BLACK IN AMERICA

COVID-19, Police Brutality, and Mental Health

By: Sheara Jennings, Ph.D., M.S.W., Affiliated Fellow

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Overview

The emergence of the COVID-19 pandemic collided with a police violence epidemic during the first half of 2020 to illuminate long standing and complex disadvantages for Black Americans. Beyond health disparities, COVID-19 also exacerbated long standing racial, social, and economic disparities. In the year 2020 alone, a number of police-involved killings of Black people, like the tragic murders of Breonna Taylor and George Floyd, dominated news cycles and social media while also inciting protests against police brutality and racism, referred to as a national reckoning on systemic racism. This report explores the intersections of these factors and their impacts on the mental health of Black Americans as population surveys demonstrate a rise in adverse mental health conditions for Black Americans during the COVID-19 pandemic.

Additionally, there is some evidence that adverse mental health conditions are directly and indirectly associated with police killings of Black Americans, who may vicariously experience trauma associated with these killings. With racism as a core element, the implications for Black Americans’ mental health and psychological well-being are substantial, given racism is associated with psychological stress, depression, and anxiety (Paradies et al., 2015). Recommendations are offered regarding efforts to meet current and post-pandemic mental health needs of Black Americans, guided by accessibility and cultural responsiveness.

Introduction

The year 2020 placed a spotlight on incredible challenges faced by Black Americans because of the COVID-19 pandemic and a police violence epidemic. The devastating effects of COVID-19 on Black people in the U.S. became alarmingly apparent within the first several weeks of the pandemic’s progression as race-related data became available in April 2020, revealing spectacular racial disparities. For example, by the end of 2020, more than 336,000 Americans had died from COVID-19, according to The Atlantic’s COVID Tracking Project (n.d). By fall 2020, the mortality rate for Black Americans was highest among all racial/ethnic groups at 108.4 per 100,000: more than double the rates of White and Asian Americans who had the lowest rates at 54.4 and 45.4, respectively (APM Research Lab, 2020). Beyond health disparities, COVID-19 has also exacerbated longstanding social and economic disparities experienced by Black Americans. Metaphorically parallel to the timing of the COVID-19 pandemic, the U.S. has also witnessed a series of highly visible cases which have resulted in the deaths of Black people at the hands of police.

According to CBS News (2020), “police have killed at least one Black person every week since January 1,” resulting in the deaths of 164 Black individuals through August 31, 2020. While police violence against Black Americans is not new (Alanget al., 2017), such incidents in 2020 have sparked a historical movement popularly referred to as a national reckoning on systemic racism. This movement has been characterized by public outrage, peaceful and violent protests against racial and social injustices, campaigns to “defund the police, ”anti-blackness awareness campaigns, and racial tension. Black people in America are experiencing a pandemic and an epidemic at the same time. Taken together, the COVID-19 pandemic and police brutality epidemic have collectively illuminated a disadvantaged state for Black Americans, putting the ills of being Black in American on display for the world to see. The intersection of the negative health, social, and economic effects of COVID-19 on Black Americans with the collective trauma associated with seeing police kill Black people too frequently have considerable implications for the mental health of Black Americans. This report aims to highlight the converging impacts of COVID-19 and police killings on the mental health and well-being of Black Americans.

Adverse Mental Health Conditions

According to the World Health Organization (2004), mental health is “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stress of life, can work productively and fruitfully, and is able to make a contribution to her or his community.” Implicit in this definition are the domains of how individuals feel (emotions), think (cognitions), and behave, particularly when faced with stress, decision-making, and/or interacting with others (American Psychiatric Association, 2018).

Disruptions to mental health are evidenced by adverse mental health conditions. For example, population surveys demonstrate a rise in adverse mental health conditions during the COVID-19 pandemic (Czeisler et al., 2020; Getachew et al., 2020). Experiences such as job loss, financial difficulties/economic hardship, health concerns for self and loved ones, including death and vaccine hesitancy, fears of contracting COVID-19, and isolation caused by stay-at-home orders and social distancing directives create psychological stress and negatively affect mental health in the forms of symptoms of anxiety and/or depression, substance use as a means of coping, and suicidal ideation (Novacek et al., 2020; Panchal et al., 2021). Similarly, through a limited number of research studies, we have some evidence that adverse mental health conditions are directly and indirectly associated with police violence against Black Americans, manifested as symptoms of depression and anxiety, acute stress, problems with emotions, and the number of poor mental health days experienced (Bor et al., 2018; Geller et al., 2014).

COVID-19

As previously mentioned, racial health disparities are well documented to the disadvantage of Black Americans in terms of contracting COVID-19, the severity of symptoms, hospitalizations, and mortality rates (Millet et al., 2020). These disparities have been attributed to a number of actors, including underlying chronic health conditions like hypertension, diabetes, obesity, and heart and lung disease (Centers for Disease Control and Prevention, 2020).

