination in every other sector of their personal and professional lives. There is a critical need, now more than ever, to adequately consider the intersectionality of race, gender, and socioeconomic status when working with marginalized individuals.^54,55

Methods

The current study

The current study provides an opportunity to understand the lived experiences of young Black women with mental health challenges and their engagement with mental health services. We interviewed 15 Black women between the ages of 18 and 30 in February 2022–May 2022 after the COVID-19 pandemic lockdown, seeking answers to the following research question: What are the mental health challenges young Black women face, and how do these challenges influence their engagement with mental health services? Emerging adulthood typically ranges from 18 to 29.^60,61 However, for the purposes of this study, we accounted for individuals turning 30 during the data collection. The study focused on young Black women because, during this life transition, they often experience increased instability and uncertainty during emerging adulthood, leading to significant mental health risks.^60,62 By centering the experiences of young Black women, we gain insight into the specific mental health obstacles they encounter and how they pursue treatment. This study is unique in that it offers valuable insights for mental health practitioners, emphasizing the importance of culturally responsive care in addressing the complex challenges faced by this demographic.

Research design

This study used a descriptive phenomenological qualitative approach to understand the lived experiences of young Black women with mental health challenges and their engagement with mental health services.⁶³ Husserl’s descriptive phenomenology was employed to gain insight into individuals’ lived experiences and understand the meanings of their experiences from an insider perspective.⁶⁴ The descriptive phenomenological approach is a research methodology that investigates little-known or poorly understood aspects of an experience by focusing on specific and practical descriptions of that experience. This approach is commonly used to explore experiences related to illness and healthcare.^65
–67 The study adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) (Supplemental Material 1).⁶⁸

Procedures

Participants were recruited using purposive and snowball sampling from three cities located in the Eastern and Western regions of the United States. Black women were recruited through an electronic flyer distributed to social media (via Facebook, Instagram, LinkedIn, and Twitter) and through word of mouth by other participants. The recruitment flyer included information for those interested in participating in the study, with a QR code that led prospective participants to a Qualtrics online screening survey. Prospective participants indicated their interest by scanning the QR code, which led to a presentation of the study’s informed consent explaining the details of the study, the risks, and the benefits. Persons were eligible to participate in the study if they identified as Black cis-gender women who had experienced mental health challenges, engaged in mental health services at least once, and were young adults between 18 and 30 years old.

Initially, 25 persons expressed interest in participating in the study; however, 10 did not respond to the request for an interview. There were no apparent differences between those who chose not to participate and those who participated. The final sample consisted of 15 women who self-identified as either Black, African American, Biracial, African Latina, or African. For this study, we used the term “Black,” consistent with the recruitment materials the participants responded to indicating an identification of Black or African American. Additionally, we chose to acknowledge the specificity of each participant’s self-identification as reflected in the Qualtrics demographic survey (see Table 1).

Table: 1.

Demographic Characteristics of Participants.

Pseudonym name	Age	Diagnosis	Sexual Orientation	No. years dealing with the illness	Diagnosed by a mental health professional
Maria	26	Depression, PTSD, premenstrual dysphoric disorder	Heterosexual	4 years	Yes
Rita	20	Depression and anxiety and binge eating disorder	Bisexual	8 years	Yes
Katie	20	Anxiety	Heterosexual	7 years	No
Elizabeth	30	PTSD, panic disorder, major depressive disorder	Heterosexual	4 years	Yes
Maureen	28	Dysthymia and persistent depressive disorder/eating disorder	Heterosexual	7 years	Yes
Kris	19	Generalized anxiety disorder, depression, binge eating disorder	Bisexual	4 years	Yes
Star	26	Anxiety induced depression	Heterosexual	4 years	Yes
Tia	30	Depression and anxiety	Queer	6 years	Yes
Mimi	23	Generalized anxiety disorder	Heterosexual	11 years	Yes
Spice	25	Anxiety, eating disorder	Heterosexual	12 years	No
Linda	25	Major depression and generalized anxiety disorder	Queer	4 years	Yes
Megan	24	Depression and anxiety	Heterosexual	7 years	No
Jovana	25	Borderline personality disorder, clinical depression, generalize anxiety disorder, PTSD	Preferred not to say	10 years	Yes
Anabel	29	Anxiety and depression	Heterosexual	10 years	Yes
Michele	30	Anxiety and depression	Heterosexual	7 months	Yes

PTSD: post-traumatic stress disorder.

