Nearly a decade ago, Sonja Flippen found herself slipping away.

“I was just out of it, as far as having any kind of energy or wanting to do anything,” she recalled. “I had awful thoughts. I felt like I wasn’t needed or wanted, to the point where I just wasn’t myself.”

Flippen, who is African-American, didn’t know where to turn to find help for her mental illness. She said her family didn’t believe she needed help at all.

“They thought ... I could get better on my own, that I can stop feeling this way on my own, but no, that wasn’t the case,” she said.

The idea that self-reliance can overcome anything—including mental illness—runs deep in black culture, said psychologist Patricia Harrison-Monroe. And it keeps many African-Americans from seeking help.

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UAMC behavioral health chief Patricia Harrison-Monroe (left) conducts a cultural competency training with a student.

“There is considerable stigma in the African-American community about the need to seek mental health services,” said Harrison-Monroe, who serves as chief of behavioral health services for the University of Arizona Medical Center. “People have gone through a lot of hard times, and so needing to reach out to a stranger to talk about some problems is just not something that many African-Americans feel comfortable doing or justified. I don’t think they see mental illness as a disease that requires treatment; it’s something that’s better dealt with within the family or community.”

Statistics confirm that the black community is less likely to receive care from a mental health professional.

The U.S. Office of Minority Health reports that African Americans are 20 percent more likely to report having serious psychological distress than non-Hispanic whites. Yet Black adults and youth are significantly less likely than whites to receive treatment, according to the National Healthcare Disparities Report.

Harrison-Monroe said these differences reflect a deep reluctance to seek care and a distrust of care providers. It also reflects a lack of access to care, said psychologist Fred Wiggins.

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Psychologist Fred Wiggins says access to care is a major barrier for African-Americans seeking mental health treatment.

“The number of people who have insurance coverage that would allow them to afford to be able to go and receive treatment is disproportionately low in the black community,” Wiggins said. “That’s part of access. And also where services are located—many of the types of services that might be required aren’t in the communities where people live.”

But Wiggins and Harrison-Monroe said that even in the face of these difficulties, attitudes are starting to shift. The mental health field is slowly attracting more and more students of color.

A 2009 National Science Foundation report said 20 percent of new doctorates in psychology were members of a minority group, up from 16.7 percent in 2000. With that increase, both Wiggins and Harrison-Monroe said they’re seeing more black patients who are willing to try treatment.

Harrison-Monroe said the shift is also due to a bigger trend toward less stigma and more awareness around mental illness. Outreach efforts geared to the black community, and in particular black churches, have helped as well, she said.

Openness about mental health issues is nothing new for Tucson’s Trinity Missionary Baptist Church.

Pastor Elwood McDowell is trained as a psychologist, and now works to meld therapy and worship in his congregation.

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Pastor Elwood McDowell encourages openness and acceptance of mental health issues in his congregation at Tucson's Trinity Missionary Baptist Church.

“It’s almost impossible in my view to separate spiritual growth from psychological growth,” McDowell said. “I think they’re so intertwined.”

McDowell encourages the members of his congregation to be open about their struggles.

It was here that Flippen finally found the help she needed. McDowell helped her start counseling, and that led to her diagnosis and treatment. Now, Flippen is a mental health advocate who leads presentations for the National Alliance on Mental Illness In Our Own Voice program. She said she has a very different and much more joyful life.

“I did not know that there was so much help,” she said. “That I had somewhere I could take my problems with somebody who understood and knew what I needed to do in order to be better.”

Flippen’s experience has in turn changed how her family sees mental health care, she said.

“That was a major turning point,” she said, “when everyone understood that there is something going on, and it has to be treated. That I have to take care of myself.”