Out

THE PERCEPTIONS AND EXPERIENCES OF SEEKING MENTAL HEALTH
SERVICES THROUGH THE LENS OF THE BLACK COMMUNITY: A

QUALITATIVE STUDY
by
Sherree Mellette Davis
Charleston Southern University
Kathy Sobolewski, Ed.D. Committee Chair
Julie Fernandez, Ed.D. Committee Member
A Dissertation Presented in Partial Fulfillment

of the Requirements for the Doctor of Education Degree

2023
THE PERCEPTIONS AND EXPERIENCES OF SEEKING MENTAL HEALTH
SERVICES THROUGH THE LENS OF THE BLACK COMMUNITY: A
QUALITATIVE STUDY
by Sherree Mellette Davis
A Dissertation Presented in Partial Fulfillment

of the Requirements for the Doctor of Education Degree

2023
APPROVED BY:
_______________________________________
Kathy Sobolewski, Ed.D., Committee Chair
_______________________________________
Julie Fernandez, Ed.D., Committee Member
i
Abstract
The purpose of this qualitative research study was to add to mental health literature by
exploring the first-generation African American college students and graduates’
experiences and perceptions of seeking mental health services in a Historical Black
College and University (HBCU) in the midlands area of South Carolina. The theoretical
framework for this study included the critical race theory and the historical trauma
theory. Stratified sampling was used to select the participants. The sample consisted of 28
participants. Data collection was semi-structured interviews. All interviews were coded
and analyzed based on the participants’ responses into themes, subthemes, and patterns.
As of the study’s findings, 19 themes emerged from the participants who had received
mental health services, and 23 emerged from those who had not received mental health
services. Some themes were consistent with the literature review. Similar themes
included mental health literacy, cultural competency, spirituality and religion, and social
injustice. This study investigated the impact of mental health literacy, possible stigma,
discrimination, cultural implications, and disparities regarding mental health treatment.
The findings indicated that the participants felt mental health services were necessary,
especially in Black communities. Participants shared how they felt it would be a benefit if
they sought mental health services and how it could contribute to healthier lifestyles.
They described a sense of feeling weak and did not want to have help from others.
Participants shared feelings about personal experiences with mental health conditions
because of their upbringings and professional education.
Keywords: qualitative, mental health, first-generation college students, African
Americans, health disparities, and seeking mental health services

ii
Copyright © 2023 by Sherree Mellette Davis

All Rights Reserved.
No part of this dissertation may be
reproduced or used in any manner without written
permission of the copyright owner except for the use of
quotations.
iii
Dedication
This dissertation is dedicated to those who do not have the space to say what
needs to be said or show their genuine emotions. I dedicate this study to those in a dark
place who often cannot see the light. I dedicate this to those who do not feel seen or
heard. I want you to know people are working to break down those barriers and stigmas
to assist you with receiving the help you need. Remember, it is okay not to be okay. You
are strong, you are brave, and you are not alone.
iv
Acknowledgment
This doctoral degree would not have been accomplished without my Lord and
Savior, Jesus Christ. He indeed provided strength when I was weak, listened to all of my
prayers, removed self-doubt, and reminded me of his promises, and I am forever thankful
to him for this.
To the staff of Charleston Southern University, thank you for pushing me and
providing me with a safe place to vent and share my challenges as I complete this path.
To the courageous Cohort C., thank you for always being in the midst of it all, reminding
me that this path was destined for me. Special thank you to Maygen Green, Ashley
Carter, Abbie Scott, Danielle Dates, Kelly Simpson, and Susan Brown.
Most importantly, I must acknowledge my family and friends’ love, support, and
encouragement. My mother and father, Robert and Debbie Bowens-Davis, thank you for
setting the blueprint, reminding me I can do anything in this world, and always
supporting my dreams. My siblings, nieces, nephews, aunts, and uncles, you have shown
up for me in more ways than I can count, and I thank you. My dear Aunt Brenda, you
stayed up those late nights with me, making edits after edits. I cannot even begin to say
how thankful I am to you. My mighty circle of friends, you all have been the glue to hold
it together. Even when I did not always see my capabilities, you have continued to
remind me that I am the prize and that there is nothing I cannot do. Thank you for
listening and, most importantly, praying with me. It means everything to me.
To the Black Community, this study is for us. I acknowledge you because you
have been the motivation to keep going. I kept reminding myself that this research was
for a greater purpose. We will change the world—one barrier at a time.

v
Table of Contents
Abstract .................................................................................................................................i
Copyright .............................................................................................................................ii
Dedication ...........................................................................................................................iii
Acknowledgments...............................................................................................................iv
List of Tables .......................................................................................................................x
List of Figures ...................................................................................................................xiii
List of Abbreviations ........................................................................................................xiv
Chapter One: Introduction ...................................................................................................1
Overview ..................................................................................................................1
Background ..............................................................................................................2
Problem Statement ...................................................................................................5
Purpose Statement....................................................................................................6
Significance of the Study .........................................................................................6
Research Questions ..................................................................................................7
Introduction to Theoretical Framework ...................................................................7
Definitions................................................................................................................8
Summary ................................................................................................................10
Chapter Two: Literature Review........................................................................................12
Overview ................................................................................................................12
Theoretical Framework ..........................................................................................12

vi
Critical Race Theory ..................................................................................13
Historical Trauma Theory ..........................................................................16
Related Literature...................................................................................................18
History and Background of Mental Health................................................18
Prevalence of Mental Illnesses...................................................................21
Mental Health Stigma ................................................................................22
Mental Health Literacy ..............................................................................26
Untreated Mental Illness Outcomes ...........................................................29
College Students and Mental Health..........................................................30
Mental Health Gender Differences ............................................................32
Mental Health Gender Differences among African Americans.................36
Cultural Impact and Mental Health............................................................38
Provider Bias and Access to Mental Health Care in the African American
Community.................................................................................................43
The Black Church and Mental Health........................................................46
Discrimination and Mental Health in the African American Community.47
Social Justice and Mental Health among African Americans ...................56
The 2019 Pandemic and Mental Health .....................................................58
Summary ................................................................................................................61
Chapter Three: Methodology .............................................................................................63
Overview ................................................................................................................63
Design ....................................................................................................................63
vii
Research Questions ................................................................................................64
Setting ....................................................................................................................65
Participants.............................................................................................................65
Sampling ....................................................................................................65
Procedures ..............................................................................................................66
The Researcher’s Role ...............................................................................68
Instruments.................................................................................................69
Interview Protocol......................................................................................70
Data Collection ..........................................................................................71
Data Analysis .............................................................................................72
Trustworthiness ......................................................................................................73
Credibility ..................................................................................................73
Dependability and Confirmability .............................................................74
Transferability ............................................................................................75
Ethical Considerations ...........................................................................................75
Delimitations ..........................................................................................................75
Summary ................................................................................................................76
Chapter Four: Findings ......................................................................................................77
Overview ................................................................................................................77
Data Collection ......................................................................................................78
Participants of the Study ........................................................................................80
Results ....................................................................................................................83
viii
Interview 1: Question 1..............................................................................87
Interview 1: Question 5............................................................................104
Summary ..............................................................................................................133
Chapter Five: Discussion and Conclusion .......................................................................135
Overview ..............................................................................................................135
Summary of Findings...........................................................................................135
Discussion ............................................................................................................138
Interview Questions: Set One ..................................................................138
Interview Questions: Set Two..................................................................143
Implications..........................................................................................................146
Limitations ...........................................................................................................147
Recommendations for Further Research..............................................................148
Summary ..............................................................................................................149
ix
References ........................................................................................................................152
Appendix A ......................................................................................................................188
Appendix B ......................................................................................................................189
Appendix C ......................................................................................................................190
Appendix D ......................................................................................................................191
Appendix E ......................................................................................................................193
x
List of Tables
Table 1. Participants’ Demographics Who Have Not Received Mental Health Services
...........................................................................................................................81
Table 2. Participants’ Demographics Who Have Received Mental Health Services ......82
Table 3. General Themes Found from Interviews with Participants Who Have Not
Received Mental Health Services......................................................................84
Table 4. Gender Themes Found from Interviews with Participants Who Have Not
Received Mental Health Services......................................................................85
Table 5. Theme 1.1.1 Perceived as Helpful and Needed .................................................88
Table 6. Theme 1.1.2 Perceived as Weak ........................................................................89
Table 7. Theme 1.1.3 Not Needed in Personal Life.........................................................90
Table 8. Theme 1.2.1 Knowledgeable Due to Personal...................................................91
Table 9. Theme 1.2.2 Experience, Knowledgeable Due to My Work Experiences .......92
Table 10. Theme 1.2.3 Knowledgeable of Mental Health Conditions .............................93
Table 11. Theme 1.3.1 Experienced Mental Health Issues Due to Environmental
Experiences ......................................................................................................94
Table 12. Theme 1.3.2 Does Not Have Experience with Mental Health Issues ................96
Table 13. Theme 1.3.3 Anxiety ........................................................................................96
Table 14. Theme 1.3.4 Being an African American ..........................................................98
Table 15. Theme 1.4.1 Negative Family Dynamics .........................................................99
Table 16. Theme 1.4.2 Positive Family Dynamics ..........................................................100
Table 17. Theme 1.4.3 COVID-19 Pandemic .................................................................101
Table 18. Theme 1.4.4 Social Injustice ...........................................................................102

xi
Table 19. Theme 1.4.5 My Race and Gender ..................................................................103
Table 20. Theme 1.5.1 Using Unsafe Coping Mechanisms ............................................104
Table 21. Theme 1.5.2 Spiritual and Religious Beliefs ...................................................106
Table 22. Theme 1.5.3 Self-Care .....................................................................................107
Table 23. Theme 1.5.4 Exercising ...................................................................................107
Table 24. Theme 1.5.5 Friends and Family .....................................................................108
Table 25. Theme 1.5.6 Traveling .....................................................................................107
Table 26. Theme 1.5.7 Isolation ......................................................................................107
Table 27. General Themes Found from Interviews with Participants Who Have Received
Mental Health Services....................................................................................108
Table 28. Gender Themes Found from Interviews with Participants Who Have Received
Mental Health Services ..................................................................................111
Table 29. Theme 2.1.1 Relationship Issues .....................................................................114
Table 30. Theme 2.1.2 Loss of a Loved One...................................................................115
Table 31. Theme 2.1.3 Anxiety .......................................................................................116
Table 32. Theme 2.1:4 Stress...........................................................................................117
Table 33. Theme 2.1:5 Postpartum Depression...............................................................118
Table 34. Theme 2.1:6 Suicide ........................................................................................118
Table 35. Theme 2.2.1 Positive–Helped a Lot ................................................................120
Table 36. Theme 2.2:2 Positive–Helped Some ...............................................................121
Table 37. Theme 2.2.3 Negative–Did Not Help ..............................................................122
Table 38. Theme 2.3.1 Sought Services Online...............................................................123
Table 39. Theme 2.3.2 Recommended by the Court .......................................................124

xii
Table 40. Theme 2.3.3 Recommended by a Professional Outside of the Mental Health
Field ...............................................................................................................125
Table 41. Theme 2.4.1 Encouraged by Friends and Family ............................................126
Table 42. Theme 2.4.2 No One Encouraged to Stop or Continue ...................................127
Table 43. Theme 2.4.3 Parents or Family Did Not Understand or Believe in the Services
.........................................................................................................................128
Table 44. Theme 2.5.1 No Preference .............................................................................129
Table 45. Theme 2.5.2 Yes, Preferred Someone of My Racial Background ...................130
Table 46. Theme 2.5.3 Yes, Preferred Someone of the Same Gender and Race as I Am
........................................................................................................................132
Table 47. Theme 2.5.4 Yes, Preferred Someone of the Same Gender as I Am ..............133
xiii
List of Figures
Figure 1. Percentage of Adults 18 and Older Who Have Received Mental Health
Treatment, Taken Medication, and Received Therapy in the Past 12 Months by
Gender in the US 2020 ......................................................................................36
Figure 2. Percentage of Uninsured Adults Ages 19-64 by Race and Ethnicity .................41
Figure 3. Pamphlet of Selective Sterilization Benefits ......................................................54
Figure 4. Adults Reporting Symptoms of Anxiety and Depressive Disorders during
COVID-19...........................................................................................................60
xiv
List of Abbreviations
APA – American Psychiatric Association
BIPOC – Black, Indigenous, and People of Color
CBD – Cannabidiol
CDC – Centers for Disease Control and Prevention
CAQDAS – Computer-Assisted Qualitative Data Analysis Software
COVID-19 – Coronavirus Disease 2019
CRT – Critical Race Theory
DJJ – Department of Juvenile Justice
DSMMD – Diagnostic and Statistical Manual of Mental Disorders
HEW – Health, Education, and Welfare
FGSOC – First-Generation Students of Color
HBCUs – Historically Black Colleges and Universities
IRB – Institutional Review Board
MM – Medical Mistrust
MHL – Mental Health Literacy
NAMI – National Alliance on Mental Health
NHGRI – National Human Genome Research Institute
PTSD – Post-Traumatic Stress Disorder
PD – Professional Development
PBI – Predominately Black Institutions
PWI – Predominately White Institution
SBWS – Strong Black Woman Schema

xv
UNCF – United Negro College Fund
US – United States
WHO – World Health Organization