Data collection

Interested participants provided demographic information and completed five screening questions. Upon completion, they were emailed and asked to select a date and time for an interview. Once agreed upon, invitations to an online Zoom interview were provided. Each participant received a $25 Amazon, Walmart, or Target gift card for their time. Data were collected through open-ended, loosely structured interviews to elicit participants’ experiences with mental health issues and subsequent engagement with mental health services. The interview protocol consisted of 12 open-ended questions with prompts and follow-up questions. These questions were developed based on a literature review of the mental health experiences and the use of mental health services among young Black women^16,33 and reviewed by a mental health researcher prior to finalization. The overarching mental health questions included:

How did you first learn that you had a mental health issue?

Can you share some of your experiences to help others understand what it is like to have a mental health issue?

Can you describe how you cope with or manage your mental health for me?

Can you tell me about your relationships with your mental health providers?

The first author conducted single interviews between February 2022 and May 2022 via Zoom (Zoom Video Communication, Inc. is headquartered in San Jose, California, USA), which lasted 40–90 min with an average of 60 min. Through these interviews, participants elaborated on their narratives of the phenomenon under study.^69
–71 At the start of each interview, the study protocols were explained again, and all participants consented to be both video and audio recorded.

Each interview was transcribed with participants’ identifying information omitted from the transcript, and pseudonyms and identification numbers were assigned to each participant before analysis. Participants were recruited and interviewed until there was a saturation in themes.

Data analysis

The data collection and analysis were conducted simultaneously. All data were audio and video-recorded on Zoom and transcribed verbatim using professional transcription services (i.e., Rev and Transcription US). All transcripts were uploaded into Dedoose 9.0.54 qualitative data analysis software program for thematic coding.⁷² Thematic analysis was used to identify themes or patterns across the data to address the phenomenological inquiry. We implemented Braun and Clarke’s⁷³ thematic analysis method by following their six-step process: (1) familiarization with the data, (2) generating initial code, (3) sorting codes into themes, (4) reviewing themes, (5) defining and naming themes, and (6) selecting exemplary excerpts.

Initially, the first and third authors extensively familiarized themselves with the dataset through multiple readings of the transcripts, ensuring a deep understanding of participant experiences and data nuances. The generation of initial codes followed this foundational step during a second detailed examination of the transcripts, identifying emergent key concepts. The research team then collaboratively categorized these initial codes into subthemes and overarching themes, structuring the analysis to reflect the dataset accurately. A subsequent review of these themes was conducted to validate their accuracy and alignment with the data.

During the fifth step, the team meticulously defined and refined each theme and subtheme through collective deliberation, aiming to precisely articulate the data’s essence. Throughout the analysis, reflexivity was prioritized, with researchers actively examining their biases and expectations to mitigate undue influence on the findings. The culmination of this process involved selecting data excerpts that exemplified the identified themes, providing clear evidence of our analytical conclusions. This systematic approach facilitated a nuanced understanding of the data, contributing meaningful insights to the field.

Trustworthiness and rigor

To ensure the trustworthiness and rigor of this study, we employed Lincoln and Guba’s framework, which comprises four key concepts: credibility, transferability, dependability, and confirmability.⁷⁴ First, to achieve the credibility and accuracy of the research findings, the researchers used bracketing throughout the research process to set aside previous personal knowledge and experiences of the phenomenon.⁷⁵ After each interview, the first author participated in peer debriefing, consulting with colleagues not directly involved in the research process to enhance the study’s validity. Second, the researchers ensured the transferability of the study by providing a comprehensive description of participants’ experiences, including direct quotes, the research context, data collection techniques, and timeframe. Finally, we maintained a detailed audit trail involving documenting the data collection process and recording the decisions made about data analysis so that each step could be traced back to the original interview. Additionally, the principal investigator kept a reflective journal to engage in reflexivity, reflecting on our impact on the research process, interacting with participants, and identifying emerging themes and potential biases, ensuring dependability and confirmability.