Beyond physical health, these racial disparities are also explained by the social determinants of health which are “conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks” (Office of Disease Prevention and Health Promotion, 2020).

Inequities within the social determinants of health that place Black Americans at risk of COVID-19 include discrimination, health care access, and utilization; their occupation; gaps in wealth, education, and income; and housing (Centers for Disease Control and Prevention, 2020). Specific to COVID-19 and occupations, Black Americans are highly represented among essential frontline workers whose jobs increase the likelihood of their exposure to the virus.

While many Americans have been able to work from home to help deter the spread of the virus, essential frontline workers like healthcare workers, cashiers, janitors, maintenance workers, truck drivers, and those who work in the food service and agricultural industries have been required to continue to work in person (Blau et al., 2020; Gould & Wilson, 2020). Millions of these jobs are occupied by Black people and have lower-paying wages. While approximately 12% of the U.S. workforce is made up of Black people, they represent 31% of public transportation workers, 31% of home health care workers, and 25% of all food and courier delivery workers (Black Demographics, 2020).

Further, according to the Center for Economic and Policy Research, more than one-third of frontline workers are a part of a low-income family (Rho et al., 2020). This one example demonstrates the complexities of increased exposure to the virus and economic hardship. When considering the +$3,000 median direct medical expenses for a symptomatic COVID-19 case (Bartsch et al., 2020), it is likely that seeking medical intervention would significantly exacerbate economic strain for essential frontline workers, including loss of wages. Such circumstances may place this subpopulation at risk for adverse mental health conditions. In Czeisler and colleagues’ (2020) examination of adverse mental health conditions during the COVID-19 pandemic, they found essential workers and racial/ethnic minorities were experiencing “disproportionately worse mental health outcomes, increased substance use and elevated suicidal ideation” (p. 1057).

The Epidemic
of Police-Involved Shootings

Due to a lack of universal guidelines or requirements for data reporting, it is difficult to accurately and fully understand the magnitude of police-involved killings. However, journalists and news organizations like The Washington Post have begun to address this vacuum by tracking police-involved killings via available police reports, public data sources, social media posts, and news stories.

Trends among the findings of journalists and scientists corroborate high and disproportionate risks for Black Americans being killed by police (Edwards et al., 2019; The Washington Post, 2020). While Black people account for approximately 13% of the U.S. population, they are killed in police shootings at more than two times the rate of white people: 31 deaths per million versus 13 deaths per million, respectively (The Washington Post, 2020). Such trends have led to proclamations that police violence is a public health crisis (American Public Health Association, 2020; University of Michigan School of Public Health-Health Behavior and Health Education Diversity, Equity and Inclusion Committee, 2020).

In the year 2020 alone, a number of police-involved killings of Black people, like the tragic deaths of Breonna Taylor and George Floyd, have dominated news cycles and social media while also inciting protests against police brutality and racism. Despite national and global outrage, police continue to kill Black people disproportionately (Cohen, 2020; Lett et al., 2020). Distressing images and video footage of police-involved killings from bystanders’ cell phones, surveillance/security equipment, dash cameras, and body cameras have indirectly exposed millions of people to such traumatic events via television and social media.

For example, the magnitude, scope, and reach of video footage of the events leading to the police-involved killing of George Floyd alone are difficult to quantify. However, estimates include social media analytics ranging from 47.8 million to 1.4 billion views (Blake, 2020; Pew Research Center, 2020). 24-hour news channels and online content allow for repeated exposure to these traumatic events, and research literature on media viewing of traumatic events has associated it with adverse mental health such as PTSD and depressive and acute stress symptoms (Hop wood & Schutte, 2017; Neria & Sullivan, 2011; Tynes et al., 2019).

In their seminal study, Bor and colleagues (2018) used nationally representative data to estimate the spillover effects of exposure (e.g., word of mouth, TV, and social media) to police killings on the mental health of Black Americans. They found evidence of adverse effects on the mental health of Black American adults in the general population when exposed to the police killings of unarmed Black Americans; however, such effects were not observed among white respondents. These findings suggest Black people may vicariously experience trauma associated with police-involved killings of Black people and related adverse mental health symptoms.

Implications

In 2020, Black Americans experienced an epidemic within a pandemic, offering yet another glaring display of this country’s legacy of racism, discrimination, and marginalization of Black people. The magnitude of this phenomenon should not be underestimated, as the anticipated effects are incompletely known and will be felt for years to come. The complexities of structural racism in the context of COVID-19 and police-involved killings are evident, at the least, in systems of health care, employment, and the justice system. The implications for the mental health and psychological well-being of Black Americans are substantial given racism is associated with adverse mental health factors, including psychological stress, depression, and anxiety (Paradies et al., 2015).

