By Al Jones, MLive

The last thing you want to do in therapy is code-switch.

That can happen when people of color feel they have to change or adapt their language or cultural customs to fit in with someone else, or to belong to a different group, or to make someone else feel comfortable.

Speaking of a trip to the doctor’s office, psychotherapist Elishae Johnson said, “We walk in often times with an anxiety about the experience, not knowing what to expect. Am I going to have to code-switch? What do I have to think about here? Can I use my own words? Can I talk about my racialized experience in the room if I’m with a provider who doesn’t share that same cultural identity?”

That should not be necessary in a doctor’s office – for psychological or physical issues, said Johnson, system director of Business Health Services at Bronson HealthCare and director of Bronson HelpNet. 

“The last thing you want to do in therapy is to think, ‘How do I translate my experiences? Or my language?’” she said.

But people of color often find themselves using a different tone or dialect. As they head to health practitioners for help. they use words they never use at home. So Johnson and others say they often struggle to get the help they need. And that’s assuming they know where to turn for help and trust the person asking intimate health questions.

Johnson is among a group of local African-American therapists, physicians, nurses and other health-care professionals who have high hopes for the recently formed Kalamazoo BlackWellness Network, a directory of Black and Brown providers in Kalamazoo County and beyond.

“The goal of it is to bridge the gap by creating greater access for people of color,”  said BlackWellness Network Founder Valarie Cunningham, referring to the gap she has discerned between the level of ongoing care provided to African-Americans vs. the experience of White patients.

“There are three components to BlackWellness Network,” said Cunningham, who is also chief executive officer and founder of The Synergy Health Center in Kalamazoo. Those components are: Bridging the gap in the level of care provided to African-American; breaking the negative stigma that has traditionally been attached to seeking mental health services, and building stronger Black and Brown communities.

The directory of practitioners – which is expected to be launched on Oct. 31 – is to be available online as BlackWellnessNetwork.org. It will be updated regularly, and function in a way similar to the directory offered by Psychology Today, according to Cunningham.

“Most times we don’t know where to look for people who look like us in the health-care field — be it mental health, or (general) health care with doctors,” Cunningham said. “So the purpose of BlackWellness Network is to create a pool of wellness providers so that the community can easily find us.”

Johnson, who will be among the professionals included, agrees. “It is so, so important for people of color – Black people in particular – to be able to find practitioners that can connect to their lived experiences,” she said.

Dr. Carolyn Whatley, chief medical officer at Family Health Center of Kalamazoo, said during her 20-year career she has had patients who have never had a Black female doctor. As a person of color, she said, “You can use those similarities to connect.”

“I think, as a provider, you try to connect to your patients and relate to them in any way that’s relatable,” Whatley said. “That’s not the only thing you can do. But as we do a lot of work on biases that you may have, these are all places where you can collaborate, understand and help to eradicate some of those biases.”

She said the network and the collaboration among the participating practitioners is an excellent opportunity to try to increase access to care and promote more understanding.

Understanding the problem

The BlackWellness Network is a result of a year-long research project by Cunningham, supported by a grant from the Michigan Health Endowment Fund. 

The study, Racial Disparities in Behavioral Health Follow-up Care, was conducted in 2021-22 and concentrated on care received from 2018 to 2020 by 330 people.

Cunningham and colleagues at Synergy Health Center focused on follow-up care that patients received after they had emergency department visits for mental health and/or substance abuse services. While the quality of care itself was not in question, they found a gap in the follow-up care received by African-Americans vs. that of Whites.

According to their findings, there was less than a 1% gap between the rate of follow-up care provided after emergency department visits related to mental illness needs. But Cunningham said, “Both African-American and White patients felt that stigma played a significant role in receiving or engaging in mental health services.”

In regard to alcohol/substance abuse emergencies, the study reported a 22-point percentage gap between the rate of follow-up care provided to African-Americans versus Whites. Thirty days after patients’ initial visit, 34% of Whites continued in follow-up care for substance abuse, compared to 12% of African-Americans.

