Jordan Neely wasn’t committing a crime. He was in need of help.
In the week since he died after a lethal choke hold inside a New York City subway car, his family has called the statement from the ex-Marine who killed him “a character assassination.” He didn’t know anything about Neely’s mental health history before he decided to police his behavior. Neely’s aunt told the New York Post last week that he had been diagnosed with schizophrenia, but a family attorney has since rebuffed that, instead saying Neely had unspecified mental health struggles that emerged after his mother was brutally murdered in 2007.
That uncertainty reflects a broader problem with mental health diagnosis in Black men. They are disproportionately diagnosed with schizophrenia and go underdiagnosed or misdiagnosed when it comes to mood disorders such as depression. This is a direct result of racism and mischaracterizing Black people as angry, aggressive, or dangerous, which influences how people respond during a mental health episode, said Dr. Christine Crawford, associate medical director for the National Alliance on Mental Illness.
“We cannot underscore the power of racism in the way in which people respond to the situation of Black people who are experiencing a mental health crisis,” Crawford said.
They also experience more disabling and persistent depressive episodes than their white counterparts. Despite the debilitating conditions on the health of Black men, as many as 74% who have been exposed to traumatic events may have unmet needs for mental health services because of knowledge and eligibility issues, and are experiencing high levels of daily crisis.
The misdiagnosis also carries a heavy stigma — a perception of violence, even though people with schizophrenia are more often victims of violence than perpetrators, studies show.
Capital B spoke to licensed psychiatrists and psychologists about the misconceptions about Black people in distress and why some with mental illness are often underdiagnosed or criminalized.
The conversation has been edited for length and clarity.
Capital B: Why are Black people in distress or experiencing a mental health crisis in public not seen as victims?
Melissa Robinson-Brown, licensed clinical psychologist and founder of Renewed Focus Psychology Services PPLC: Often, the patriarchal, Eurocentric society that we live in has painted Black individuals in a very primal and animalistic light. When mental health episodes are observed that demonstrate externalizing behaviors such as hyperactive behaviors, anger, frustration, rapid body movements, a raised voice, etc., these behaviors are not seen as symptoms.
They are placed in the context of Black individuals already being seen as animals who cannot control themselves. So, it fits the beliefs that have already been socialized. It is another great example of being othered as a Black man.
As Black people, there is often so much suppression of anger, hurt, and sadness from years of oppression and racism, that when it does eventually come out, the expression of these feelings may appear to be more extreme or misunderstood given that others have not had the same experiences.
Capital B: Oftentimes, Black men go misdiagnosed or underdiagnosed when it comes to mood disorders such as depression. Why?
Crawford: Black men tend to be more often diagnosed with psychotic disorders, when in fact, they may have an underlying mood disorder like depression. There is a way in which depression can present such that the individual doesn’t look like they’re sad or crying all the time. They may present as irritable, on edge, very short-tempered, and that unfortunately could be read as someone who may be more aggressive, who may be more agitated, which are sometimes some of the presentations that can come along with someone who has a psychotic disorder like schizophrenia.
I want to note that not all people who have psychotic disorders present as aggressive or agitated or irritable, but because of some clinician bias, they’re quite quick to assign that diagnosis to people, especially Black people.
Capital B: What happens when someone doesn’t receive treatment?
Crawford: Unfortunately, over time, you can start to feel as though you’re a burden to other people, that there is no way out of the despair that you’re experiencing — when you run out of tools to be able to cope with it, the stress that you’re experiencing — the option that presents itself for a lot of people is suicide. What we are seeing are rates of suicide going up within the Black community, and suicide is as bad as it gets.
Robinson-Brown: When trauma goes untreated, it can lead to significant difficulties with functioning down the road. Trauma often violates a sense of safety [and] causes recurrent intrusive symptoms, disrupts sleep, and can disrupt attachments. This will ultimately impact someone’s ability to be functional in the workplace, poor functioning at home, and poor care for self. Trauma can also lead individuals to become hyper-vigilant and mistrustful of the world and the people in it. This will ultimately impact relationships and the ability to interact with others.
Capital B: Lack of access to substantive mental health care and social services are the ways systemic racism plays out. What can elected officials do to better serve vulnerable communities?
Crawford: In terms of accessibility, we need to invest in outpatient mental health support, creating community mental health centers that have flexible hours. For example, in Massachusetts, the former governor, Charlie Baker, revealed this plan in January to open up 25 Community Behavioral Health Centers across the state. These basically serve as urgent mental health walk-in centers that are open from 8 [a.m.] to 8 [p.m.], Monday through Friday. On the weekends, 9 [a.m.] to 5 [p.m.]. The idea is that if you have a mental health concern of any sort, you can just show up and receive an evaluation the same day.
Robinson-Brown: Many Black men would benefit from care, but the way the system is currently set up … it makes it that much harder for Black men to get the care they need. We have to demand culturally sensitive training when training new practitioners. There is too much harm being done because clinicians have not been appropriately trained to work with individuals from diverse backgrounds. Many practitioners are being trained to practice mental health in a way that works great for some white people, but completely misses the mark for Black men.
This story has been updated to correct the spelling of Melissa Robinson-Brown’s name.