The collective experiences of the Black community, as a consequence of COVID-19 and police killings in 2020 alone, can be characterized by the following: fears of contracting COVID-19, isolation, anxiety, economic strain, frequent messaging about “Black” health disparities and risk factors that pathologize Blackness, fear of victimization, anger, feelings of despair and hopelessness, heightened awareness of racism and injustice, grief and loss, and the inundation of images/videos of Black people dying at the hands of police officers. This lengthy list represents a “dangerous convergence [of trauma] for Black Americans” (Egede & Walker, 2020) and commands attention to their mental health and psychological well-being.

Recommendations

Given a history of mistrust of health care systems and significant stigma associated with mental health issues in the Black community, efforts to meet current and post-pandemic mental health needs must be accessible and culturally responsive. The following recommendations are offered as frameworks to take immediate and necessary action.

Improve accessibility to mental health care and services for Black people. Spikes in adverse mental health conditions during the COVID-19 pandemic create service needs for new, first-time patients in addition to those who were receiving mental health services prior to the pandemic. Such demands on the mental health care system further complicate existing pre-pandemic issues of access to care, particularly for marginalized groups.

Structural barriers such as a lack of insurance, under insurability (no mental health coverage), the high costs of mental health care, under serviced locales, and a national shortage of mental health professionals must be addressed in order to improve access. While telehealth has emerged as a viable tool to improve accessibility given social distancing directives during the COVID-19 pandemic, it is still an unattainable option for many who do not have the money, insurance coverage, or necessary technological equipment. In the short term, targeted stimulus and relief funding specifically for mental health services are needed, just as there has been funding for widespread COVID-19 testing and vaccinations.

Furthermore, initiatives to integrate primary health care (screening and initial treatment) with specialized mental health care must continue as a means to bridge gaps in accessibility. Long-term efforts should focus on expanding affordable health care coverage to those who are uninsured, and mental health care benefits should be a standard component of all health insurance plans.

Build trust and destigmatize mental health through culturally responsive approaches. The mistrust of healthcare systems for Black people is warranted given countless historical and contemporary, well-documented examples of mistreatment, discrimination, and misdiagnosis. This mistrust can prevent people from seeking needed care, and it further complicates overcoming the stigma associated with mental health in the Black community. Shame and stigma surrounding mental health issues within the Black community must be challenged, especially in light of elevated distress and mental health needs related to the issues reviewed in this brief.

Studies show that Black people are more likely to trust professionals who look like them; therefore, education and advocacy efforts from trusted informants like health care professionals, religious and political leaders, survivors, family, and friends are worth while strategies. Multi-faceted approaches such as public service announcements, education campaigns, and personal testimonies through a variety of platforms like radio, television, social media, community health fairs, and church appearances can help build trust and affirm mental health as an essential aspect of overall health and well-being.

All health care providers who interact with Black patients can serve as allies by employing culturally responsive approaches. For example, primary care providers are uniquely situated to screen for mental health distress and intervene if needed. Having an empathic awareness of the challenges currently faced by Black people can guide a culturally responsive plan of mental health care. Acknowledging the trauma associated with the current climate and validating the social ills of racism and discrimination as real contributors to mental health issues can help counter stigma, build trust, and promote healing.

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About the Author

Sheara Jennings is an Affiliate Fellow with the Center for Justice Research, an Associate Professor at the University of Houston (UH), and the Humana Endowed Chair in Social Determinants of Health with dual appointments in the UH Graduate College of Social Work and the UH College of Medicine. Her research has focused on the well-being of Black and LatinX students and families in the areas of academic achievement, teen pregnancy prevention, healthy marriage/relationships, and community-based interventions. Her research project with the Center for Justice Research examines the mental and emotional health responses of Black people at the intersection of COVID-19 and police misconduct.

In 2020, Dr. Jennings was appointed by Mayor Sylvester Turner to serve on the City of Houston Health Equity Response Task Force in response to the COVID-19 pandemic and its disproportionate impacts on minority, vulnerable, and under-resourced communities.

Currently, Dr. Jennings is a second term Commissioner for the Council on Social Work Education Commission on Membership and Professional Development, the Social Work Practice Cluster Co-Chair for the Society for Social Work and Research 2022 annual conference; and a member of the Good Life Outcomes Community Engagement Advisory Board which is a policy advocacy initiative of the community-based organization Change Happens, designed to affect change that addresses racial and social injustices.

Dr. Jennings holds a B.S. in rehabilitation psychology for Southern University, A&M; an M.S.W. from Louisiana State University; and a Ph.D. in social intervention research from the University of North Carolina at Chapel Hill. Her professional affiliations include the American Public Health Association, the American Evaluation Association, the Council on Social Work Education, and the Society for Social Work and Research.

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