The MENTAL HEALTH CRISIS In BLACK AMERICA

Surgeon general leads a national campaign to raise awareness

LEOLA Williams knows first-hand how difficult it can be for African-American families to seek help in the face of mental illness. It took years for her family to acknowledge that the erratic, self-destructive behavior of one of her brothers was not the result of outside influences. "My mother thought he was either voodooed or drugged," Williams recalls. "She couldn't accept that something else might be wrong with him."

When punishment, pleading and prayer failed to alter her brother's increasingly bizarre and occasionally violent behavior, the family finally sought professional help. That was when they discovered that the troubled 13-year-old suffered from schizophrenia. Now, nearly 20 years later, his condition is stabilized through medication. He has a job and lives independently.

Her family's experience convinced Williams of the need to educate more Black people about the effects and treatment of mental illness. An outreach coordinator for the greater Milwaukee chapter of the National Alliance for the Mentally Ill, Williams is involved in the effort to heighten awareness and eradicate the stigma of mental illness in the Black community. Her job makes her a footsoldier in a growing national movement designed to dislodge mental illness from Black America's closet.

That effort has exposure of late, thanks in part to the release last year of two important reports on mental health and mental illness by U.S. Surgeon General David Satcher. While the focus of both reports was the mental health of the general population, each contained key passages addressing major mental health concerns of specific interest to Black America and other minority communities.

For example, in the first report, a comprehensive document that identified suicide as a major public health threat, the surgeon general toppled the myth that suicide is not an issue of great significance in Black communities. In fact, the report noted that suicide rates for African-Americans 10 to 19 had more than doubled from 2.1 per 100,000 in 1980 to 4.5 per 100,000 in 1995.

In a second, equally expansive report on the nation's mental health released in December, the surgeon general's team of experts noted that 1 in 5 Americans--roughly 50 million people--suffers from some form of mental illness, ranging from dementia to depression. And while the incidence of mental illness in Black communities is no greater than it is in the general population, a tremendous gap exists between the need for mental health services and their availability in minority communities, leaving a greater percentage of Black individuals feeling trapped in the pain and suffering of their conditions.

The effects of untreated mental illness on the Black community are obvious. Many, for example, believe that a large percentage of the homeless people trolling the streets in urban communities are mentally ill individuals who have fallen through the social service cracks. "If you look at where the chronically ill go when they're estranged from friends and family, you find that they go to the cities," says Gregory John, executive director of the greater Milwaukee chapter of the National Alliance for the Mentally Ill. "So there is a correlation between the degree of homelessness we see in many of these communities and the lack of mental health services."

Similarly, the rise in suicide among Black teenagers--the bulk of them urban males--is linked not only to the rise of violence in the culture, but also to a lack of awareness about the nature of depression and the absence of counselors who are culturally sensitive enough to recognize depression in young Black men.

Satcher says that what makes these phenomena so alarming is the fact that their causes, like 80 to 90 percent of all mental disorders, are treatable, meaning the sufferers--including the chronically ill homeless people--can often return to productive lives and relationships with the right course of treatment.

"Among the most important things we hope will come out of our reports," he says, "is that number one, we will provide parity of access for mental illness, we will develop programs that eliminate the stigma. And we will get people who need treatment the treatment as early as possible."

But several barriers stand in the way of efforts to address Black America's mental health needs. First, there is the general suspicion that Black Americans have for the field of psychiatry. It is a suspicion rooted in the "legacy of racism" in the field of medicine in general and in psychiatry in particular, says Dr. Carl Bell, president and CEO of the Community Mental Health Council in Chicago, and a clinical professor of psychiatry at the University of Illinois School of Medicine.

That racism has taken the form of research projects--most infamously the Tuskegee syphilis study--in which African-Americans were unwitting and unwilling subjects of medical experiments. Compound those incidents with the racist utterings and writings of many of psychiatry's towering figures, including Carl Jung, and you have, Bell says, a sense of distrust that you can't chalk up to mere paranoia.