Why Black People Don’t Trust Psychiatrists: What the Research Confirms and What I See in My Practice

I am Nicky Cameron, a trauma-focused therapist of Caribbean descent and the founder of Emergent Counseling and Consulting, a group practice based in Oakland Park, Florida. Our entire team is Black. Every therapist on staff is trained in trauma-focused, mind-body therapies. I see the weight of this issue in my work every single week, serving clients across Fort Lauderdale, Sunrise, Pompano Beach, Deerfield Beach, Miramar, Coral Springs, Hollywood, and Oakland Park.

This post is for every Black person who has sat in a psychiatrist’s waiting room and felt unseen. And it is for every provider who claims to want to do better.

The Numbers First: How Wide Is the Gap?

According to the U.S. Department of Health and Human Services Office of Minority Health, in 2024, Black adults were 36% less likely than the overall U.S. population to have received mental health treatment in the past year. (Source: HHS Office of Minority Health)

The National Alliance on Mental Illness reports that only one in three Black adults with a mental illness receives treatment. (Source: NAMI)

A 2021 National Survey on Drug Use and Health found that of Black and African Americans who had a mental health concern, only 39% received services, compared with 52% of non-Hispanic white Americans. (Source: University of Michigan School of Public Health)

These are numbers about a system that has not earned trust.

A History That Explains the Distrust

To understand why Black patients hesitate to walk through a psychiatrist’s door, you have to understand what psychiatry has done to Black people over time.

The National Alliance on Mental Illness documents that as early as the 1800s, physicians used psychiatry to pathologize Blackness itself. Samuel Cartwright, a physician, invented diagnoses in 1851 to classify enslaved people who ran away as mentally ill. That is not ancient fringe history. It is the documented foundation of American psychiatric thought. (Source: NAMI History of Racism in Mental Health Care)

The American Counseling Association further documents that Benjamin Rush, widely called the father of American psychiatry, described Blackness itself as a medical disorder. (Source: American Counseling Association)

NAMI also documents that in the 1970s, psychiatrists added the word aggressive to the definition of schizophrenia and marketed pharmaceuticals specifically at Black patients. The long-term result: Black men continue to receive disproportionate schizophrenia diagnoses, with no scientific justification for the disparity.

The Tuskegee syphilis experiment, which ran from 1932 to 1972, used 600 Black men as research subjects without informed consent. That wound is still alive in the cultural memory of Black families today. It is one of many reasons Black Americans hold legitimate mistrust of medical institutions.

What the Research Says About Today’s Practice

The history is real, and the problem did not stay in the past. Research published in peer-reviewed journals shows the disparities continue in current clinical practice.

Misdiagnosis and Diagnostic Bias

NAMI documents that Black individuals are more likely to receive a misdiagnosis of schizophrenia when they present with symptoms of a mood disorder. A 2021 study published in Frontiers in Psychiatry confirmed that implicit bias prevents Black patients from receiving proper treatment, and a lack of empathy from predominantly white mental health professionals compounds the problem.

A 2021 study in JAMA Network Open found that Black children are more likely to be diagnosed with conduct disorders than ADHD, even when ADHD symptoms are present. A 2024 study in Scientific Reports, analyzing 849,281 ADHD patients, found that non-Hispanic white individuals were approximately 26% more likely to receive an ADHD diagnosis than Black individuals. (Source: Scientific Reports, Nature)

Medication Disparities

A 2022 Harvard Medical School study published in Psychiatric Services found that Black children with ADHD were significantly less likely than white children to access ADHD medication, and had lower overall mental health treatment expenditures. (Source: PubMed/NIH)

Research from the American Psychiatric Association documents that Black patients are also less likely to be offered either evidence-based medication therapy or psychotherapy compared to white patients with the same conditions. (Source: APA Mental Health Facts for African Americans)

Communication Failures

A study cited by McLean Hospital found that physicians working with Black patients were 33% less likely to engage in patient-centered communication compared to their interactions with white patients. (Source: McLean Hospital). Patient-centered communication includes explaining diagnoses, discussing medication options, and inviting the patient into the decision-making process. When that is absent, it is not a minor inconvenience. It causes harm.

What I See as a Trauma Therapist Who Advocates for Black Clients

I want to speak plainly here because statistics only tell part of the story.

I have worked with Black professionals, adults with ADHD who were clearly struggling at work, who went to see a psychiatrist and were denied the medication that evidence supports. They were told no without a clinical conversation about what had already been tried, what had not worked, and what the client’s own experience was. They were treated as suspects instead of patients.

