Mental Health Disparities in

African Americans:
Innovations for Addressing
the Challenge

Dr. Alfiee M. Breland-Noble

Associate Professor
Georgetown University Medical
Center
Department of Psychiatry

The AAKOMA Project

Advisory Board
Raleigh/Durham, NC &
Washington, DC area

Presentation
Citation
Breland-Noble, A.M. & The AAKOMA Project
Advisory Board (September 19, 2016). Mental

Health Disparities in African Americans:

Innovations for Addressing the Challenge .
Invited talk for the National Press Foundation,
Washington, DC

Presentation
Agenda
Introduction/Overview
Disparities in African American Mental Health
Innovation in Studying and Addressing the Needs:

The AAKOMA Project

Future Directions
Summary
Q & A

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Background &
Philosophy
Logo: 2006 - 2013

EMBRACE

ENCOURAGE

ENLIGHTEN
Current Logo

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TM

2007 A. M. Breland-Noble

Historically
African American access to care barriers:
Historical
Provider
Individual

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Mental Illness
Data
Major Mental Illnesses in U.S.

Depression
Anxiety

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Mental Illness
Data
Mental Illnesses in U.S.

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Mental Illness
Data
Depression in U.S.

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Mental Illness
Data - Teens
Mental Illnesses in U.S.

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Mental Illness Data Teens

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Mental Health
Service Use
Racially and ethnically diverse youth consistently demonstrate the greatest unmet
need in the area of mental health treatment received (Alegria, Vallas, & Pumariega,
2010; Caldwell, Assari, & Breland-Noble, 2016).
African American youth
Receive significantly less mental health specialty care (i.e., from a
psychologist or psychiatrist).
Demonstrate lower rates of treatment completion (33.5 % of African
American youth vs. 45.1 % of white youth)
and in some instances, spend 50 % less time in treatment as compared to
white youth (Alegria, Carson, Goncalves, & Keefe, 2011; Angold et al., 2002 ;
Garland et al., 2005)
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Mental Health
Service Use

African American youth are less likely to receive disorder specific treatment
than white youth even though differences in prevalence rates of depression
are non-statistically significant (i.e. relatively equal).

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Background: How does the

Literature Support this
novel idea?
Margerita Alegria and other scholars indicate the need for more data from:
Mental Health Disparities in Treatment Access
Mental Health Disparities in Treatment Outcomes
In 2010, Huey and Polo indicated that there are no well- established evidencebased treatments for African American youth.
Overall..
Experts agree that more research within diverse communities is needed because
even with all other things being equal, African Americans are significantly under
represented in mental health treatment.

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How do we get there?

Addressing the
Challenges
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Sample
Rationale
Depression
Has detrimental effects
Exists among African American Youth

African American youth are

underrepresented in current research about

youth depression

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Study Aims & Objectives

The development and testing of:
An Evidence-Based (Motivational Interviewing)
Culturally Relevant
Behavioral Intervention
To improve treatment engagement by:
African American youth with depressive disorders
and their families
2 Phase Project
Gathering background data for the development of
the intervention
Qualitative via Focus Groups and Individual Interviews

Pilot RCT of Intervention

Traditional vs. Community-Engaged

Research Approach

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THIS IS HOW WE DO IT

Lean on Me
The community
liaison, Mrs. H. Kathy
Poole, leads the
womens fellowship
group of New Shiloh
Holiness Church in an
upbeat rendition of
Lean on Me.

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Community
Liaison
Mrs. H. Kathy Poole serves as the lead community liaison for
The AAKOM A Project. She is an active community leader
through her service as Director for the Durham County,
North Carolina Yellow Ribbon Program, a suicide prevention
program. Mrs. Poole started the affiliate chapter of Yellow
Ribbon Program in 1996 in memoriam of her son, Torian L.
Graves.
She also conducts workshops on Identifying
Depression/Suicide Prevention for conferences, schools,
churches, youth groups, and various organizations. Her
seminars on Breaking the Silence focus on recognizing and
identifying the symptoms of depression in teens and on
preventing suicide.

Mrs. Poole is a recently retired school counselor of the

Durham Public Schools in Durham, North Carolina.

