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William Glanz

Senior Writer at the National Council for Behavioral Health

In New Orleans, Overcoming Stigma through Relationships

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The black community’s suspicion over behavioral health care treatment is well known.

The need for treatment also is well known.

An estimated 4.8 million African Americans over the age of 18 – about 16.2% of the black population in the U.S. – had a mental illness in 2018, according to a report by the Substance Abuse and Mental Health Services Administration (SAMHSA). Among that group, nearly 70% hadn’t received treatment, according to SAMHSA.

In 2020, those numbers likely are worse due to a series of factors, including the COVID-19 pandemic, historic unemployment and widespread unrest as a result of the killing of George Floyd and black Americans that spawned months of protests.

“There’s always been a cultural issue with people of color,” said Dr. Rochelle Head-Dunham, M.D., executive and medical director for Metropolitan Human Services District in New Orleans. “They don’t go to see therapists. They don’t talk about mental illness. It’s just not what they do.”

In New Orleans, where nearly 60% of the city’s residents are black, behavioral health care professionals have found ways to increase the number of residents receiving care by erasing the stigma surrounding behavioral health.

The Metropolitan Human Services District (MHSD) relies on two programs that reach deep into black communities to help residents achieve recovery by leveraging established relationships to connect with residents and give therapists greater legitimacy.

Chance Encounter

In 2018, Brittany Howard walked into a barbershop in New Orleans to meet her boyfriend. When she arrived, her boyfriend’s barber was discussing another client struggling with a substance use disorder.

After her boyfriend introduced his barber to Howard, she encouraged the barber to tell his client about services available through MHSD.

Eventually Howard, director of advocacy at MHSD, was able to connect with the individual, thanks to the barber’s willingness to intervene. MHSD got the client treatment and housing.

The success of that chance encounter led Howard to begin thinking about a program to enlist barbers and stylists – people who have a prominent role in black communities – to spread the word about behavioral health care treatment and services.

In 2019, MHSD applied for, and received, a grant to help fund the new program, and the agency just completed the first year of its Barber and Beauty Shop Initiative.

“To this day, I can’t believe we got the grant,” Howard said. “It’s so non-traditional.”

But it has succeeded, Howard said, because of the trust people have in their barbers and stylists. MHSD has enlisted 264 barber shops and salons in the effort, and its staff has served 574 people through the program.

MHSD provides each business enrolled in the program with material on treatment and services they can share with their clients. Barbers and stylists also reach out to MHSD’s peer specialists when they hear of a client in need.

Leap of Faith

People also pour their hearts out to their ministers, so in 2017, MHSD launched its Faith Partners Initiative to give clergy throughout New Orleans the resources to identify parishioners in crisis. Clergy can address an individual’s crisis or reach out to the agency.

Today, an estimated 40 churches are involved.

Like the Barber and Beauty Shop Initiative, the Faith Partners Initiative works because MHSD has enlisted trusted members of the community to effectively endorse behavioral health care as a safe, viable, necessary alternative to people in a mental health or substance use crisis.

“We are beginning to see black people in New Orleans understand that behavioral health is not a bad thing. The program has reduced the stigma surrounding treatment and service,” said Kelli Bertrand, program manager at MHSD.

Clergy have helped behavioral health care professionals overcome a big hurdle by convincing people not to rely solely on their faith to address a clinical issue.

“If someone has cancer, they go to the doctor. It has to be the same with mental health,” Bertrand said. “One’s faith is incredibly important, and we won’t get in the way of that. But it’s important that people understand there are resources to help them. Faith and medication can work together.”

Third Initiative in the Works

With New Orleans focused on rebuilding its economy, MHSD is sharpening its focus on a new outreach effort that will support workers in the city’s vibrant tourism and entertainment sector.

“Most people in the hospitality industry have no behavioral health care coverage at all,” Dr. Head-Dunham said. “They suffer silently, with mental illness, as well as with substance use as a coping factor. They are the heartbeat of the city. We have to take care of them.”

MHSD developed a public relations effort to reach the hospitality industry workers in New Orleans, which allows Medicaid to cover behavioral health care – then COVID-19 struck. New Orleans became one of the nation’s hardest hit metropolitan areas early in the pandemic.

The city’s hospitality industry has not fully rebounded, so the initiative stalled. But the program represents one of the next efforts MHSD will take to reach an underserved population.

An Agency that Looks Like the Community it Serves

The Barber and Beauty Shop Initiative and the Faith Partners Initiative have succeeded in connecting people with services and reducing stigma for two primary reasons.

One reason is MHSD is able to introduce its programs to people in friendly environments with support from people who are trusted in the community. Another reason is that MHSD reflects the community it serves.

“It’s hard enough to get black people to talk to a therapist. If that therapist doesn’t look like them, it’s even harder,” Dr. Head-Dunham said.