Reflexivity

As Black scholars and qualitative researchers, our reflexivity involved considering our positionality throughout the research process. The interviewer (first author) kept a reflective journal after each interview, documenting each participant’s interactions, which assisted in identifying preconceived notions, building self-awareness, and learning how social identity can impact the research process and analysis. While the research team identifies as Black, we approach the study with cultural sensitivity and humility using an insider-outsider perspective.

For instance, the first author identifies as a Black Afro-Caribbean cisgender queer male who moved to the United States to pursue doctoral education and has experienced microaggressions, mental health disparities, and ethnocentrism, which reminded him of the longstanding history of colorism and the distribution of privilege and disadvantage to the color of one’s skin tone.⁷⁶ During the interviews, only when relevant would he share his unique experiences, which might have influenced how the participants would share experiences of racism, mental health stigma, and trauma, how that impacted their mental health journey, and the difficulty of finding culturally appropriate mental health interventions. While the participants were willing to share their experiences, the first author realized he would never know what it feels like to be a Black woman in the United States, combating society’s expectations.

The second author acknowledges her social location as an educated Black queer cis woman who conducts her research through an intersectional lens. She has previously worked in direct practice mental healthcare and acknowledges Black feminist epistemology influences her experiences in both practice and research. The third author identifies as a Black heterosexual cis woman who is a professor and an older adult, two generations ahead of the first and second authors. In some ways, her lived experience is reflected throughout the interviews, requiring her to be intentionally self-reflective and self-aware and to bracket her experiences,⁶³ only interjecting when deemed appropriate to add understanding and meaning to the analysis.

Results

After analyzing the data, we discovered 5 main themes and 17 subthemes (see Figure 1) that provide insight into the mental health challenges and help-seeking barriers faced by young Black women. The five overarching themes were (1) “Strong Black Woman” persona as a barrier to seeking care, (2) impact of mental health stigma in the Black community, (3) intergenerational mental health trauma amongst Black women, (4) lack of culturally responsive practitioners, and (5) the impact of COVID-19 on mental health.

Figure 1.

Young Black women’s mental health journey.

“Strong Black Woman” persona as a barrier as a barrier to seeking care

All participants recalled and described how they felt they had to conform to societal expectations of being that “Strong Black Woman,” sacrificing themselves for the sake of others and enduring pain without complaining. One participant, Tia (age 30), described that due to cultural messages, many Black women who struggle with anxiety and depression often delay treatment or do not acknowledge their symptoms because of their multiple roles:

There are a lot of Black women who struggle with anxiety and depression, but we still manage to do all the things in our daily lives. Right, we’re taking care of our families, and we’re working, and we’re in our communities and doing all this work.

Tia also noted that White practitioners do not understand Black women who struggle with anxiety and depression, explaining that practitioners might look for the typical symptoms of depression and anxiety, forgetting that these may present differently for Black women. As Jovana (age 25) added:

For women of color, much of the processing is mental before it becomes verbal. Before I say it out loud, I have to make sure it sounds as non-threatening as possible. That’s why it sounds so well-spoken, as they like to say.

Participants also described their reluctance to disclose their mental health conditions to friends and family because it is often seen as a sign of weakness. The socialization of being that “strong Black woman” may keep them from disclosing their mental health diagnoses as it may confirm society’s negative perception of Black women. As Tia states:

Also, going back to what I was saying earlier about the strong black woman thing, I haven’t communicated or told most of my family that I have anxiety or depression.

Impact of mental health stigma in the Black community

Stigma and a lack of understanding of mental illness left many women feeling unsupported. Rita (age 20) explained, “It’s hard to be part of a community that doesn’t fully understand or respect that you are challenged daily.” The lack of support many Black women face adds to the psychological distress. Additionally, Mimi (age 23) recalled and described her experience navigating society as a Black woman. She explained:

Being aware, as a Black person and as a Black woman, of how you’re perceived, and that the system isn’t set up for us.