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What did we Learn?

www.aakomaproject.org

The primary goal of our

adolescent research was
to learn more about what
African Americans think
about depression,
participation in research,
and obtaining depression
treatment from mental
health professionals.

Breland-Noble, A.M., Burriss, A., Bell, C.C. & The AAKOMA Project
Adult Advisory Board (2011). Mama just wont accept this: Adult
Perspectives on Engaging Depressed African American Teens in
Clinical Research and Treatment. Journal of Clinical Psychology
in Medical Settings.

Breland-Noble, A. M., Burriss, A., & Poole, H. K. (2010). Engaging

depressed African American adolescents in treatment: Lessons
from The AAKOMA Project. Journal of Clinical Psychology, 66(8),
868-879.

Breland-Noble, A.M. & Weller, B. (2012). Examining African

American Adolescent Depression in a Community Sample: The
Impact of Parent/Child Agreement. Journal of Child and Family
Studies. 21(5), 869-876. doi: 10.1007/s10826-011-9547-z

Breland-Noble, A.M. (2012). Community And Treatment

Engagement For Depressed African American Youth: The
AAKOMA FLOA pilot. Journal of Clinical Psychology in Medical
Settings. 19, (1), 41-48.

Demographic
s

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Derived Themes
Adult Participants
Mental Health Help

Logistics
Stigma
Importance of the
Church
Role of the Family
Trust
Concerns about
Researchers &
Research

Youth Participants
Adolescent pluralism

in Depression
Management
Triggers & Outcomes
Impressions of
Treatment
Trust & Frustration
Treatment
Recommendations

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Mental Health Help Logistics

Revolving
Door

BoilerPlate

What am I here
for?

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Stigma

Labeling

Others
Perceptions

Psychotropic
Medications

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Church

A major sociocultural barrier

to treatment engagement is
the significance of prayer
and the lack of information
about depression and mental
illness shared, from the
pulpit.

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Pluralis
m
sometimes you get to a stage in
depression where you feel like,
okay, you think about it everyday,
you think about what would happen
if this person knew me, or what
would happen if this person noticed
me and then you start thinking
about you know what would it be
like if I was popular and then when
you start getting some attention you
dont know what to do with it and
you feel like you need it all the time
and when you dont get it all the
time then youre just upset when
you dont get it and I noticed that
with myselfand its just a, its just
a struggle for attention when you
get to a certain stage of
depression.

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Triggers/Outcom
es

Internalize

Externalize
Im depressed. I was
diagnosed with
depression about 4 or 5
years ago, and its really
something that hurt
other people as well as
yourselfIt can cause
you to hurt yourselfAnd
it can cause you to hurt
other people by closing
them outbuilding
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Social Support &

Family
Helpmate vs. Hindrance
Mama just wont
accept this.

The importance of
family and friends
as frontline
treatment seeking

Efforts at
treatment seeking
were thwarted by
family members

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Sustainabilit
y
Helping People Remember

And Return

Sample Outreach
Materials
Mechanisms of Dissemination:
Presentations
Study focused outreach events
Community Requests
School Requests
Creative Events

Heart2Heart

Sample Outreach
Materials
Mechanism of Dissemination
Person to person via Mrs.
Williams and Adult Advisory
Board

What have we
done?
Measurable/Behavioral

Objectives

At the conclusion of this activity,

participants should be able to:

Articulate primary psychological
barriers to depression research
and treatment engagement
cited by African Americans.
Relate historical and
contemporary systemic factors
to racial disparities in
depression care for African
American adolescents and
adults.

Why is this important?

ALL CHILDREN AND ADULTS

DESERVE THE CHANCE TO FEEL

THEIR BEST
Diverse families have legitimate
concerns regarding the identification
and treatment of depression.
Researchers are developing targeted
strategies for providing support to
African American and diverse
communities about the clinical nature
of depression and available
treatments.
Disparities researchers need funding
and support to continue this work
and our journalist colleagues can
help us highlight this important issue.

Alfiee.brelandnoble@georgetown.edu
@dralfiee www.aakomaproject.org www.dralfiee.com