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Chapter One: Introduction
Overview
Mental health is essential to physical, emotional, and psychological health, as well
as life satisfaction and an individual’s well-being. Mental health influences one’s ability
to cope with the stressors of life, interpersonal relationships, decision-making ability, and
learning capabilities (Vance, 2019). In 2020, the National Institute of Mental Health
reported that one in five adults in the United States (US) lived with mental illness, about
53 million people, ranging from mild to severe (U.S. Department of Health and Human
Services, 2022). In the general population, mental illness remains undertreated, and there
is even lower utilization of mental health services among African Americans than non-
Hispanic Whites (Vance, 2019). In 2021, an estimated 47 million people identified as
Black or African American, making up about 14% of the US population (Moslimani et
al., 2023).
Due to some African Americans experiencing inequalities in health care, their
experiences may lead to disengagement or not being as assertive as necessary when
receiving health services and managing chronic diagnoses, which can result in increased
disabilities and higher inpatient hospitalizations (Pederson et al., 2023). Beyond physical
health challenges and disparities, some African Americans face various hurdles that
compound general mental health challenges, including but not limited to higher rates of
poverty, unemployment, and incarceration. More recently, the impact of the Coronavirus
pandemic, social injustice, and police brutality within the Black community have only
intensified or magnified some of their struggles (Bogan et al., 2022; Laurencin & Walker,
2020).
2
Mental health disorders in college students have become an unprecedented crisis
in public health. The rates of depression and anxiety have doubled within the last decade
(Kodish et al., 2022). An estimated 44% of college students have moderate to severe
anxiety, and 36% have mild to severe depression (Lee et al., 2021). Specifically, students
at HBCUs may experience racial and ethnic-related (e.g., interracial dating, multiracial
ethnicity) adversities and environmental stressors (e.g., living conditions, geographical
location).
This qualitative study provides literature addressing mental health background,
discrimination, racism, and their cultural impact on first-generation African American
college students and graduates. The research also includes critical race theory and
historical trauma theory as the theoretical frameworks in this study. The research
questions, problem, purpose, and significance of this study are also identified in this
chapter.
Background
Mental illnesses are common concerns in the US (US Department of Health and
Human Services, 2022). As described by Lake and Turner (2017),
Mental health care is an essential offshoot of integrative medicine
focusing on the whole person rather than a particular disorder. Like
integrative medicine, mental health care emphasizes wellness and healthy
lifestyle choices while addressing biological, psychological, cultural,
economic, and spiritual or religious factors that affect general well-being
and mental health. (p. 21)

3
On April 30, 2021, President Biden signed A Proclamation on National Mental
Health Awareness Month 2021, which drew attention due to the increased number of
Americans experiencing symptoms of mental illnesses such as anxiety and depressive
disorders over recent years (Center for Behavioral Health Statistics and Quality, 2021).
Between August 2020 and February 2021, the percentage of adults with anxiety or
depressive disorder symptoms increased from 36.4% to 41.5%. During the pandemic’s
peak, those reporting unmet mental health care needs increased from 9.2% to 11.7%
(Vahratian et al., 2021). These increases were most significant among adults aged 18–29
(Vahratian et al., 2021).
President Biden addressed and outlined specific plans on mental health in his
Unity Agenda. In 2021, the Centers for Disease Control and Prevention (CDC) made
efforts to launch a campaign to provide resources for mental health care within
workplaces. Biden also addressed the Mental Health Parity and Addiction Equity Act,
passed in 2008, to ensure all health insurance plans complied with the federal law
(O’Connor, 2023). As a result of President Biden’s Proclamation, there was an
investment in crisis counseling services to help all Americans. In 2019, the Federal
Communication Commission proposed the 988 suicide and crisis lifeline to improve
access to support the nation’s growth of suicide, substance use, and mental health needs.
On July 16, 2022, the three-digit number was federally named and became
available to all cellphone and landline users. The nationwide phone number is used to
connect individuals with mental health professionals to assist if one is faced with a
mental health crisis. The 988 Lifeline comprises a network of more than 200 call centers
administered by Vibrant Emotional Health and funded by the Substance Abuse and
4
Mental Health Services Administration (O’Connor, 2023; O’Connor & Yanos, 2022).
President Biden also urged colleges and universities to use American Rescue Plan funds
on college campuses to provide mental health support to students. Other actions included
expanding access to telehealth, fighting the opioid overdose crisis, recruiting diverse
mental health professionals, and supporting veterans and families to help reduce suicide
(O’Connor, 2023).
President Biden’s proclamation also highlighted rising rates of suicide, especially
among African American youths and other vulnerable groups. The suicide rate among
African Americans aged 15‒24 increased by 30% (from 5.7 to 7.4 per 100,000
individuals) between 2014 and 2019. The suicide rate among Asian or Pacific Islanders
aged 15‒24 increased by 16% (from 6.1 to 7.1 per 100,000 individuals) in 2019. There
was a decrease in suicide rates between 2018 and 2019 for White Americans, Native
Americans or Alaska Natives, and Hispanic individuals. White American suicide rates
were reported as 17.6 per 100,000 individuals in 2019. American Indian or Alaskan
Native individual’s suicide rate of 22.2 per 100,000 individuals in 2019 (Ramchand et al.,
2021).
The Hispanic population was 7.3 per 100,000 individuals (Ramchand et al.,
2021), with such looming evidence of an even more significant mental health crisis.
President Biden asserted his administration’s commitment to addressing disparities in
mental health services faced by people in underserved communities, especially
communities of color (Center for Behavioral Health Statistics and Quality, 2021). The
call to action for the mental wellness of marginalized populations in this proclamation
5
provided additional attention to those who otherwise might not be seen or considered
(Mezuk et al., 2022; O’Connor & Yanos, 2022).
Problem Statement
Although there has been a recent and increasing growth in discussing mental
health care in American society, there is still much stigma surrounding the topic in the
African American community. One in three African Americans who need mental health
services will receive it. Some structural inequalities and social determinates have limited
some African Americans from receiving quality healthcare (Guerra, 2022). In the US and
other countries, attention has been placed on university and college students regarding
their well-being and mental health.
Although some African American students may attend historically Black colleges
and universities (HBCUs), they may also experience stressors despite being the majority.
Stressors associated with race, also known as minority status stress, are experiences some
African Americans face that affect their mental health and well-being (Mushonga &
Henneberger, 2020). A focus has been on the increasing need for mental health services
due to the rise of anxiety, depression, and suicide (Rakow & Eells, 2019). Some college
and university students may learn to manage their emotions and distress. However,
students’ increased technology use, including social media and smartphones, has
contributed to mental health concerns (Rakow & Eells, 2019). This study highlights
college students’ and graduates’ ethnicities, cultures, perceptions, and experiences with
mental health treatment.

6
Purpose Statement
The purpose of this study was to add to mental health literature. Factors in the
Black community, such as racism, oppression, and trauma, can severely affect a person’s
mental well-being (Lockett, 2023). Mental health issues are a concern in the African
American community, with opposing economic and social impacts (Lockett, 2023).
Therefore, this study specifically explored African American college students’ and
graduates’ experiences and perceptions of seeking mental health services. The literature
review provides the history of mental health and factors affecting African Americans.
The study addressed mental health stigma while highlighting mental health policies.
Furthermore, the study discussed experiences and perceptions of mental health and
subsequent effects on the African American community.
The demand for mental health care among college students is a concern and has
increased with the impact of COVID-19, and the national reckoning with racism has
further increased the necessity to address these needs (Polishchuk, 2022). Some colleges
have implemented promotional and preventive public health programs to address these
concerns (Jaisoorya, 2021). These findings could be directly tied to academic,
socioeconomic, and pandemic-related concerns. This study will benefit policymakers,
educators, mental health professionals, and students as they may receive data and
research on the impact of mental health literacy, possible stigma, discrimination, cultural
implications, disparities, and critical race theory regarding mental health treatment.
Significance of the Study
The present study extended knowledge of the Black community’s attitudes and
perceptions of seeking mental health services. About 25% of African Americans seek
7
mental health resources in comparison to about 40% of Whites seeking mental health
resources (O’Malley, 2021). Gaiotto et al. (2022) stated, “Mental health problems are a
global concern, and the complex phenomenon of suicide is considered a public health
problem because it is the second leading cause of death among young people aged 15 to
29 years” (p. 1). Mental health issues can cause long-term disabilities and premature
death. An untreated mental health diagnosis can lead to interpersonal, social, family, and
educational neglect.
This study uncovered the importance of seeking mental health services according
to the participants’ points of view. This study provided findings and analyzed the
perceptions and experiences of the Black community’s views of mental health resources.
Often, there are advocates to encourage others to seek mental health services, but rarely is
there an understanding of the attitudes and perceptions of individuals who may or may
not seek mental health resources.
Research Questions
The following questions guided this study.
RQ1: What are the perceptions of seeking mental health services among first-
generation African American college students and graduates?
RQ2: What are the experiences of seeking mental health services among first-
Introduction to Theoretical Framework
Mental health among African Americans and college students has been a topic of
ongoing research and data. The theoretical models discussed in this study were critical
race theory and historical trauma theory. George (2021) expressed, “Critical race theory
8
acknowledges that the legacy of slavery, segregation, and the imposition of second -class
citizenship on African Americans and other people of color continue to permeate the
social fabric of this nation” (p. 1). The framework also offers a public health paradigm
for investigating the root causes of health disparities. Based on race equity and social
justice principles, critical race theory encourages the development of solutions that bridge
gaps in health, housing, employment, and other factors (Ford & Airhihenbuwa, 2010).
The research also examined historical trauma theory as an additional component
of the theoretical framework within this study. Maria Yellow Horse Brave Heart
developed the historical trauma theory in the 1980s; her objective was to understand the
generational legacy of trauma and its potential effects (Marte, 2021). A critical aspect of
historical trauma theory is identifying the traumatic historical events that have taken
place (Pihama et al., 2014). Historical trauma may impact an individual's physical well-
being and emotional issues (Pihama et al., 2014). The intergenerational trauma of slavery
can cause challenges among African Americans (Whitfield, 2022). Historical trauma
responses are multi-level, including individual, familial, and community impacts, with
transmission being at both personal and societal levels (Pihama et al., 2014).
Definitions
The following are terms that readers will benefit from familiarizing themselves
with as they appear frequently throughout the research study.
Black Community ‒ refers to African Americans (also referred to as Black
Americans or Afro-Americans), an ethnic group of Americans with total or partial
ancestry from any of the Black racial groups of Africa (Africa Health Organization,
2019).
9
Critical Race Theory ‒ the acknowledgment of embedded racism. Critical race
theory is the ongoing impact of racism, particularly among minorities, in their everyday
lives and is a social construct used to oppress and exploit people of color (Anandavalli et
al., 2021).
Discrimination ‒ a group or individual is mistreated compared to another group or
individual based on race, ethnicity, gender, disability, sexual orientation, or other
categorical statuses (Fibbi et al., 2021).
Jim Crow Laws ‒ state and local laws legalizing racial segregation (Krieger et al.,
2013).
Mental Health ‒ is a person’s psychological and emotional well-being (Fusar-Poli
et al., 2020).
Mental Health Disparities ‒ noticeable and significant differences among mental
health services (Hall et al., 2015).
Mental Health Literacy ‒ knowledge and beliefs about mental disorders that aid
their recognition, management, or prevention (Dang et al., 2020).
Mental Illness ‒ refers to emotional, mental, or behavioral disorders ranging from
mild to moderate to severe impairment (National Institute of Mental Health, 2023).
People of Color ‒ a term primarily used in the United States and Canada to
describe a person who is not white (Moses, 2016).
Perceived Stigma ‒ an individual’s beliefs about the attitudes of others toward
mental illness (Subu et al., 2021).
Prejudice ‒ an emotion or opinion of a person or people based on a group they are
a part of (Fiske, 2023).

