What do Aaron Alexis, John Constantino, and Miriam Carey have in common?

For starters, in recent weeks each has been involved in some violent, disastrous event that ended in his or her death and, in one case, the deaths of many others.

Aaron Alexis was the government contract worker believed responsible for killing a dozen people in September during his mass shooting attack at the Washington Navy Yard.

John Constantino was the 64-year-old resident of Mount Laurel, N.J., who died in early October after dousing himself in gasoline and setting himself on fire near the National Gallery. Despite frantic attempts to save him, Constantino died from his self-inflicted injuries.

And Miriam Carey was the Connecticut dental hygienist whose futile attempt to drive her car into a White House barricade ended in her shooting death.

The similarities between the three continue. Alexis, Constantino and Carey, were each believed to have suffered from some form of mental illness. And it doesn’t stop there. They were also African American, meaning that they were a part of a cultural community that all too-often faces healthcare disparities in every arena, which is only compounded by the fact that Black Americans have historically stigmatized mental illness and its impact.

Some experts say the stigma associated with mental illness in the Black community is rooted, at least in part, in how others, chiefly Whites, have perceived and treated African Americans.

“Historically, mental health services were provided by European-Americans, whom African-American’s didn’t trust, and for good reasons. In the old days, African-Americans were considered not intelligent enough to receive mental health treatments. If you had a mental health problem, you were told something was wrong with your mind,” explains David Cramer, a clinical social worker and therapist.

Cramer’s insights are borne out by a U.S. Surgeon General report, “Mental Health: Culture, Race, and Ethnicity,” released in 2000 as a supplement to a 1999 report on mental health. According to that report:

“African Americans occupy a unique niche in the history of America and in contemporary national life. The legacy of slavery and discrimination continues to influence their social and economic standing. The mental health of African Americans can be appreciated only within this wider historical context.

Historical adversity, which included slavery, sharecropping, and race-based exclusion from health, educational, social, and economic resources, translates into the socioeconomic disparities experienced by African Americans today.

Racism is another aspect of the historical legacy of African Americans. Negative stereotypes and rejecting attitudes have decreased, but continue to occur with measurable, adverse consequences for the mental health of African Americans. Historical and contemporary negative treatment have led to mistrust of authorities, many of whom are not seen as having the best interests of African Americans in mind.”

Treatment methodology is considered one of many barriers to mental health care for African-Americans.

“The system the client is operating in is flawed,” says clinical socialist and therapist Ronald E. Fletcher, Sr. “White supremacy and racism is a part of that system. We are in a system (society) that promotes mental illness within the African-American community. Specifically, the sicker you are the more you get paid, whether it’s SSI, Worker’s Comp, VA benefits, etc. And if you are born into a community where schools are lacking resources, there are barrooms on every corner, you witness or experience violence, alcohol and drugs, then mental illness is right around the corner.”

A report by the American Psychiatric Association also echoes such concerns:

“Historically, mental health research has been based on Caucasian and European based populations, and did not incorporate understanding of racial and ethnic groups and their beliefs, traditions and value systems. Culturally competent care is crucial to improving utilization of services and effectiveness of treatment for these communities.”

To be sure, mental health and its treatment have been generally, if silently, eschewed by many African Americans. It has been the “dirty laundry” and the never-mentioned “family secret.” And few would argue that—for whatever reason—the tendency to dismiss, evade, dodge and ignore mental illness is deeply embedded in the African-American culture.

“It’s a reality. Your business is your business; and you don’t tell what goes on at home,” says counselor/therapist Deatrice M. Green, who specializes in treatments for depression, anxiety, relationships and addiction. “Many African-Americans wait until an emergency arises within their family or home, before seeking therapy.”

The therapist does see light at the end of the tunnel, adding that she has seen a growing number of African-Americans seeking mental health in recent years.

“Now more than anything else, it’s changing,” says Green of negative attitudes surrounding mental health treatments.

Cramer, who is a traumatic stress expert, says he has seen a rise in the need for mental health services in the local African-American community particularly post-Katrina. He works with children, adolescents, adults and their families who have been exposed to significant trauma.

“I serve persons experiencing interpersonal violence, sudden death and complicated grief, associated depression, self-medication and anger management issues,” says Cramer. “We have a bunch of problems. There is a trauma epidemic in New Orleans because of Katrina. Post-Katrina trauma is very serious.”

All of this makes what has happened in New Orleans as it relates to mental health treatment and access a difficult pill to swallow. Just as more and more African-Americans express a need for services and are perhaps more willing to be candid and open about their illness despite the cultural stigma, the options for quality, affordable in-patient care in the city of New Orleans have diminished. This reality is highlighted by the 2012 story of Chelsea Thornton, the Gert Town mother charged with killing her two toddlers.

According to reports, family members say the young woman suffers from bipolar disorder and schizophrenia and had not been taking her medication. They believe Thornton could have gotten more help if not for state budget cuts and letdowns in the social system. According to the report, Thornton’s mother said her daughter was committed to mental health hospitals around the region two times—stays that lasted a few weeks before her daughter was released after which she would stop taking her meds. According to the same report, Thornton’s family said she was denied disability assistance because the government decided her mental illness was not severe. Without money or assistance, Thornton’s mother said her medicines, follow-up and rides to the clinic stopped.

Currently, Thornton awaits trial for the murder her two toddlers.

Mental health care and access to it have become hot button issues statewide, particularly in New Orleans and especially in the wake of Katrina. Gov. Piyush “Bobby” Jindal’s closure of mental health care facilities and privatization of care leaves a lot to be desired, especially when it comes to comes to serving the African-American community.

In 2009, the state merged the New Orleans Adolescent Hospital (NOAH) into Southeast Louisiana Hospital (SELH) in Mandeville. NOAH was an acute psychiatric hospital that treated children and adolescents ages 6-17 with severe mental illness.  However, after Hurricane Katrina, adult beds were added to NOAH to cope with the mental health shortage of beds in the New Orleans area. The merger of NOAH into Southeast LA Hospital (SELH) resulted in the transfer of 20 adult beds and 15 youth beds to SELH.

According to DHH, the consolidation resulted in no reduction of services. A statement sent from the DHH to The New Orleans Tribune reads:

“Additionally, with the implementation of the LA Behavioral Health Partnership (LBHP) in 2012, OBH utilizes the Statewide Management Organization (Magellan) to contract with providers in order to maintain a sufficient network.  As a result, there has been an 86% increase in adult psychiatric bed capacity since March of 2012,” according to a statement sent to the Tribune by officials in Louisiana’s Department of Health and Hospitals (DHH).
While there may not have been a numerical reduction in services, many New Orleanians—especially the city’s poorest residents who often rely on health care services provided by the state—are not happy with the state’s decision to move all of the city’s mental health hospital beds to Mandeville.

Do the math: New Orleans’ population of 369,250 (2012) is 60.2 percent Black and 33 percent White. Mandeville’s population of 12,112 (2012) is 90.55 percent White and 4.40 Black. So, who is really benefiting from Governor Jindal’s privatization and budget reduction move?

Add to that the Governor’s decision to not accept the Medicaid expansion under the federal government’s Affordable Care Act (ACA), which will certainly hurt poor patients in need of varied medical treatments, including mental healthcare.