In regard to breaking the stigma associated with seeking mental health treatment, Cunningham said 90% of survey respondents said they believe that negative stigma is a barrier to obtaining mental-health services.

“Sometimes it’s (considered) shameful to feel like you need help because as a people we’ve been taught that we’re strong people and that we can overcome anything,” Cunningham said. “And to admit that I need help is admitting your vulnerability, and it’s admitting that maybe I’m not as strong as I thought I was. And now that’s considered a weakness.”

Cunningham said her organization is working to combat that thinking through community events with Black churches and Black community organizations. It has partnered with five predominantly African-American churches in Kalamazoo and the Urban Alliance to do “Breaking the Stigma” events that show people where they can find help. They include speakers to talk about such things as depression, addressing mental health issues, and identifying issues with children. 

Cunningham has received secondary funding to develop and implement resolutions for the disparity in rates of care.

“That started this year,” she said. “So 2023 and 2024 is implementation for what I think is a resolution to the disparity.”

The BlackWellness Network is one of three strategies she has identified to address the disparity. 

Another is working with public safety to help first-responders understand  how to respond to a Black person in a mental health or substance abuse crisis. Cunningham is working to develop training that helps officers respond better. 

The third component is working with hospitals to help train staff members how to engage Black patients in culturally appropriate ways, and recognize when biases are involved.

Some hurdles to clear

Whatley said the network will have to work to get to a place where people understand it and its benefits.

“It’s a starting place,” she said.

As the network grows, it will hopefully allow patients and practitioners to build relationships and understand one another better. She said she hopes it will allow care providers to treat patients in a non-judgmental setting, and she hopes patients will be able to see value in why they should use network members.

The network will also have to grow and include practitioners from many fields in order to have the holistic wellness focus that Cunningham envisions. While 115 wellness practitioners attended an Aug. 11 organizational gathering, Cunningham did not have solid numbers on how many will be regularly listed as part of the network. 

That special organizational meeting was a recruiting space for professionals from a variety of disciplines including group home care, holistic health/wellness coaching, sound therapy, talk therapy, nutrition, natural pathology, massage therapy, retreat leaders, doulas, and lactation consultants, as well as nurse practitioners and physicians.

Can the Network help in other ways?

When it comes to health services, “Black people ask: Who am I going to see? How much is it going to cost? And what are they going to say?” said a retired Kalamazoo-area family therapist.

“And then they get embarrassed if they’re not going to have the money,” said Sandra Fields-Neal, who retired in 2020 from 29 years in private-practice psychological counseling and social work. “A lot of them will do without (services) rather than put themselves in a position to tell somebody that they’re finances aren’t good.”

So she hopes that the BlackWellness Network grows to try to help address the cost of care and patients’ ability to pay for needed services.  “It’s very difficult for people to come up to someone – especially when they’re a different color – and say, ‘I don’t have any money,’ ‘I can’t afford an MRI,’ or ‘I can’t afford whatever they’re talking about,’ or ‘I can’t even afford an examination in your office,’” Fields-Neal said.

When they don’t pay or don’t pay on time, that is a big concern to service providers particularly those in private practice. If the network can help in such situations, “It would really save a lot of us both mentally and physically,” Fields-Neal said.

Cunningham said she hopes members of the network will use their expertise to collaborate and offer ideas that expound on hers and others. She said the organization will host educational events and workshops to raise awareness of the access it provides, and it will partner with other local organizations to facilitate care. 

Why is all this necessary?

Whatley said practitioners want people to be comfortable in the medical system so they will seek preventative treatments, and stop illnesses before they advance. 

“A lot of times people simply want to find a provider who looks like them, is of the same gender, or has some similar life experiences,” Whatley said. 

Of the BlackWellness Network, she said, “I think it will be a very useful resource.”