10
Public Stigma ‒ an individual’s beliefs about the attitudes of others toward mental
illness (Subu et al., 2021).
Self-Stigma ‒ negative attitudes, embarrassment, shame, and disappointment from
those with a mental health diagnosis (Minichil et al., 2021).
Stereotyping ‒ a belief that categorizes people based on their membership in a
group (Fiske, 2023).
Stigma ‒ societal disapproval, or when society shames people who live with a
mental illness or seek help for emotional distress (Subu et al., 2021).
Suicide ‒ death by intentional and voluntary behavior (Klonsky et al., 2016).
Suicide Attempt ‒ self-directed, non-fatal, potentially injurious behavior with the
intent to die due to the behavior. A suicide attempt may not result in injury (Klonsky et
al., 2016).
Suicidal Ideation ‒ having thoughts, considerations, or plans to die by suicide
(Klonsky et al., 2016).
Summary
Chapter One introduced the significance and purpose of this study. This study
analyzed the lived experiences and perceptions of mental health resources among first-
generation African American college students and graduates. Mental health at some
university and college campuses has been challenging as students face various
adversities. Mental health has been an ongoing conversation nationwide since the
COVID-19 pandemic arose. Mental health can be complex and affect one’s daily
activities and abilities. One’s physical and emotional well-being can directly connect with
11
their mental health state. Some universities and colleges continue to make policies and
provide resources to assist students’ mental health needs (Harris et al., 2022).
Chapter Two will outline the theoretical frameworks of critical race theory and
historical trauma theory that shape the research topic. Chapter Two will also synthesize
literature on mental health related to college students and African Americans. Chapter
Three will include the methods section, encompassing this research study’s methodology
and design. This chapter will provide qualitative methods to investigate the research
questions, including interviews and procedures.
Chapter Three will present pertinent information about the study design, research
questions, setting, participant sampling, procedures, data collection, trustworthiness,
ethical considerations, and delimitations. This chapter will provide a detailed summary of
the qualitative methods used to investigate the research study. Chapter Four will include
the findings and results of this study. This chapter will highlight all themes uncovered
from the interviews with explicit examples of participants’ experiences and perceptions
of seeking mental health services. Last, Chapter Five will include a concise summary of
the findings and the connections with the literature discussed in Chapter Two. Chapter
Five will also have implications, limitations, and suggestions for further research.
Chapter Two: Literature Review
Overview
This chapter explores the research and literature on mental health history and its
decades-long changes. Historical traumas such as the Tuskegee Syphilis Study of
Untreated Syphilis in the Negro Male, J. Marion Sims’ medical research, Henrietta Lacks
experiment, and the eugenics movement have been critical in medical mistrust among the
12
Black community (Bajaj & Stanford, 2021). Critical race theory and historical trauma
theory will be examined as the theoretical frameworks for this research study. The
theoretical frameworks will further explain how this research is conceptualized and
investigated. This chapter will provide explanations and historical events that may have
shaped the views of mental health in the Black community and other aspects of mental
health. The literature discusses the history, background, prevalence, and stigmas of
mental health. This chapter will also provide literature on mental health literacy, cultural
impact, gender differences in mental health, provider biases of mental health care, the
Black church’s impact on mental health, social justice in mental health, and COVID-19’s
impact on mental health.
Theoretical Framework
Critical race theory and historical trauma theory serve as the two frameworks for
this study. Critical race theory offers public health a new paradigm for investigating the
root causes of health disparities. The theory also includes social justice and equity
principles (Ford & Airhihenbuwa, 2010). Historical trauma theory relates to populations
that have endured slavery, war, mass trauma, colonialism, and genocide. These result in a
higher prevalence of ongoing trauma. Sotero (2006) noted, “Understanding how
historical trauma might influence the current health status of racial and ethnic populations
in the US may provide new directions and insights for eliminating health disparities” (p.
93).
Critical Race Theory
Critical race theory examines knowledge production, precisely how a field’s
norms and conventions reproduce the current racialized power structure. Critical race
13
theory was developed by lawyers, scholars, and activists who studied the relationship
between race, racism, and power (Delgado et al., 2017). In adopting this approach, CRT
scholars attempted to understand how systemic racism victims are affected by cultural
perceptions of race and how they can represent themselves to counter prejudice (Delgado
& Stefancic, 2012, 2013). The theory helps one understand the rationale for racial
inequalities and their existence in societies (Butler, 2021). Philosophical writings from
legal scholars, activists, and lawyers studied the relationship between race, racism, and
power, which is how CRT was created (Delgado et al., 2017). Researchers in this theory
include Derrick Bell, Kimberlé Crenshaw, Cheryl Harris, Richard Delgado, Patricia
Williams, Gloria Ladson-Billings, and Tara Yosso (George, 2021).
Critical race theory acknowledges that the legacy of slavery, segregation, and the
imposition of second-class citizenship on African Americans and other people of color
continue to permeate the social fabric of this nation. Critical race theory does not
traditionally define racism as solely the consequence of discrete irrational, harmful acts
perpetrated by individuals but is usually the unintended consequence of choices (George,
2021). Critical race theory also recognizes that race intersects with other demographics,
including but not limited to gender identity and sexuality, and recognizes the impact
racism has on the experiences of various people of color, including Hispanics, Native
Americans, and Asian Americans (George, 2021). The approach has branched into
LatCrit, TribalCrit, and AsianCrit, which have emerged from CRT, explaining the impact
on each culture (Delgado et al., 2017). These other branches seek to examine specific
experiences of oppression (George, 2021).

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Critical race theory is associated with prejudice and inequalities of race and
focuses on minorities, specifically African Americans, and their communities (Graham et
al., 2011). The theory explains historical patterns such as segregation due to slavery and
the impact of Jim Crow laws, which were state and local laws legalizing racial
segregation. Jim Crow laws were a racial caste system that operated between 1877 to the
mid-1960s in the southern and border states (Mack, 2017; Pilgrim, 2000). These laws
denied African Americans the right to vote, get an education, hold specific jobs, and
other opportunities and passed statutes to regulate social interactions between races
(Mack, 2017; Pilgrim, 2000).
Jim Crow signs were placed at public facilities, door entrances, and above-water
fountains. There were separate prisons, schools, churches, public restrooms, and
cemeteries for African Americans and Whites. Segregation was created as some believed
White and African Americans could not coexist. Under the Jim Crow Laws, controlled
segregation used signs labeled Whites only and Colored only (Pilgrim, 2000). The
African American facilities were generally unclean and older, or there were no
accommodations for African Americans at all. African Americans who violated Jim
Crow laws were beaten by White Americans, jailed, and possibly lynched (Hansan, 2011;
Library of Congress, n.d.; Pilgrim, 2000). African Americans did not have legal options
because the justice system was all White under the Jim Crow laws, including judges,
juries, the police, and prosecutors (Pilgrim, 2000). These events led to inequalities for
African Americans and other minorities.
There are three primary objectives of CRT to include experiences of
discrimination against people of color, racial subjugation and the acknowledgment of

15
race being a social construct, and other issues of dissimilarity such as socioeconomic
class and injustices experienced (Graham et al., 2011). Critical race theory examines race
and racism within one’s culture and helps one understand those affected by systemic
racism and how individuals may represent themselves when faced with prejudice. There
are vital connections with America’s history of slavery, the civil rights movement,
current events, and critical race theory. Essential topics of CRT include understanding the
significance of one’s health and social life, which may consist of social struggles and
historical problems causing illnesses (Graham et al., 2011). The history of African
Americans’ mental health and illnesses has included racism and discrimination that
affects some African Americans’ ability to seek treatment (Umeh, 2019).
Research explains that race may affect psychological illnesses and health.
Understanding CRT can become meaningful to those who research mental health. Further
knowledge of this theory explains the connection between racial inequalities and how
they contribute to health and diseases (McCoy & Rodricks, 2015). Inequalities continue
through bias or as some cultural orientations are privileged over others (Graham et al.,
2011). When cultural norms are devalued, it can lead to an act of liability and sources of
ineradicable shame. Therefore, CRT examines topics and issues related to the
disadvantages of groups and cultures, such as racism, identity, heterosexism, hegemony,
homonegativity, or unequal power in societies (Graham et al., 2011). This qualitative
research explains oppression and racism and how it has contributed to the effects of
seeking mental health among African American students and graduates. Critical race
theory describes the relationship between the factors that may contribute to the
16
experiences and perceptions of African American first-generation college students and
graduates.
Historical Trauma Theory
The theory of historical trauma has been explained as a part of the clinical health
science works of literature. Historical trauma consists of psychological suffering and
health disparities within the indigenous population. Indigenous historical trauma
emphasizes adversity related to the populations’ ancestors that has been transmitted and
passed down to their descendants (Gone et al., 2019). African Americans are one of the
many groups vulnerable to historical trauma. Elements of historical trauma can result
from a group of people or individuals who have experienced trauma throughout
generations. Historical trauma theory refers to the cultural group affected by trauma-
related experiences and symptoms without being present in the previous traumatizing act
(Mohatt et al., 2014). In addition, there are psychological effects from events that have
happened decades before the current generation; however, trauma can impact families,
individuals, and a community (Hoskins, 2022; Jones, n.d.).
Historical trauma theory is a collective trauma experienced within a racial or
ethnic minority population. Historical trauma theory explains the influences and health of
communities and individuals. There is a history of group trauma, victimization, and
oppression among African Americans, including the Tuskegee Syphilis Experiment, J.
Marion Sims experiments, the eugenics movement, and the Henrietta Lacks experiment.
The Tuskegee Syphilis Experiment consisted of hundreds of African American men who
were infected with syphilis and untreated, although there was a cure. The cure was
withheld from men in the experiment. Dr. J. Marion Sims performed surgical
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experiments on African American enslaved women without consent. The Eugenics Board
of North Carolina used forced sterilizations targeting African American women.
Henrietta Lacks was an African-American woman whose cancer cells were used for
research without permission or knowledge from her or her family (Miller & Miller,
2021). Medical research and experiments on African Americans have led to considerable
medical mistrust in the Black community (Mohatt et al., 2014). The legacy of torture,
lynching, medical experiments, forced sterilizations, forced migration, brutal
colonization, and slavery are historical and significant to the Black community (Equal
Justice Initiative, 2017).
African Americans have survived centuries of social and economic oppression in
the US. Some African Americans have historical oppression within their culture, causing
a history of generational and historical trauma, which can also be explained as
intergenerational trauma (DeAngelis, 2019; Equal Justice Initiative, 2017). Canadian
psychiatrist Vivian M. Rakoff explained generational trauma in 1966 while researching
the psychological torment received by the descendants of survivors of the Holocaust
(DeAngelis, 2019). Because of Rakoff’s explanations, other researchers have assessed
depression, post-traumatic stress disorder, and anxiety in other trauma survivors
(DeAngelis, 2019).
Related Literature
History and Background of Mental Health
According to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.),
mental health is how one thinks, feels, and their well-being. Factors include how
individuals view their abilities to cope with everyday work and productive stresses of life
18
can contribute to one’s mental health (Fusar-Poli et al., 2020). Mental health is critical to
individuals’ ability to emote, interact with others, work, think, and enjoy a quality life
(World Health Organization, 2018). Previously, a lack of scientific evidence caused
individuals to make other explanations to understand the cause of mental disorders. There
was a common belief that those with psychological disorders were being punished by
God or possessed by demons (Farreras, 2023).
As society began understanding mental illnesses, they were first categorized into
supernatural, somatogenic, and psychogenic theories. The supernatural theory explains
mental illnesses as having demonic spirits, being possessed by evil, curses, and sin. The
somatogenic ideas refer to those who suffer from abnormal physical functioning caused
by an illness, brain damage, or genetics. Psychogenic theories consist of traumatic
experiences or distorted perceptions. These theories have helped caregivers determine the
type of treatment needed for individuals who may have been diagnosed with mental
illnesses (Farreras, 2023).
During the late 1400s to the 1600s, there was a common belief that those who
suffered from mental illnesses were possessed by demons or made pacts with the devil
(Dunn, 2017). Society considered them witches under the influence of witchcraft,
resulting in their being condemned by courts. An estimated 10,000 individuals with
mental illnesses were killed during this time (Farreras, 2023).
Phillippe Pinel, a French physician of the 1700s, advocated for those with a
mental illness. Pinel believed they should be unchained and have access to someone to
speak to about their mental health conditions. Pinel used this treatment with patients at La
Salpêtrière in Paris, France. As this change was made, patients could be discharged from
19
the hospital due to the humane treatment (Misra et al., 2019). In the US, Benjamin Rush
created the country’s first hospital to house individuals treated for mental health illnesses.
In 1773, hospitals began being designed specifically for individuals with mental illness;
Virginia was the first state to have a hospital for this population, and later in the 1800s,
Kentucky, Massachusetts, New York, and other states followed (Misra et al., 2019).
In the 1800s, some individuals who presented abnormal behavior were placed in
asylums (Farreras, 2023). Asylums were the first institutions to house individuals who
had psychological disorders (Farreras, 2023). The focus was to separate individuals
suffering from mental issues from the rest of society rather than treating their
psychological conditions. The individuals rarely had contact with caregivers, were
beaten, and were chained to beds (Misra et al., 2019).
In the 1900s, efforts were made by Dorothea Dix regarding mental health care.
Dix researched the treatment for the mentally ill and discovered the abuse, poor patient
care, and underfunded systems for the mental illness population. Dix began petitions with
US Congress and state legislators to advocate for a change. Dix founded 32 hospitals that
treated mentally ill patients ethically (Misra et al., 2019). In the early 1900s, the mental
hygiene movement was designed to help continue improving mental health care. Clifford
Beer was a patient who had firsthand experience with the issues of the institutions. In
1908, he published A Mind That Found Itself, a book to advocate for change and
reorganization of hospitals and to establish mental health associations (Misra et al.,
2019).
Shortly after World War II, there were new initiatives regarding mental health
policies (Misra et al., 2019). The National Mental Health Act was passed in 1946,
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creating funding for psychiatric education and research and ultimately creating the
National Institute of Mental Health in 1949. In 1963, the Community Mental Health
Center Act and the Mental Retardation and Community Mental Health Centers
Construction Act were passed, prompting increased funding for creating centers in the
community that provided a wide range of psychiatric services (Tracy, 2019).
The Community Mental Health Centers Construction Act had three initiatives.
The first initiative was to provide federal funding to states to build centers for treatment
and care for those diagnosed with mental health conditions. Second, outpatient, inpatient,
and satellite treatment were created within major medical centers and universities. Third,
Congress planned to fund training teachers and research centers to learn more about
mental health conditions and human development. This act aimed to decrease the number
of mental health patients under custodial care by 50 percent within ten to twenty years
(Kim, 2017).
In the late 1960s and 1970s, the deinitialization movement was a significant part
of America’s mental health policy. Deinitialization included new medications to help the
mentally ill with symptoms, insurance available for inpatient mental health coverage, and
financing for community-based centers helping with mental health care (Misra et al.,
2019). In the 1980s, the US experienced fiscal cutbacks from then-President Ronald
Reagan’s administration. Government regulations were removed from many mental
health care programs, leading to states having to create their policies and procedures. The
removal of government regulations also led to limited mental health programs and a lack
of support (Misra et al., 2019).