Similarly, Anabel (age 29) recalled her experiences disclosing her mental health diagnosis to her parents, stating, “I think they treat me differently in some ways.” She explained that if she got upset, her mother would say, “You’re just so angry,” making her engage in self-doubt and believe her emotions were invalid. Additionally, with her father, when she would try to communicate with him about her mental health, his recommendation was, “You just need to go pray.”

Although there is hesitancy among Black women to disclose their mental health status, Maria (age 26) explained that she told her mother and friends. She reported being “initially nervous” about divulging her mother that she was in therapy because “I didn’t want my mom to think something was wrong with me.” Furthermore, her mother, originally from the Caribbean, did not correctly understand the “American mental health model” and, therefore, had reservations. She was “nervous,” informing her to “be careful what you say.” Maria indicated that her friends were very supportive; however, she wondered if the response would be the same if she had a severe mental illness like schizophrenia.

Some participants reported experiencing stigma coupled with racial bias. Jovana (age 25) described previous encounters with medical providers where racial bias resulted in unequal treatment:

I think the first time I realized it, I was a kid, and the questions the doctors presented at my regular physical checkups were not usual. They ask, “Do you want your parents to leave the room?” They left. They would ask me are you sexually active? Yes or No? Well, that has been at least my experience. Whereas my White friends will get asked if they have problems with eating disorders or stuff of that nature. I was like, really? No one has ever asked me anything like that or even asked me about my mental health. Whereas my friends, who are Americans of European descent, would get asked stuff of that nature by them but not me.

Intergenerational mental health trauma amongst Black women

Most participants spoke about intergenerational mental health concerns, describing one of their parents as having unaddressed or diagnosed mental health issues such as bipolar disorder, personality disorders, depression, or anxiety and how that impacted them psychologically. One participant, Kris (age 19), describes growing up with her mother as a “toxic situation.”

My mom also has severe depression and anxiety disorder. She was not in the best mental health situation. So, growing up, it was definitely a difficult experience, and she made plenty of mistakes.

She recalled the experiences she felt were not deserved; instead, she “deserved a mom who cared.” Mimi (age 23) describes her childhood growing up with her mother, whom she believed to have anxiety and depressive symptoms:

She’s a very interesting person. She won’t like to see anybody or rejects that thought, so she has anger issues, and she was abusive to my sister and verbally abusive to me at times.

Another participant echoed similar sentiments and concerns about her mother’s undiagnosed mental illness. Anabel “suspected” her mother suffered from a mood disorder, stating:

I suspected when I was younger that my mom maybe had some untreated mental things going on because her mood was always very erratic; you never knew what you were going to get from her. So, it was hard to anticipate.

She further explained several issues of “neglect” and “emotional abuse” from her mother.

Neglect is the biggest one. And at that point, just like not being there, getting very angry and being, “Oh, you know, I’m not buying food,” or things like that. I remember once my sister got sick, and she got so upset and just left.

Lack of culturally responsive practitioners

All the women discussed difficulties in finding a culturally competent practitioner, indicating that finding a therapist who understood their intersectional identity was challenging. Thirteen out of 15 women preferred a Black woman as a therapist due to the familiarity of a shared identity. Many, once they found a therapist they liked, experienced several barriers, such as insurance or long wait times for appointments. One participant, Kris (age 19), summarizes her experience trying to solidify a Black therapist long-term. She describes her as “amazing” following the initial intake session; however, due to the long wait time for continued services, she settled for a White therapist covered by her insurance. She describes this choice as “not a good idea in hindsight”:

I felt like she didn’t listen to me on certain things. I would tell her about my situation with my mom, and she would like, just stand up for yourself. I’m like, ma’am, I have tried.

Several participants’ interviews presented the feeling of being misunderstood by their current therapists, specifically those who were not Black. Star (age 26) recalled and explained that due to disappointing past experiences with a “non-Black therapist,” she prefers a Black therapist:

I have had a challenging experience with non-Black people or non-Black therapists. And, even to a Black woman, it’s not guaranteed, but most likely, they will understand your plight. Right! So, I finally found one, and she was amazing.

