If you live in Baltimore, nearly one out of every three people around you is affected by a mental health condition. They probably haven’t sought out the support they need, and it isn’t just because that care costs money.
Struggle is built into the fabric of Baltimore’s story. Ours is a city where violence and lack of opportunity feed off one another to produce poor mental health. It’s true that we boast world-class hospitals and clinicians, top-tier researchers and passionate, civic-minded residents. As such, we have the human capital to respond to our mental health crisis. But we seldom consider whether mental health resources are culturally competent enough.
Cultural competence is when providers deliver care that meets people where they are socially, culturally and situationally. Achieving culturally competent care is an enduring and lifelong process, according to Baltimore therapist Candra Jackson, the founder of counseling practice Assembly|706. It is a “lifestyle of self-examination” that shifts worldviews, honors lived experiences and amplifies cultural humility, she says.
Culturally competent care has strong positive associations with better clinical outcomes, studies show. When people trust their providers and feel seen by them, they’re more likely to keep appointments, follow treatment plans, and stick with things when the going gets tough.
When it comes to seeking therapy, this process starts well before someone begins their first session. Wherever a person starts, the path to healing runs through a number of obstacles. The cost of care is one, with close to a third of therapists not accepting insurance at all. I started The Mental Health Emergency Fund Inc. to help address this barrier for Baltimoreans who are ready to access mental health care but have limited income and savings.
Providing stipends is only part of what we do, however. We are actively building a network of partner therapists, focusing on clinicians who are Black men and those specializing in the care of young Black men in Baltimore. As much as possible, people need to see themselves reflected in those that are supporting them on their healing journeys. This minimizes the time a therapist has to spend breaking down walls of misunderstanding and apprehension, which people have built over generations to protect themselves from harm.
Indeed, many Baltimoreans continue to associate clinical providers and institutions with racism and wrongdoing. These beliefs are passed down generationally, and easily morph into a broad distrust of clinical care. Instead, people go where they know, reaching out to family, friends and religious institutions for counsel and advice, even if pastoral teams are not necessarily trained to support people with mental health conditions.
The consequences of a lack of culturally competent care are stark. When people do not seek out the care they need, the pressure builds until it explodes, either as violence or in the form of stress-related illnesses such as high blood pressure, heart attack or stroke.
Finite resources mean there is still more to do to create a stronger pipeline of Black and Brown therapists, lower the cost of care and increase its accessibility. Meeting people where they are is a promising solution.
A crucial part of my work has been seeding the Mindful Ministries Collective, a fellowship project launched in partnership with the former Open Society Institute in Baltimore that bridges the gap between faith-based institutions and mental health organizations. The thinking is this: Churchgoers in need of mental health support will go to their pastors because those leaders position themselves as both a spiritual and emotional safe haven for them.
The mental health crisis in Baltimore will only meaningfully improve when people feel the same way about providers who can give culturally competent care. Badia Khalid-Manning, the owner of Larada Counseling Services in Baltimore, observed recently that it is crucial for people to be able to access mental health care that actively addresses the oppressive systems affecting their lives. Clinicians that have personal experiences navigating those systems, she said, are uniquely equipped to provide invaluable support.
“This form of care goes beyond professional expertise,” Khalid-Manning added. “It’s offering genuine understanding and guidance in navigating and challenging systemic oppression.” In other words, healing does not just happen when people learn to navigate the systems that hold them back. It happens when they are able to actively change those systems.
Jessica Smith is a writer, mental health advocate and social entrepreneur based in Baltimore. She founded The Mental Health Emergency Fund Inc., a nonprofit organization that reduces financial barriers for community members struggling with their mental health who cannot afford treatment.