21
Prevalence of Mental Illnesses
The high prevalence of mental illnesses is a serious public and medical factor
worldwide; it was estimated that 322 million people would be diagnosed with mental
health conditions or disorders in 2021 (Bezerra et al., 2021). Mental health disorders
affect low, middle, and high-income countries worldwide, as some form of mental illness
affects nearly one-third of the global population (Bezerra et al., 2021). The prevalence of
mental illness impacts social and economic issues, employment loss, higher healthcare
costs, quality of life, and productivity (Rancans et al., 2020). Researchers have found that
the rates among patients with severe mental illness die about 10‒20 years earlier than the
general population (de Mooij et al., 2019). According to The World Health Organization,
individuals diagnosed with schizophrenia and depression have a greater chance of earlier
death by 40 to 60% than those without the diagnoses (Rancans et al., 2020).
Common mental disorders’ risk factors for psychological distress are depression,
anxiety, and suicidal ideations (Bezerra et al., 2021). Suicidal ideation can be associated
with schizophrenia, mood disorders, substance use disorders, and anxiety. These risk
factors explain the importance of understanding the early detection of mental health
disorders (Rancans et al., 2020). Daily activities such as work environment relationships,
everyday living, and being social with friends and family are affected when one suffers
from common mental disorders (Bezerra et al., 2021; Rancans et al., 2020).
Mental Health Stigma
Mental health stigma is the disgrace, social disapproval, or discrediting of
individuals with mental health conditions. Stigma is one of the barriers causing
individuals not to seek and receive proper treatment. Mental health stigma causes
22
discouragement in seeking help for behaviors and lessens the likelihood of appropriate
use of mental health services (Minichil et al., 2021). The cause of stigma may stem from
family, cultural, personal, and social sources. Research reveals that mental illness stigma
can arise from a lack of knowledge and understanding. Often, people relate agitation,
violence, or aggressiveness as a characteristic of mental health illness, resulting in
implications for patients and increasing a sense of isolation secondary to discrimination
(da Silva et al., 2020).
Understanding mental health stigma clarifies the rationale for the higher levels of
stigma toward psychotherapy. Minorities have a higher level of mental health stigma than
other cultural groups (DeFreitas et al., 2018). In a qualitative study, Matthews et al.,
(2006) revealed that African Americans were embarrassed to seek treatment for their
mental health and reported in their communities that the stigma behind mental health had
been an ongoing issue. African Americans have insecurities regarding how others view
them if they know they utilize mental health resources or treatment (DeFreitas et al.,
2018). There has been an ongoing issue regarding incorrect information from generation
to generation in the African American community. Having misinformation may cause
significant factors to create a stigma (DeFreitas et al., 2018).
The quality of mental health services and treatment has significantly improved
over the last 50 years; however, reducing mental health stigma is still a significant
concern (da Silva et al., 2020). Because of the mental illness-related stigma, many
mentally ill people have poor health care quality and treatment. Stigma impacts one’s
ability to seek treatment and the work environment of health providers (da Silva et al.,
2020). Many individuals who may suffer from mental health conditions tend to lack a
23
support system due to the stigma associated with mental health (Mannarini & Rossi,
2019). Stigma prevents those with mental illness from accessing professional treatment.
The condition may worsen without proper psychological and medical treatment (Subu et
al., 2021).
Public stigma manifests when labeling, separations, stereotyping, status loss, and
discrimination co-occur within a situation of inequitable power (Parcesepe & Cabassa,
2012). Mental illness is associated with anger, fear, prejudice, and exclusion. Mental
illness stigma causes interference with patients’ quality of care (Parcesepe & Cabassa,
2012). Stigma is an underlying cause of health inequalities, causing reluctance to seek
mental health services and influencing health decisions (da Silva et al., 2020). Due to
mental illness stigma, people may avoid seeking help for mental health due to a fear of
disclosing a diagnosis (Mannarini & Rossi, 2019).
Types of Mental Illness Stigmas. Mental illness stigma can make an individual
reluctant to seek mental health care due to negative attitudes and beliefs (Pescosolido et
al., 2021). Living with mental illness stigmas has been described as being worse than
having experienced mental health conditions or illness (Shahwan et al., 2022). There is a
concern about stigma among policymakers, mental health professionals, advocacy
groups, and patients (Pescosolido et al., 2021). The stigma associated with mental illness
has been characterized as public, perceived, self, institutional, professional, structural,
label avoidance, and stigma by association (Grappone, 2018; Subu et al., 2021).
Public mental illness stigma refers to negative attitudes and beliefs motivating
individuals to fear, reject, avoid, and discriminate against people with mental illness
(Conley, 2021). Research has demonstrated the significant impact of public stigmas,
24
which can lead to discrimination in workplaces and public agencies, which is punishable
by law (Subu et al., 2021). Stereotypes common among people with mental illness are
being dangerous, incompetent, and unpredictable. Having these stereotypes causes one to
become fearful and uncertain, which may also lead to one’s mental illness becoming
untreated (Ong et al., 2020).
Related to public stigma is perceived stigma, defined as an individual’s beliefs
about the attitudes of others toward mental illness (Subu et al., 2021). Perceived stigma
refers to how a person believes others will view them and how they will be treated. This
stigma is associated with discrimination and deviation from others. Some who suffer
from mental illnesses may experience shame, psychological suffering, and
embarrassment from family and friends. Because of the belief of being stigmatized due to
the stereotypes of mental illnesses may lead to a delay in seeking help or not seeking
treatment at all (Minichil et al., 2021).
Self-stigma involves negative attitudes, embarrassment, shame, and
disappointment from those with a mental illness diagnosis (Minichil et al., 2021). Self-
stigma can affect self-efficacy, self-esteem, and one’s view of their overall life. Without
proper treatment and services, individuals may experience adverse outcomes (Minichil et
al., 2021; Ponte, 2021). Those who struggle with self-stigma may face alienation,
stereotype endorsement, discrimination, and social withdrawal (Ponte, 2021).
Institutional stigma refers to the policies or culture of an organization. An
intuitional stigma may consist of negative beliefs and attitudes toward those suffering
from mental health conditions. Institutional stigma can be reinforced by professional
practices and legal and public policies, which may affect society significantly (Subu et
25
al., 2021). Institutional stigma affects the policies of the government and organizations
and its lack of funding for mental illness research (Mannarini & Rossi, 2019).
Professional stigma occurs when some healthcare professionals hold stigmatizing
attitudes toward their patients. This stigma is typically based on fear or
misunderstandings of the symptoms of mental illness or when professionals themselves
experience stigma. Professionals may develop this stigma from the public or other
healthcare professionals because of their employment and connection with stigmatized
individuals (Subu et al., 2021). Stigma affects those who suffer from mental illnesses and
their family and friends (Mannarini & Rossi, 2019).
Structural stigma is related to cultural norms, institutional policies, and
organizational practices that decrease consumers’ opportunities to receive mental health
services and quality of care (Corrigan, 2004; Klein et al., 2021). Corrigan and Phelan
(2004) suggested that intuitional policies have been embedded in structural stigma,
causing the restrictions of opportunities or yielding unintended consequences for those
stigmatized. Structural stigma occurs when a person discloses their history of mental
illnesses during employment or school applications, limiting privacy and discrimination
(Ong et al., 2020).
Label avoidance occurs when individuals decide not to seek mental health
services or treatment to avoid a stigmatizing label. Label avoidance can harm those
suffering from mental health conditions (Nohr, 2021). Those who suffer from internal
stigma caused by negative public views of individuals with mental illnesses can lead to
label avoidance stigma (Fox, 2021). Label avoidance may lead to consequences in one’s
family dynamics, employment, and friendships (Fox, 2021).