Jovana reflected on her experience with a non-Black therapist who did not understand cultural nuance, stating, “The things I was saying didn’t translate properly to her.”

As an adult in the mental health system, I guess just seeing how your culture impacts so much of how people recognize what you’re saying and how it can sound so different to someone who doesn’t understand its cultural nuances. Because to her, the things I was saying were triggering, “she’s going to end her life. She’s going to do something very drastic to harm herself.” Whereas, for me, the things I was saying during that time were like describing a desire to go to sleep and just not wake up again. But it is more like a peaceful passing than I’m going kill myself.

While most participants stated a preference for a Black woman as a therapist for cultural reasons, Maria offered a different perspective:

Just because we are, you know, melanin people, and we all are Black doesn’t mean that we automatically will be like the best click or fit for like the client, right and so um, you know, just because yeah like, for example, the whole Gospel like you assume that listen to Gospel music, because you know that’s very common in a black community, but I don’t. And so, you know, kind of just like things like that where you’re assuming something because we’re both Black, but that’s not, you know, we’re not a monolith.

Impact of COVID-19 on mental health

In the earlier stages of the COVID-19 pandemic, with quarantine and other social restrictions, participants recalled their feelings of isolation and separation from family and friends. These experiences were only exacerbated by the sociopolitical climate at the time. One participant, Linda (age 25), recalled that the lack of social connectedness and the racial unrest of 2020 made her mental health worse.

Not being in person was hard. Doing Zoom classes and stuff was overwhelming. I was lonely, even though I had a roommate, so I felt fortunate there was somebody else. I also had a cat that I got over COVID. Even then, I just wasn’t motivated.

Later in the interview, she expanded upon the impact of the racial unrest:

That summer of 2020, with George Floyd and everything, I was writing my master’s thesis. It was tough, and my advisor was tough, but in a good way, and it was lots of writing, and the world was on fire.

The loss of social connectivity and the inability to receive social support during the earlier stages of the pandemic impacted several women’s mental health. One participant, Anabel (age 29), described it as a challenging process to have family members die, not being around family members during such an emotional time and the fear of contracting the virus when little was known about it.

I was in grad school at the time. So, I was in Georgia, basically alone, quarantining alone. I had a roommate, but we didn’t talk to each other. So yeah, I felt very separated from my family because I was across the country, and I was in an apartment by myself, and we had a family member pass during that time. So, it was just very difficult to sit with all the fear of COVID, particularly in the beginning when a lot of us didn’t know anything that was happening about it.

Anabel’s feelings were not isolated, as participant Tia identified with similar experiences of not knowing how to navigate the new unknown. She explained that she never “transitioned” to the new normal, specifically as it related to her job. However, as the country adapts to living with the virus, she is now required to return in person, and she anticipates elevated anxiety levels as she must find childcare:

In my current job for nine months, the pandemic hit, and I have been working from home ever since, so I’ve been home for about two years over two years now. In the fall, I’ll be transitioning back in person and, like all my kids, will be in school or childcare, which I haven’t had since COVID hit, so I’ve been doing this work-from-home balancing and unable to do 100% work.

While most women recalled how the social restrictions prevented social connectivity, which had a tremendous impact on their mental health, Star (age 26) explained that her experience was positive. The social restriction and lockdown measures improved her mental health. She explained that loved ones surrounded her and that being away from an institution with a history of racial oppression ameliorated a mental burden.

COVID-19 has been terrible overall. But I will say that with COVID-19, I could be home with family and friends and not be on campus. And it made me realize I love remote work. And it’s so much better for my mental health because I don’t have to interact and be fake with people I don’t care to talk to. To have to physically be there on those grounds with a history of slavery, and you feel that energy. It’s a spiritual disruption that I can tell you about. You feel it. To have to feel like you don’t belong there.