When I have referred other clients, without that additional layer of bias at play, to those same providers, they received the same medication without hesitation.

I have seen a postpartum Black woman struggle to complete intake paperwork because her distress was that significant. The office refused to accommodate her. When I called to advocate for her, the response was not compassion. It was bureaucracy dressed up as policy. I never referred to that office again.

What appalls me is not that every psychiatrist is malicious, many are not. What appalls me is the casual, uncritical way that assumptions are applied to Black bodies and Black minds. The assumption that a Black adult requesting a stimulant medication is drug-seeking rather than struggling. The assumption that a Black woman in crisis is difficult rather than overwhelmed. The assumption that a Black man who presents with emotional intensity has a psychotic disorder rather than unprocessed trauma.

These assumptions have clinical consequences. They push people out of care and into self-medication, into crisis, into a system that treats mental illness with incarceration instead of treatment.

Why Stigma and Distrust Reinforce Each Other

It would be incomplete to discuss this topic without naming the internal barriers that exist alongside the systemic ones.

The USC Suzanne Dworak-Peck School of Social Work documents that in many Black communities, seeking mental health care is still perceived as a weakness, a product of the survivalist mentality that was culturally necessary under centuries of oppression. Prayer and faith are often prioritized over clinical treatment, and while spiritual community is genuinely valuable, it should not replace care when daily functioning is significantly impaired. (Source: USC Social Work)

The fear of criminalization also plays a documented role. When Black people have seen that mental health symptoms are more likely to result in incarceration than in treatment, it creates a rational calculation against disclosure.

The stigma and the systemic failures are not separate problems. The stigma is, in significant part, a rational adaptation to a system that has repeatedly demonstrated it cannot be trusted. You cannot fully address one without addressing the other.

What Would Actually Help: Practical Paths Forward

Healing is possible. Access to genuinely good psychiatric care is possible. But it requires knowing what to look for and what to demand.

When Seeking Psychiatric Support, Look For:

• Providers who ask about your history and context before prescribing
• Providers willing to explain diagnoses, medication mechanisms, potential side effects, and alternative options
• Providers who engage in collaborative decision-making rather than unilateral prescription
• Black and culturally informed providers when available. Resources such as Therapy for Black Girls and Inclusive Therapists can help
• Pharmacogenomic testing, also called genetic medication testing, which can identify which medications are likely to be effective for your specific biology before you spend months trying medications that do not work

What You Are Entitled to in a Psychiatric Appointment:

• A full clinical history intake that includes your lived experience, not just your symptoms
• A clear explanation of any diagnosis and the basis for that diagnosis
• Transparency about what a medication does, what it does not do, and what the risks are
• The right to ask questions and receive answers that are not dismissive
• The right to bring an advocate, such as your therapist, to appointments when needed

What Therapists Can Do:

Therapists who work with Black clients have a responsibility to actively advocate when psychiatric care is failing their clients. That includes being willing to call, write letters, and accompany clients through those systems. At Emergent Counseling and Consulting, advocacy is not optional and is part of the work.

A Direct Word to the Psychiatrists Reading This

If you are a psychiatrist who has made broad assumptions about a Black patient’s motivations for requesting a specific medication, I am asking you to examine that. If you have never questioned whether your communication style shifts when your patient is Black, I am asking you to question it now.

There are genuinely excellent psychiatrists working with cultural humility, acknowledging systemic context, and collaborating meaningfully with their Black patients. I have seen it, I commend it. I refer to those providers.

But there are also providers whose behavior I have witnessed directly, who compound their patients’ distress rather than relieve it. That is not a small failing, it is a clinical and ethical problem that has real consequences in people’s lives.

You have the power to change the interaction. The question is whether you choose to.

The Takeaway

If you are a Black person in South Florida who has been dismissed, misdiagnosed, or avoided psychiatric care because the system has not felt safe: your perception is accurate, your distrust is earned, and you deserve better.

If you are ready to work with a team that understands you without needing an explanation, we are here.

Emergent Counseling and Consulting is a Black-led, trauma-focused group practice serving clients in Fort Lauderdale, Sunrise, Pompano Beach, Deerfield Beach, Miramar, Coral Springs, Hollywood, and Oakland Park.

Contact us at 954-533-4828 or visit dare2emerge.com to schedule a consultation.

Resources

Therapy for Black Girls (therapist directory)

NAMI: National Alliance on Mental Illness helpline: 1-800-950-NAMI (6264)

Crisis Text Line: Text HOME to 741741

Inclusive Therapists (culturally affirming provider directory)

HHS Office of Minority Health: Black Mental Health Data Dysfunctional Families (ACA)