26
Sociologist Erving Goffman first introduced stigma by association, which is also
referred to as courtesy stigma. Stigma by association involves an individual’s disapproval
of someone with a mental illness (Phillips & Benoit, 2013). People associated with
individuals with mental illnesses can be stigmatized because they are, in some way,
connected to someone with a stigmatized identity (van der Sanden et al., 2016, p. 1).
Stigma by association can limit social support and cause social isolation (van der Sanden
et al., 2016). Those who experience stigma by association may avoid attending or
participating in social events to prevent possibly becoming a victim of discrimination.
This group may also isolate themselves from others to avoid dealing with misperceptions
and stereotypes (van der Sanden et al., 2016).
Mental Health Literacy
The term mental health literacy (MHL) was first used in 1997 by Jorm et al. to
describe the beliefs and knowledge of mental disorders (Dang et al., 2020). Jorm et al.
defined MHL as the ability to understand, gain access to, and use information in ways
that promote and maintain good health. When possessing MHL, one is also
knowledgeable of mental health conditions, management, and prevention (Jorm et al.,
1997).
MHL is essential to helping oneself and others regarding mental health conditions
and supporting attitudes toward mental health issues. Mental health development and
support are central to health literacy (Dang et al., 2020). Research regarding MHL has
shown that many do not seek mental health care or postpone seeking help (Dang et al.,
2020).
27
Mental health literacy is a social health determinant, leading to improved health
factors, patient empowerment, and reduced inequalities. This form of literacy also
consists of applying one’s prior knowledge to understand mental health care and how to
advocate for health improvements (Fusar-Poli et al., 2020). Mental health literacy has
been researched as a supportive way to assist when seeking help for others and
themselves. Having MHL helps with the attitudes of mental health stigma and problems
(Dang et al., 2020). Tambling et al. (2021) expressed, “Poor mental health literacy and
the potentially confounding challenge of poor health insurance literacy poses problems
for adequate mental health awareness, treatment, and care reimbursement” (p. 3).
Because of the lack of MHL, people with mental illness cannot recognize
symptoms due to a lack of knowledge and inappropriate responses from society and peers
(Nguyen & Nguyen, 2018). Those with a higher knowledge of mental health better
understand mental health issues and their symptoms. Having MHL encourages
individuals to seek information and help (Tambling et al., 2021). DeFreitas (2019) stated,
Research has also suggested that incorrect information about mental illness is
passed down throughout generations of African American families. This
misinformation about the cause of mental illness is a potential factor in
perpetuating stigma beliefs. These ideas ‒ i.e., not believing in biological causes
of psychological disorders—are related to thoughts about how treatable
psychological conditions are perceived and how likely those with mental illness
will recover. (p. 3)
According to scholars, having a poor understanding of mental health hinders
individuals from seeking mental health care and resources (Furnham & Swami, 2018).
28
Individuals with MHL will better understand mental health problems and symptoms.
Having higher levels of MHL helps individuals when seeking help and learning how to
treat mental health issues (Furnham & Swami, 2018).
A lack of culturally relevant research on the mental health experiences of African
Americans might also result in misconceptions regarding the treatment of mental health
conditions within the Black community. Also, lacking MHL may make individuals
perceive mental illnesses as a weakness. Not understanding the symptoms may make
them less likely to seek help (Tambling et al., 2021). Therefore, without knowledge of
MHL, treatment providers, and patients are less likely to recognize culturally specific
manifestations of symptoms of mental illness.
Behavioral health care use is associated with MHL and the likelihood of seeking
mental health services. According to Tambling et al. (2021), there are indications of low
rates of MHL and an association between stigma and health insurance literacy. Their
study assessed mental health literacy, mental health, and health insurance literacy
(Tambling et al.). In addition, the study included a diverse group of Americans in the US
during the COVID-19 global pandemic (Tambling et al., 2021). Without the proper
knowledge of MHL, many individuals continued to work without having mental health
disorders identified, leading to a lack of treatment and other difficulties due to disorders
(Tambling et al., 2021).
Untreated Mental Illness Outcomes
Untreated mental illnesses have been an ongoing issue for mental health services
(Kessler et al., 2001). Untreated mental illnesses cause a steady decline in one’s mental
health. The more prolonged mental conditions persist, the more difficulties in treatment.
29
Some individuals may experience few symptoms when first diagnosed with a mental
illness; however, leaving signs untreated may cause more intensive and uncertain
treatment recovery (Young, 2015). According to the National Alliance on Mental Health
(NAMI), the cost of untreated mental illness is estimated at $300 billion per year of
productivity (Gillison & Keller, 2021). Several factors, including mental illness stigma,
have caused higher percentages of untreated mental illness in the US. Untreated mental
illness may lead to direct and indirect conditions such as physical health issues, being
taken advantage of by others, job instability, financial problems, and suicide productivity
(Gillison & Keller, 2021; Young, 2015).
Delayed treatment for mental health disorders may lead to suicide. According to
medical autopsies from the middle of the previous century, most people who have died
by suicide have suffered from mental health conditions (Brådvik, 2018). Various risk
factors contribute to individuals’ suicide attempts, including but not limited to lack of
mental health literacy, loss of social network, depression, anxiety, separation of family,
and other barriers (Brådvik, 2018).
College Students and Mental Health
Mental health conditions among college students have been a significant public
health issue (Gaiotto et al., 2022). Mental health concerns, specifically depression and
anxiety, have been rising among college students (Hanson et al., 2022). In 2018, the
World Health Organization (WHO) completed a survey of 14,000 college students
worldwide. Within the study, more than a third of students faced mental health challenges
(Hanson et al., 2022). Anxiety and depression can significantly impact college students’
academic achievement (Hanson et al., 2022).

30
College students may face employment competition, academics, distance from
family and friends, and environmental adjustments. Mental health issues among college
students may affect their professional lives (Gaiotto et al., 2022). Additionally, Gaiotto et
al. (2022) stated that this issue “reinforces the importance and need for the development
of institutional coping strategies, with the university environment being considered fertile
for the conduct of actions that promote mental health” (p. 2). Students experiencing new
life changes can feel stress without the proper coping mechanisms (Hanson et al., 2022).
Some campuses have developed prevention programs to assist students with
mental health issues. The programs are created to help with clinical services that are
available to students. Some colleges offer prevention programs that are designed to build
skills to help those who are faced with stressful situations. Such programs offer education
related to general health, providing coping strategies to support students and campaigns
to help reduce stigma around mental health (Wei, 2022).
HBCUs and Mental Health. HBCUs educate more African American students
than predominately White institutions (PWIs). In Polishchuk’s (2022) study, African
Americans reported anxiety, stress, and depression while attending their HBCUs. In
2022, the United Negro College Fund (UNCF) conducted a survey which stated the
following:
The findings included that 95% of students who responded to an online survey
reported that COVID-19 had negatively affected their mental health, 46% said
feelings of social isolation, 45% increased anxiety, 36% increased depression, and
35% increased severity of stress, and 32% loss of hope or a sense of helplessness.
(Greenfield, 2023, p. 2)
31
College tuition has continued to increase, leading to debt and the financial
challenges students may face after completing courses. Students attending HBCUs have
reported that financial assistance, loan repayment, and future educational expenses have
contributed to ongoing stress (Polishchuk, 2022). As mental illness conditions continue to
rise, HBCUs remain essential to educating African American students. Overlooking the
challenges associated with mental health contributes to the six-year graduation rates for
some African American students (Walker, 2015).
First Generation College Students of Color. Thirty percent of college students
represent first-generation students of color (FGSOC). Some FGSOCs may have increased
social and psychological issues compared to other ethnic groups. Some FGSOCs lack
academic preparation, racial discrimination, socioeconomic stigmas, marginalization, and
cultural differences (Schuyler et al., 2021). First-generation college students of color
sometimes stem from families with lower socioeconomic status. They may face barriers
that may lead to isolation and alienation and can lead to increased mental health
challenges (Schuyler et al., 2021).
Access to emotional support is vital for the well-being of college students, as the
transitional nature of college and young adulthood can contribute to increased
psychological difficulties, including depression, anxiety, and stress. Despite their
potential for improved mental health, FGSOCs are often unlikely to seek psychological
support through counseling centers on campus (Espinosa et al., 2019; Stebleton &
Huesmane, 2014). The number of African American, Asian, Pacific Islander, Native
American/Alaska Native, and multiple-race non-Hispanic attending colleges and
universities will increase in the coming years. FGSOCs are more likely to have
32
experienced conditions that impact their health, education, and development, such as
experiences resulting from systemic racism and oppression, than other ethnicities within a
college or university’s student body (Espinosa et al., 2019). Further, some FGSOCs are
often more likely than continuing-generation students to view themselves negatively if
they seek professional mental health services (Espinosa et al., 2019; Garriott, 2020).
Mental Health Gender Differences
According to the American Psychiatric Association (APA, 2022) book entitled
Diagnostic and Statistical Manual of Mental Disorders (5 ed., text rev.), the term gender
differences entails variations that result from one’s biological sex and self-preference.
The APA (2022) states, “Sex differences are variations attributable to an individual’s
reproductive organs XX or XY chromosomal complement” (p. 15). However, some
gender differences are solely based on one’s biological sex (APA, 2022). Mental health
differences between women and men have been characterized by gender and sex
differences. Along with anatomy, genetics, and physiology, a person’s sex is a part of
their biological construct (Otten et al., 2021).
Sex and gender differences significantly affect mental health and mental illness.
Though biological differences between men and women may impact mental health,
societal differences between men and women can influence the development of mental
health issues. Gender is used to construct roles, behaviors, and identities socially. Some
women face societal barriers regarding social and economic determinants of mental
health, such as susceptibility and exposure to mental health risks and social
considerations. Research has shown significant differences between genders regarding

33
the development of common mental health disorders, with some diseases being more
prevalent in women (Otten et al., 2021).
Gender can also determine whether a person is at risk for disorders such as
diasporic premenstrual disorder, which is only found in women. The likelihood of
symptoms from a disorder can be influenced by gender. Some signs are more prevalent in
men or women (Mishra et al., 2023). As noted by the APA (2022), “Studies show women
may be likely to recognize a depressive, bipolar, or anxiety disorder and endorse a more
comprehensive list of symptoms than men” (p. 15).
Gender has psychosocial elements that make men and women different. Gender
can be distinguished based on behavior norms, gender relations, gender identity, and
institutionalized gender (Otten et al., 2021). Often, society has ideas and opinions
referencing the behaviors deemed acceptable for men and women, which are referred to
as gender roles. However, men and women often have characteristics based on their
cultural ideas of femininity and masculinity instead of role identities or psychological
qualities (Coveney, 2022). Sex and gender differences can significantly affect mental and
neurological disease and disorder rates. Women can be regularly affected by some health
problems of women only, while many men can be affected by some health conditions of
only men. Social groups, culture, and experiences influence men’s and women’s mental
health (Suanrueang et al., 2022).
Research revealed that in the US, women have reported higher levels of distress
than men. In addition, women are more likely to have an emotional or mental health
disorder than men presenting similar symptoms (Coveney, 2022). During some women’s
adulthood, there is a significantly higher rate of depression and anxiety, while men have a
34
higher prevalence of substance abuse and antisocial disorders. Most depression and
anxiety disorders in women are based on women’s biological and genetic factors
(Coveney, 2022).
According to the WHO, men are 1.8 times more likely to die by suicide than
women (Sagar-Ouriaghli et al., 2019). Although there is a higher rate of suicide among
men, reports show men have a lower rate of depression, which is a significant factor that
can lead to suicidal ideations or suicide (Sagar-Ouriaghli et al., 2019; Suanrueang et al.,
2022). Men are less likely to seek help for mental health conditions and are more likely to
have adverse perceptions of mental health treatment and services (Sagar-Ouriaghli et al.,
2019). Men may be more vulnerable to negative attitudes and beliefs toward mental
illness, restricting their ability to seek help (McKenzie et al., 2022). Experiencing mental
illness may transgress gender roles within the male culture. Some men are encouraged to
use self-reliance while caring for their health needs rather than seeking proper treatment.
Society’s gender roles may increase fear and shame, increasing stigma among males
(Coveney, 2022).
Socio-cultural factors reveal that some women have biological factors leading to
common mental disorder symptoms. These symptoms are sometimes linked to women’s
reproductive cycles. Various estrogen-related moods are associated with premenstrual,
menopause, and puerperium (Bezerra et al., 2021). Society has associated the stereotype
that women are expected to be more emotionally sensitive with women’s likelihood of
having mental health conditions (Hentschel et al., 2019). Women experience depression
twice as much in their lives compared to men. Social, gender, genetic, and economic
35
differences are a few factors that may contribute to the development of depression in
women (Hentschel et al., 2019).
Women are twice as likely to experience post-traumatic stress disorder (PTSD)
than men. PTSD can stem from domestic violence, sexual abuse, and other traumatic
experiences leading to women developing symptoms of PTSD. Women are more likely to
have suicide attempts, although men are more likely to die by suicide (Bommersbach et
al., 2022; De visé, 2023). Furthermore, young men and women with lower mental health
literacy are more likely to hold negative views toward those with mental illness,
suggesting increased stigma may stem from having less exposure to and knowledge of
mental illness (McKenzie et al., 2022; see Figure 1).