Discussion

The goal of this study was to understand the lived experiences of young Black women, specifically those between the ages of 18 and 30, with mental health challenges and their engagement with mental health services. This study is unique; in that, it was conducted during one of the most significant times in recent human history: a worldwide pandemic that shone a light on the fragility of mental health and heightened the impact of racially systemic factors and disparities on the lives of the Black community.⁷⁷ As a subset of this community, the young Black women in this study reinforced the significance of the stronghold of the “Strong Black Woman” persona and the stigma of mental health within the community that negatively affects their mental health as well as their attitudes toward help-seeking. These women also provided a nuanced understanding of the intersectional challenges many Black women face, including finding culturally responsive practitioners who understand their experiences as part of a collective community and as individuals. The results of this study also suggest that the complexity of the identity of Black women remains present in this younger generation and continues to be influenced by a history of intergenerational trauma, discrimination, and mental health disparities.

In this study, the “Strong Black Woman” persona emerged as a barrier to help-seeking. Others have found that while the SBW persona can be a source of liberation and empowerment, it has become a central component of their gender and racial identity.^8,16,37 The embodiment of the SBW persona is seen as crucial for the survival of many Black women in a society where they must navigate the dual burdens of systemic racism and mental health issues. Findings from this study, however, are consistent with previous research that has suggested some Black women do internalize the SBW persona, which can significantly impact their mental well-being.^16,18,78 The relentless need for self-monitoring and the expectation to shift their identity can prohibit many Black women from being their authentic selves, which can lead to significant psychological distress.^17,48 Practitioners must help Black women to prioritize their mental well-being and self-care, creating safe spaces for them to express themselves and deal with internal distortions related to the SBW persona that may be at play without fear of judgment.

The stigma surrounding mental health in the Black community left the women in this study feeling unsupported and misunderstood. This stigma can prevent Black individuals from seeking necessary mental health services.⁷⁹ Consistent with prior research,^80
–82 findings in this study supported the perceived stigmatization around mental health disclosure within the Black community. Although stigma is pervasive in the Black community, the women in this study indicated that they have attempted to talk about their mental health challenges with their families; however, the results were not positive. This result highlights the need for a transformative approach to mental health literacy within the Black community. Individuals must understand that mental health is integral to an individual’s well-being and that knowing risk factors and symptoms is vital.

Although intergenerational trauma was not the focus of our study, we observed that over half of the sample (n = 8) had lived experiences of being raised by a parent suffering from mental health challenges. This is worth noting as it is considered an anomaly of the sample. Intergenerational trauma has severely impacted the mental health of many Black women, influencing their experiences, behaviors, and emotional responses, resulting in their marginalization in the mental health system. Intergenerational trauma is pervasive in the Black community.^83
–85 This finding underscores how childhood may be negatively impacted by poor parental mental health, leaving a range of complex emotions and uncertainty in various situations. These findings also highlight the need to promote mental health literacy in the Black community. Many practitioners find it challenging to address and provide direct intervention regarding intergenerational trauma.⁸⁶ It is important that practitioners working with parents help them to develop the necessary skills to support and actively participate in their children’s mental health journey to promote ongoing generational healing.

The findings of this study are consistent with previous studies showing Black client’s preference for a practitioner of African descent.^87
–90 Black women’s complex experiences navigating intra- and inter-cultural spaces significantly affect their mental health journey, including their ability to trust support, disclose, and seek professional help.^87,89 This study highlighted the participants’ feelings about having a Black female therapist. Many of the women indicated that being comfortable disclosing to someone who shared an intersectional experience could provide support and validation. Furthermore, the findings shed light on the challenges and barriers that some women face in accessing mental healthcare, particularly in finding a Black female therapist. The lack of representation of Black therapists, in general, as well as the insurance barriers to access, is a significant and structural problem⁹¹ that prohibits Black women from seeking mental healthcare.