36
Figure 1
Percentage of Adults 18 and Older Who Have Received Mental Health Treatment, Take
Medication, and Received Therapy in the Past 12 Months by Gender in the US 2020
Note. Adapted from Terlizzi, E.P., & Norris T. (2020). Mental health treatment among
adults: United States, 2020. NCHS Data Brief, No. 419. National Center for Health
Statistics. https://doi.org/10.15620/cdc:110593external icon
Mental Health Gender Differences among African Americans
According to the study completed by the National Center for Education Statistics
in 2020, African American women have been obtaining college degrees at a high rate for
the past decade (Davis, 2020). The statistics showed that African American women were
enrolled in college at a more significant percentage than other ethnicities or genders
(Davis, 2020). While African American women have excelled in higher education across
the US, they face many inequalities that affect their mental health (Dawson, 2022).
37
African American women face race and social injustices rooted in the history of their
culture, including sexism, racism, and financial inequities (Richards, 2021).
In the Black community, African American women often have the cultural
expectation of having strong determination and emotional strength even when faced with
hardships and adversity (Castelin & White, 2022). The Strong Black Woman Schema
(SBWS) is an emerging construct that highlights the impact of race and gender on the
identity of African American women and is argued to play an essential role in the stress
and health of African American women (Castelin & White, 2022, p.196). The SBWS
proposes that African American women can cope with stressors without the proper
support needed to overcome challenges (Castelin & White, 2022). Going against the
norms of traditional cultures can sometimes create malalignment and disharmony within
an individual (Hamedani & Markus, 2019). Those stressors may cause psychological
distress, leading to depression and driving suicidal behaviors in African American
women (Atewologun, 2018; Castelin & White, 2022).
Intersectionality theory outlines the language and mindset for examining
interconnections and interdependencies between social groups such as women and other
systems (Atewologun, 2018). Intersectionality theory suggests that African American
women differ from African American men because African American women are part of
a double minority status, leading to psychological experiences (Castelin & White, 2022).
These experiences may include gendered racial microaggressions and mental illness
stigma (Lui, 2019). Those psychological experiences place African American women at a
greater risk of experiencing PTSD than White women (Castelin & White, 2022). Being
diagnosed with PTSD has led to African American women being twice as likely to have a
38
diagnosis of major depressive disorder compared to African American men (Castelin &
White, 2022).
Having exposure to trauma increases the impact of developing mental health
disorders. African American men are at a greater risk of experiencing or witnessing
traumatic events than their White counterparts (Bauer et al., 2022). African American
men aged 18-30 are less likely to seek services (Bauer et al., 2022). However, mental
health screening is recommended by the National Institute for Mental Health when one
undergoes trauma compared to other male and female peers and older African American
men and women (Bauer et al., 2022). Some African American men have exemplified
high levels of resilience when faced with adversity. Self-resilience is a coping mechanism
for mental health concerns (Bauer et al., 2022; Hoskin, 2022).
African American men may have been accustomed to social norms, leading them
to struggle with being vulnerable and open to sharing their feelings and emotions
(Hoskin, 2022). Social inequality and racial discrimination risk some African American
men’s mental health. African American men have a lower prevalence of major depressive
disorder than African American women and men of other ethnicities. However, research
has found evidence of misdiagnosis and racial and gender biases among African
American men (Adams et al., 2021). Adams et al. (2021) noted, “Researchers have
recently highlighted the divergence between lower depression diagnoses and rising rates
of suicide completion among Black boys and men, which has necessitated national
attention among researchers and policymakers” (p. 3).

39
Cultural Impact and Mental Health
Culture includes systems of norms, behaviors, values, history, and language used
and passed throughout generations. Culture also involves communication, family roles,
social roles, and spirituality (Johnson & Carter, 2019). According to the Diagnostic
Statistical Manual (5th ed.), mental disorders relate to cultural, familial, and social norms.
Mental health conditions may be connected with community engagement, cultural
perceptions, and spirituality. These beliefs substantially impact the rationale and
expectations when seeking care (Wharton et al., 2018).
Culture can impact health outcomes, and understanding the relationship between
culture and health can help improve health-related behaviors (Ogundare, 2020). Culture
may influence an individual’s symptoms, ways to cope with mental health challenges,
and willingness to seek services or treatment (Ogundare, 2020; Wharton et al., 2018).
Ogundare (2020) stated, “Culture is central to the etiology of mental disorders as it
provides standards for normality and abnormality, and the definitions of what constitutes
a mental disorder are socially and culturally negotiated ” (p. 26).
Understanding culture helps in assisting patients’ needs. Cultural factors play a
significant role when the provider makes a diagnosis and provides a treatment plan.
Neglecting social and cultural factors may lead to misdiagnosis and stereotypes
associated with gender, ethnicity, and race, causing disparities in mental health. Being
culturally sensitive in a doctor or clinician-patient relationship significantly impacts
outcomes beyond mental health and psychiatry, as well as gynecology, pediatrics, and
obstetrics (Ogundare, 2020). Specifically, in the US, dating as early as the 1900s, there
has been a misdiagnosis of mental health disorders among African Americans (Ogundare,
40
2020). Studies have shown that the mortality rate for African American newborns
decreases by close to 50% when attended to by those of the same race (Richards, 2021).
Cultural competence is awareness of values, attitudes, and policies that enable the
knowledge of one’s cultural history and how they may differ from other cultures. Cultural
competence can be a lifelong journey of learning and understanding various cultures.
Clinicians can benefit from being culturally competent as it can help communicate
effectively between patients and caregivers (Ogundare, 2020). Cultural competence may
help define problems and plan interventions that are best for a patient’s treatment plans.
Physicians and patients sharing similar cultural backgrounds can help understand
symptoms and make the proper diagnoses without making assumptions (Ogundare, 2020;
Vance, 2019). Culturally responsive providers understand and recognize the cultural roles
and assist other healthcare providers with efficient treatment for clients’ needs (Vance,
2019).
Historically, African Americans have a financial burden or an issue with health
insurance providers (Dempsey et al., 2015). African Americans have much higher
uninsured rates than White Americans (Baumgartner et al., 2020; 2021; K. F. Umeh,
2019; see Figure 2).

41
Figure 2
Percentage of Uninsured Adults Ages 19-64 by Race and Ethnicity
Note. Baumgartner, J. C., Collins, S. H., & Radley, D. C. (2021, June 9). Racial and
ethnic inequities in health care coverage and access, 2013–2019. Commonwealth Fund.
https://www.commonwealthfund.org/publications/issue-briefs/2021/jun/racial-ethnic-
inequities-health-care-coverage-access-2013-2019
The lack of culturally responsive mental health care can relate to racism and
prejudice in a daily environment (Vance, 2019). However, racial matching clinicians with
clients may not always be an option due to the lack of minority clinicians and
representation available in mental health (Meyer & Zane, 2013). Based on the American
Psychiatric Association (APA, 2022) data, just two percent of the estimated 41,000
psychiatrists in the US are African American, and only four percent of psychologists are
African American (O’Malley, 2021).

42
Because of the limited number of African American clinicians, some African-
Americans may struggle to feel that other races will not understand their life experiences
(Dempsey et al., 2015). According to the 2020 Association for University and College
Counseling Center, 61% percent of counseling staff are White, and 13% percent are
Black (O’Malley, 2021). The APA began to focus on equity, inclusion, and diversity. In
2021, their annual conference was dedicated to equity. In addition, the APA has used its
platform to recruit and employ more underrepresented mental health practitioners
(O’Malley, 2021).
The shortage of psychiatrists and counselors of color severely affects all Black
individuals needing treatment. One in three Black adults who need mental health
care receives it. Because of the scarcity of mental health professionals of color, it
can be difficult for African Americans to find a practitioner with whom they feel
comfortable sharing race-related trauma. (O’Malley, 2021, p.1)
According to Bilkins et al. (2015), some African Americans are concerned with
non-African mental health clinicians; they may feel negative African American
stereotypes influence clinicians who would not be culturally sensitive. African American
clients may feel mental health therapists lack the knowledge or personal experience of the
racism and trauma of a minority, which causes them to feel dismissed, or the therapists
may be insensitive (Brenner, 2022). The lack of diversity in mental health causes a
challenge for clients due to the professional not having cultural competencies. The lack of
cultural competence offers a problem of racially biased treatment, alleged racist theory,
and potential malpractice because of negligence (Brenner, 2022).

43
Provider Bias and Access to Mental Health Care in the African American Community
Biases are explained as unfounded attitudes, prejudices, or judgments. Bias can
result from a lack of knowledge, culture, or religious beliefs (Solo & Festin, 2019).
Although the US may have shown a decline in institutional and discrimination bias
regarding provider treatment in recent decades, implicit attitudes may impact the
providers’ treatment and behavior choices (Hall et al., 2015). Hall et al. (2015) stated,
“Provider attitudes and behavior are a target area for researchers and practitioners
attempting to understand and eradicate inequitable health care” (p. 1).
Subtle biases may be explained in various ways, including failing to provide
patients with interpreters as needed, failing to complete adequate diagnostic assignments,
providing and recommending treatment options based on assumptions, granting special
privileges such as unfair visitation hours for different families, and using condescending
tones that gives the perception to patients of being unheard and undervalued (Hall et al.,
2015). The relationship and communication between patients and their mental health care
providers are crucial aspects of treatment. Individuals with culturally responsive
providers who understand their identity may receive the best support and care (NAMI,
2021). As Cooper et al. (2022) noted, “Some state legislation requires implicit bias
training to be based on empirical evidence and approved by an accrediting organization”
(p. 3).
Medical mistrust (MM) has increased worldwide in healthcare systems, causing
racial and ethical disparities in psychiatric care. MM causes insufficient care
interventions because of low patient-centeredness and efficiency of treatment processes
(Molua, 2021). The American Board of Internal Medicine Foundation has revealed that
44
59% of patients agree that discrimination and implicit bias have been an issue in health
care in the US, and 49% of physicians agree with these findings (Molua, 2021). Patients
perceive discrimination in the medical industry, and at least half of healthcare providers
understand the issue, and it causes problems in providing a quality medical encounter
(Molua, 2021).
Medical mistrust is caused by insufficient involvement from patients in
psychiatric facilities, leading to poor decision-making, lack of cultural awareness from
the caregivers, denial of the opportunity for informed consent, and discriminative
tendencies by caregivers (Hostetter & Klein, 2021). Medical mistrust is a critical barrier
to treatment regarding stigma, cost of care, and low self-report in at-risk populations.
When patients mistrust their providers, it may lead to issues with attending follow-up
appointments, filling prescriptions, and adhering to medical instructions or advice.
Medical mistrust causes a patient’s health conditions to worsen significantly in
unrepresented populations (Molua, 2021). Twelve percent of the patients reported they
experienced discrimination in the medical setting; African American patients are twice as
likely as White patients to report discrimination, leading to lower trust in medical
providers and the healthcare system (Molua, 2021). Mistrust can be deeply rooted in
prejudices, biases, and racism. These aspects may cause a distrust of those in the helping
profession. Assessing mental health is essential to ensure better treatment outcomes
(Bazargan et al., 2021).
Some African Americans have been reported to be less likely to receive treatment
for depression. African Americans diagnosed with depression and other mood disorders
are more likely to become misdiagnosed with schizophrenia (Lee, 2020). There are some
45
African Americans with a high misdiagnosis of depression. The language physicians use
to describe mental illness symptoms differs as they may use words such as blue or
downhearted instead of the clinical diagnosis of depression (Wharton et al., 2018).
Research has found that African American teens are less likely to ask about or receive
treatment for eating disorders. However, African American teens are more likely to show
symptoms of bulimia (Lee, 2020). African Americans are more likely to be issued drug
testing for misuse or cease their prescriptions than other races (Lee, 2020). African
American patients are more vulnerable to malpractice due to a lack of mental health
clinicians. (Lee, 2020).
African Americans are more likely to receive less treatment than other races;
however, some may have fallen victim to lower-quality health care, even those with
similar insurance, status, income, and conditions as their White peers (Bridges, 2018).
For example, “One study of 400 hospitals in the US showed that Black patients with heart
disease received outdated, more conservative treatments and medications than their
White counterparts” (Bridges, 2018, p. 2). In some instances, African Americans were
provided with less desirable treatments. This lack of treatment and failure to give people
of color quality health care was often rooted in historical and systematic racism. With
persisting negligence in dealing with these issues, life expectancy for these groups
continues to decrease or remain uncertain (Quach, 2020).
Research has found that African Americans are often undertreated for pain by
caregivers relative to White patients. Studies have also suggested that medical residents
believe African American patients have a higher pain tolerance than other races
(Hostetter & Klein, 2021). This treatment in the health care system explains the
46
emotional and physical issues of systemic racism in discriminatory experiences that some
African Americans have encountered while seeking treatment (Hostetter & Klein, 2021).
The Black Church and Mental Health
Literature suggests that some African Americans use their faith by attending
church and receiving support rather than seeking mental health resources. Using religion
has been a common coping mechanism for African Americans as they face stress
(Samuel, 2019). Research has found that 90.4% of African Americans continue to seek
advisement from their place of worship to deal with their mental health conditions
(Armstrong, 2021). Historically, African Americans have a deep-rooted connection with
the Black church. In the Black community, churches are a place to repair any personal or
mental health conditions. The Black church is also often used as an institution to provide
individuals with religious, social, and spiritual needs (Samuel, 2019).
Church support has served as a safe place for those faced with obstacles (Bilkins
et al., 2015). Some feel more at ease within their church’s environment due to an existing
relationship with the congregation and the church’s counselor, if applicable (Dempsey et
al., 2015). Although Black churches are historically known to provide outpouring support
to the Black community, some Black clergy use Bible teachings to correct values. At the
same time, mental health professionals are trained to administer counseling to individuals
diagnosed with mental illnesses (Dempsey et al., 2015).
Therefore, utilizing the Black church has been a critical resource to some
individuals of the Black community and may be a part of their not receiving professional
treatment and services. Usually, individuals receiving counsel from pastors within the
church will not have to pay for the services they receive (Dempsey et al., 2015). Some
47
African Americans may find they receive a therapeutic church experience consisting of
fellowship and the outward expression of prayer, singing, and praising. The Black church
feels an external manifestation provides emotions of therapeutic release that will restore
faith and hope (Dempsey et al., 2015). Hays (2015) stated,
At the organizational level, Black churches serve as a vital cultural resource for
African Americans. Black churches align individuals’ subjective cultures about
African American values, providing a common place for African Americans to
express and celebrate their beliefs. (p. 301)
Discrimination and Mental Health in the African American Community
Discrimination occurs when a group or individual is mistreated compared to
another group or individual. Fibbi et al. (2021) stated, “Discrimination also occurs when
unequal treatment is ascribed to membership in a certain category that cannot be readily
chosen or changed (whether the ascription reflects the actual identity if the individual is
not important)” (p. 1). Specifically, racial discrimination is defined as inequalities based
on a group or individual’s race, ethnicity, origin, and national descent (Fibbi et al., 2021).
According to Mental Health America screenings, racism and discrimination severely
impact Black, Indigenous, and People of Color’s (BIPOC) mental health (Nurideen &
Fuller, 2020). Mental health-related discrimination causes a negative impact when people
are seeking treatment for mental illness (Chatmon, 2020). Ferdinand et al. (2015) stated,
“Exposure to racial discrimination is widely understood as a social determinant of health
and contributing to health inequities between racial and ethnic groups” (p. 3).
Racism has a long-standing history in the US. In 1619, about 20-30 enslaved
Africans were brought to Virginia, an English colony (Holcomb-McCoy, 2022). This

48
event was the beginning of racism in America and the impact it would continue to have
on Americans’ lives (Holcomb-McCoy, 2022). Racism is the oppression of specific racial
groups, which may include but is not limited to hate crimes, stereotyping, and
socioeconomic inequality. All have a significant effect on mental health. Racism can
cause depression, anxiety, post-traumatic stress disorder (PTSD), suicidal thoughts, and
other mental illnesses (Robinson & Smith, 2023). African Americans may face historical
trauma causing race-based stress (Hoskin, 2022).
In “An American Health Dilemma: A History of Blacks in the Health System,”
physicians Byrd and Clayton explained that African Americans had experienced adverse
healthcare outcomes since slavery in the American colonies. For example, some African
Americans were used as medical subjects to benefit the doctors rather than the patients
(Miller & Miller, 2021). Acknowledging injustices associated with racist policies and
healthcare systems can help with strategies to minimize hesitancy in the African
American community (Rusoja & Thomas, 2021).
The medical distrust in mental health care and medical research may stem from
the history of African Americans being victimized (Hostetter & Klein, 2021). Mistrust in
the healthcare system has been linked to knowledge of historical medical malpractices
such as the Tuskegee experiments and Dr. J. Marion Sims’ experimentation with
enslaved African American women to treat vesicovaginal fistula without the use of
anesthesia in the 1840s (Smith et al., 2021). In addition, African American women were
victims of involuntary sterilization in the 1960s, experiments on African American
women to perfect the C-section were performed in the 1830s, and inmates were injected
with HeLa cells to test their immunity to cancer in the 1950s (Smith et al., 2021).
49
Additionally, the US Public Health Service and Centers for Disease Control and
Prevention used African Americans’ bodies for medical experiments, contributing to the
historical mistrust among African Americans. Further adding to the distrust of African
Americans was the Tuskegee Study of Untreated Syphilis in the Negro Male, also known
as the Tuskegee Syphilis or the Tuskegee Experiment (Cokley et al., 2021; Hostetter &
Klein, 2021). The Tuskegee Experiment took place between 1932 and 1972, lasting 40
years. The study took place in Tuskegee, Alabama, located in Macon County. In late
1920, various foundations completed studies on health conditions in the South of the US.
Tuskegee, Alabama, was chosen because there were higher cases of Syphilis than in the
rest of the US (Hostetter & Klein, 2021). African Americans were believed to have a
different outcome from the disease than Whites (Hostetter & Klein, 2021).
The US Public Health Services and Tuskegee Institute monitored this study for
six to eight months. The institute included African American professionals to build trust
with African American men (Hostetter & Klein, 2021). Approximately 600 African
American men enrolled, some with the disease and others without (Alsan & Wanamaker,
2018; Hostetter & Klein, 2021). The African American men were in a controlled group
and contracted the disease. An advertisement illustrated a new health plan, free medical
treatments, meals, blood tests, and burial insurance (Hostetter & Klein, 2021).
During the experiment, hundreds of African American men in Tuskegee,
Alabama, were denied treatment for their condition and were not given medical advice
from medical providers outside of the study (Alsan & Wananmaker, 2018). The institute
was aware of the risks to African American men (Hostetter & Klein, 2021). The study
was used to observe and trace human participants with untreated syphilis. Penicillin was
50
later identified as the treatment needed for syphilis; however, the researchers did not
reveal to the African American men that they were withholding medication from them
(Cokley et al., 2021). During this study, there was no evidence of informed consent
(Hostetter & Klein, 2021). Among the study participants, more than 200 African
American men suffered complications, including blindness, insanity, and death (Brossard
& Chandler, 2022).
In another example, Dr. J. Marion Sims was a physician in the 19th century who
was recognized as the first to develop a technique to complete the operation closure of
the obstetric vesicovaginal fistula. A vesicovaginal fistula is an abnormal opening
between the bladder and the vagina, resulting in continuous urine leakage through one’s
vagina. Dr. Sims operated on enslaved African American women suffering from the
condition in the 1940s (Lynch, 2020). There were 14 enslaved African American women
for whom Dr. Sims completed experimental surgeries without their consent (Khabele,
2021). Sims’ autobiography documents how he repeatedly performed procedures on three
enslaved African American teenagers he purchased: Betsy, Lucy, and Anarcha. Sims
documented his procedures and operations, leading to his invention of the vaginal
speculum (Brossard & Chandler, 2022).
In Sims’ experiment, the enslaved African American women were not given
anesthesia (Khabele, 2021). During the 19th century, 90 percent of African Americans
lived in Southern America. During this century, Dr. Sims used and experimented with
enslaved people while being abusive and performing involuntary medical
experimentation to develop profit and cures (Domonoske, 2018). Sims used unconsented
51
experiments to prevent White women from having to experience painful procedures
(Brossard & Chandler, 2022).
In another medical case, Henrietta Lacks, an African American woman with five
children, was diagnosed with cervical cancer. Lacks was treated in Baltimore, Maryland,
at Johns Hopkins Hospital; she later died from her diagnosis. Before Henrietta’s death,
samples of her cells from the tumor in her cervix were removed by doctors without her
knowledge or consent (Cramer, 2021). Lacks’ cells were used for scientific experiences
and were named HeLa cells, well-known among those connected to or studying
biological sciences (Brossard & Chandler, 2022). HeLa cells were the first human cells
documented to contribute to science and medicine significantly. The cell line has assisted
with genome studies and discoveries for cancer, tuberculosis, and Ebola. The HeLa cell
line has been used over the last 60 years; however, the Lacks family only learned about
the HeLa cells 20 years ago (Brossard & Chandler, 2022).
As mentioned, there has been a legacy of discrimination and exploitation of
African Americans that could lead to distrust. Historically, some African Americans’
bodies have been used without consent to advance and support medical theories,
institutions, and technologies, leading to injustice. The reminders of the historical actions
among African Americans have helped contribute to the disparities in the US healthcare
system (Wells & Gowda, 2020). Understanding the historical trauma inflicted on African
Americans regarding medical treatments and methods is essential (Miller & Miller,
2021). In December 2020, the Kaiser Family surveyed the public’s hesitation towards
receiving the COVID-19 vaccine. It was found that 35 percent of African American
adults would definitely or probably not get the vaccination due to mistrust of vaccinations
52
and fear of contracting COVID-19, compared to 51.5% of their White counterparts
(Adeagbo et al.; 2022; Rusoja & Thomas, 2021).
The decades of medical mistrust in the healthcare field among many African
Americans, discrimination, experimentation, and racism continue contributing to the
negative ideations to seeking healthcare. Some African Americans are apprehensive
regarding possible side effects due to the historical abuses (Rusoja & Thomas, 2021).
There are many documented studies regarding the high levels of distrust between African
American patients and physicians. In an analysis study entitled Trust in African
Americans’ Healthcare Experiences, Nurse Traci Murray explained what it meant to have
distrust and how it relates to healthcare (Miller & Miller, 2021).
Murray explained that historically, forced dependency has caused barriers to trust
issues in the medical field and has led to some African Americans who would rather risk
having an unpredictable possible illness than voluntarily have a patient-physician
relationship. Another study by Jacobs et al. (2006) found that African Americans
expected routine care to face experimentation and racism (Miller & Miller, 2021).
Additionally, it was found that African Americans’ trust in physicians was based on
communication, reliability, compassion, and dependability and that their best interests
were considered within the patient-client interactions (Miller & Miller, 2021).
After the Emancipation Proclamation on January 1, 1863, the mindset among
African Americans was to remain silent (Briseno, 2022). Those born from 1928 to 1945
were called the silent generation. This generation witnessed the Civil Rights movement
and Jim Crow laws (Briseno, 2022). Being silent was a coping mechanism to escape the
53
trauma of the ongoing racism, lynching, rapes, and the other injustices African
Americans faced (Briseno, 2022).
Segregation in health care was justified due to the history of racism in psychiatry
(Smith, 2022). In 1883, the demographer, English statistician, and eugenicist Francis
Galton coined eugenics (National Human Genome Research Institute [NHGRI], 2022).
Eugenics is a study of agencies under social control to improve or impair the racial
qualities of future generations, either physically or mentally (NHGRI, 2022). Eugenicists
believed there could be perfect people by eliminating particular genetics and heredity.
Eugenicists also proposed that segregation, involuntary serialization, and social exclusion
were necessary to create perfections (NHGRI, 2022).
Galton believed race and heredity were the reasons for individuals’
characteristics, health, disease, and social intellect (NHGRI, 2022). From 1907 until
1932, 32 states passed laws on eugenics (Villarosa, 2022). These laws would permit the
government to forcefully sterilize those they believed diseased, dependent, feebleminded,
or insane. Eugenicists believed that having these characteristics and traits meant one was
incapable of making decisions regarding reproduction (Stern, 2020; see Figure 3).
54
Figure 3
Pamphlet of Selective Sterilization Benefits
Note. Stern, A. (2020, September 23). Forced sterilization policies in the US targeted
minorities and those with disabilities–and lasted into the 21st Century. Institute for
Healthcare Policy & Innovation. https://ihpi.umich.edu/news/forced-sterilization-
policies-us-targeted-minorities-and-those-disabilities-and-lasted-21st
Specifically, in the early 1800s, physicians and psychiatrists believed African
Americans were biologically inferior (Smith, 2022). Dr. Samuel Cartwright, a
psychologist and surgeon in the 1800s, argued that enslaved African Americans were in
their natural state. Cartwright believed African Americans benefitted from hard labor and
could not take themselves outside the slavery system. In 1851, Cartwright published a
report entitled Report on the Diseases and Physical Peculiarities of The Negro Race. The
report outlined Cartwright’s meaning of the two psychiatric disorders: drapetomania and
dysaesthesia aethiopica (Smith, 2022).
Cartwright explained drapetomania and dysaesthesia aethiopica as mental
illnesses enslaved African Americans have due to wanting to escape from slavery to
55
avoid hard work. In addition, Cartwright argued that the entire race of African Americans
who were enslaved had child-like characteristics and were unable to exemplify emotional
complexities. Because of Cartwright’s claims, hospital officials adopted these ideas,
resulting in a lack of treatment for African Americans. African American patients were
segregated from other races in the hospitals and instead required to work in the hospital’s
kitchens, laundry facilities, and fields (Smith, 2022).
In the 1960s, during the new Civil Rights legislation, lawyers and activists
worked to end racial segregation in hospitals, including psychiatric hospitals. In 1967, an
inspection of the facilities in the South was completed by the Office of Equal Health
Opportunity within the Department of Health, Education, and Welfare (HEW); it was
found that psychiatric hospitals continued to discriminate against African Americans in
breach of the Civil Rights Act (Smith, 2022).
Showing signs of mental health illnesses led to some African Americans being
punished by their owner, which led to enslaved African Americansguising their mental
health issues to avoid penalties. The history of enslaved African Americans has
influenced the enduring mental health myths in the Black community, leading to their
views of depression as a weakness instead of seeking professional help (Wilkins et al.,
2013). Hankerson et al. (2015) noted, “Racism has been hypothesized to affect the mental
health of African Americans in several ways. Institutional racial discrimination can limit
socioeconomic mobility, leading to poor living conditions that negatively affect mental
health” (p. 2).