Lastly, as anticipated, navigating a global pandemic as part of their mental health journey was an added layer to the participants’ challenges. Participants who relied on family support while taking care of their mental health had to deal with additional feelings of isolation, which recent research on COVID-19 has shown to exacerbate mental health issues.⁹² However, the fact that one study participant found the consequence of social distancing that followed COVID-19 as a protective factor and positive influence on her mental health due to the lack of proximity to a space that felt unsafe warrants further research. Specifically, as in the case of this participant, it begs the question of what actions universities need to support community members, particularly Black women, as it relates to the historical and oppressive history in its structure and aesthetics.

Limitations

There are limitations to this study that are worth noting. First, as a qualitative study, the results are not generalizable beyond the sample. Similarly, given that the participants were recruited through two research sites in Eastern and Western states, the results may not be transferable to other young Black women who struggle with mental health issues and live in different areas in the United States as well as women over the age of 30. Additionally, many of the women in our study had achieved a high level of education, including bachelor’s, master’s, and doctoral degrees. Therefore, their education levels may have influenced the results. The second limitation is that the interviews were conducted via Zoom because of COVID-19. Although Zoom was a strength in gaining participants from other regions, the limitation of virtual interviews was that it was difficult to recognize non-verbal cues, especially if participants asked for their cameras to be off after reading the IRB protocol. Also, conducting multiple interviews would have been beneficial in capturing a more nuanced understanding of the intersectional experiences of young Black women’s mental health. Finally, the study is retrospective and self-reported, as it relied on the recollection of the participants talking about their journey. However, despite these limitations, the Black women in this study were in a unique social location to give in-depth details about their mental health journey and the difficulties in seeking help when faced with dual oppressions.

Implications for mental health interventions and practice

The findings of this study highlight the need for practitioners to understand the intersectionality of young Black women through a Black feminist lens. Practitioners should be equipped to assess the complex dimensions of Black women’s intersecting identities to develop culturally specific treatment plans that consider identity shifting and centrality. We urge practitioners to use a radical healing framework when working with young Black women as a means of resistance and liberation.

Radical healing has five anchors: (1) collectivism, (2) critical consciousness, (3) radical hope, (4) strength and resistance, and (5) cultural authenticity and self-knowledge.⁹³ These five components of radical healing also acknowledge the necessity of moving away from individual deficit-based perspectives to critically interrogating systems of structural oppression that impede the healing process. Practitioners working with young Black women can use different modalities of healing (i.e., journaling, painting, and writing poetry)⁹⁴ that focus on resisting oppression⁹⁵ while integrating social justice as a part of the healing process.⁹⁶ These modalities can be seen as a form of building critical consciousness, or “an individual’s capacity to reflect and act upon their sociopolitical environment critically.”⁹⁷ Working toward the healing process for Black women with psychological distress is not something a practitioner should believe they can achieve alone. Practitioners also have a duty to connect clients with communities and collectives that help nourish the radical healing process and promote radical hope. This duty can be especially salient when the sociopolitical climate threatens to exacerbate mental health distress and stigma.

Conclusion

Young Black women who engage in mental well-being have embarked on a journey of self-discovery, healing, growth, and empowerment. By seeking professional help, these young Black women are challenging the negative narratives discouraging help-seeking and dismantling the stigma surrounding mental health within the Black community. However, this is not without challenges that can be counterproductive to healing, particularly in a field with a history of unethical racial experiments and present-day racial biases and practices. Practitioners who offer a culturally responsive and client-tailored therapeutic approach have the potential to provide a safe space for young Black women to explore their emotions, experiences, and concerns without judgment. Similarly, using unorthodox and radical approaches can provide a safe healing process in the face of marginalization and adversity.

Supplemental Material

sj-docx-1-whe-10.1177_17455057241297106 – Supplemental material for “The System isn’t Set up for Us”: Stories of young Black women’s mental health journey

Supplemental material, sj-docx-1-whe-10.1177_17455057241297106 for “The System isn’t Set up for Us”: Stories of young Black women’s mental health journey by Akeem Modeste-James, T’Shana McClain and Michele Hanna in Women’s Health

Footnotes

Acknowledgements

The authors would like to thank all the women who came forward to discuss their mental health journey.

Declaration

ORCID iD

Akeem Modeste-James

Supplemental material

Supplemental material for this article is available online.

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