56
Social Justice and Mental Health among African Americans
Social injustice has significant connections to mental illnesses and mental health
inequalities. When discussing these issues, one must understand their correlations.
Various forms of oppression perpetuated by societal systems cause these issues to be
toxic and harmful. The US healthcare system has produced inequitable outcomes, causing
ongoing social injustice, and the mental health system is not excluded (Shim & Vinson,
2021). The US’s aggressive policing, which led to the killings of some unarmed African
Americans, impacts the mental health decline in the Black community within the state
where the incident occurred (Williams & Etkins, 2021).
In 2020, the murders of George Floyd, Ahmaud Arberry, and Breonna Taylor
heightened the awareness of racial inequalities in mental health outcomes. The
subsequent Floyd murder trial significantly influenced African Americans’
psychological, mental, and physical well-being in the US (Williams & Etkins, 2021). In
2017, law enforcement across the US had been responsible for the deaths of more than
300 African Americans within a year; 25% of the African Americans were unarmed (Bor
et al., 2018).
Police brutality and social injustice can sometimes correspond to higher rates of
involuntary psychiatric hospitalization for individuals of color. Within this larger context
of cultural mistrust, African Americans weigh the decision to enter the mental health care
system (Hankerson et al., 2015). Some African Americans’ mental illnesses have been
viewed as criminal and aggressive behavior, which may cause an issue with the law and
its relation to the need for mental health services (Lee, 2020). Unfair treatment can harm
health, including discrimination against ethnic or racial identities. Race-related stress

57
refers to the psychological distress that is racially related between groups and their
environment. Race-related stress can become a threat to one’s well-being. The Stress
Process Model theorizes that any psychological stressor will impact one’s health
negatively (Mouzon & Brock, 2022).
The recurring videos and images of African Americans killed by law enforcement
cause continuous psychological damage due to systemic racism. The videos and photos
may cause one to feel overwhelmed, leading to mental health conditions due to exposure
(Boynton, 2020; Downs, 2016; Graham et al., 2017). Michael Brown (age 18), Freddie
Gray (age 25), Tamir Rice (age 12), Eric Garner (age 27), Ahmaud Arbery (age 25),
Atatiana Jefferson (age 28), Breonna Taylor (age 26), Elijah McClain (age 23) and
George Floyd (age 46) are just a few African Americans whose videos or images were
captured showing racial injustices, which may have contributed to the rise of mental
health issues in the Black community (Boynton, 2020; Downs, 2016; Graham et al.,
2017).
Police brutality and social injustice have been videoed, causing torment. Viewing
violence inflicted on African Americans by police officers can negatively affect a
person’s mental health. Medical experts, educators, clinical psychologists, psychologists,
ministers, and senior administrators have uncovered that African Americans being
exposed to the death of African Americans leads to racial trauma, causing mental health
issues. The National Alliance on Mental Illness reported that viewing social injustice can
push an endurance of racial bias and discrimination against individual mental health
among African Americans. As African Americans are faced with videos documenting the
58
deaths and injustice causing one to become mentally overwhelmed, other mental health
concerns are prevalent in the Black community (NAMI, 2020).
Globally, there is a significant overrepresentation of incarcerated African
Americans, resulting in a mental health consequence of racialized incarceration. The
overrepresentation of African Americans incarcerated has caused a historical shift from
hospitals being the primary source of mental health care to prison systems. In addition,
the overrepresentation has caused jails and prisons to become the largest mental health
care providers (Williams & Etkins, 2021).
The 2019 Pandemic and Mental Health
On March 11, 2020, the WHO declared the Coronavirus Disease 2019 (COVID-
19) a pandemic due to the speed of the virus (dos Santos, 2020; dos Santos et al., 2020).
COVID-19 rapidly progressed from an isolated case report in Wuhan, China, in late 2019
to a pandemic in March 2020. October 2020 saw 38 million confirmed cases globally and
1.1 million confirmed deaths, coinciding with the second peak of COVID-19. By
February 2021, there were 130 million cases and 2.2 million deaths (Byrne et al., 2021).
The nationwide outbreak led to significant challenges in various fields, especially
healthcare. These included associated major physical health problems and mental health
sequelae with related risks and reduced quality of life (Byrne et al., 2021).
The pandemic brought several worldwide challenges, including social, health, and
economic. Research shows a high prevalence of anxiety, stress, and depression
symptoms. During the COVID-19 pandemic, individuals faced an increased risk of
suicide, domestic violence, substance use, and grief (dos Santos et al., 2020). Also, some
individuals faced medical phenomena affecting mental and physical health, including
59
anxiety, xenophobia, and stigma resulting from the COVID-19 pandemic (Javed et al.,
2020). As the pandemic continued, conversations about the health crisis provoked
discussions that led to the onset of psychiatric conditions (dos Santos et al., 2020).
According to the data collected by Johns Hopkins University, there were over 400
million COVID-19 cases worldwide and over 5.7 million deaths among Americans
(Ellyatt, 2022). Due to the danger of the virus, restrictions to prevent the spread also
affected individuals’ social contact, including milestones such as weddings, family and
friend gatherings, births, and attending funerals during the mandated quarantine (Ellyatt,
2022). As the COVID-19 pandemic arose, many individuals were forced to stay home,
which caused self-isolation and hostile mental health conditions. Individuals faced
separation from their loved ones, boredom, loss of freedom, and uncertainty. As the
COVID-19 pandemic continued in the US, four in 10 adults reported depressive disorder
or anxiety symptoms. From January to June 2020, adults reported specific impacts that
concerned their mental health (Panchal et al., 2021).
During the summer of 2020, the Centers for Disease Control and Prevention
(CDC) completed a survey as the pandemic continued and social injustice protests took
place. The survey found that 15% of African American respondents had seriously
considered suicide in the past three days compared to the 8% of White Americans who
responded (Stone et al., 2023). The socioeconomic impact of the COVID-19 pandemic
played a crucial role in psychological distress. The COVID-19 pandemic caused
individual changes in social isolation and loneliness, causing economic changes and
mental health challenges among the general population (dos Santos et al., 2020). Also,
60
the rates of mental health issues have continued to rise, resulting in a cost of 1 trillion
dollars to the global economy annually (Doraiswamy et al., 2021, see Figure 4).
Figure 4
Adults Reporting Symptoms of Anxiety and Depressive Disorders during COVID-19
Note. Adapted from Panchal, N., Rabah, K., Cox, C., & Garfield, R. (2021, July 20). The
implications of COVID-19 for mental health and substance use. KFF.
https://www.kff.org/coronavirus-covid-19/issue-brief/the-implications-of-covid-19-for-
mental-health-and-substance-use/
According to psychologists and psychiatrists, there has been an influx of
individuals seeking mental health care during the COVID-19 pandemic. The global
health crisis increased anxiety and depression during the worldwide health crisis, which
added to those already managing mental health conditions (Ellyatt, 2022). Many have
confronted psychological issues, including frustration, depression, stress, anxiety, and
uncertainty, as the COVID-19 outbreak arose (Serafini et al., 2020).

61
The psychological reactions were high due to a mass quarantine global mandate as
the virus spread. Individuals were faced with potential virus outbreaks, ongoing new
cases, and anxiety based on updates provided by the local media stations. Some
psychological reactions to the COVID-19 pandemic were hopelessness, suicidal
ideations, anger, and sadness (Serafini et al., 2020). The ongoing concerns of COVID-19
also increased mistrust in medical healthcare facilities. As medical distrust was
heightened during the COVID-19 pandemic, there was a link between mental health,
discrimination, and COVID-19, police brutality, and mental health concerns (Cokley et
al., 2021).
Summary
This chapter reviewed various aspects of mental health, the concerns surrounding
the issues over decades, and current studies in the mental health field. The literature
review analyzed the background of mental health, mental health literacy, the stigma of
mental health, cultural impact, discrimination, social justice in mental health, and the
2019 pandemic and mental health. The research on these factors provided important
information about mental health attitudes and perceptions. This chapter also included
existing research on psychological well-being and its association with college students
and African American students. In addition, the literature review discussed other research
and history that may affect one’s views on seeking mental health services. Exploring
multiple contributing factors to this population helped to understand the experiences and
perceptions of African American students’ mental health concerns. This chapter also
explained critical race theory and historical race theory, which guided the development of
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the methodology for research. Chapter Three will provide an overview of the method of
this study, including data collection and sampling procedures.

63
Chapter Three: Methodology
Overview
The previous literature review discussed the theoretical frameworks: critical race
theory and historical trauma theory. The historical traumas discussed included the
Tuskegee Syphilis experiment, J. Marion Sims experiments, Henrietta Lacks
experiments, and the eugenics movement. The literature provided a perspective on mental
health in the Black community, including the background of mental health, the
prevalence of mental health, untreated mental health outcomes, mental health literacy,
and the stigma of mental health providers on contributing to the culture of African
Americans. The literature review also presented information on the cultural impact,
discrimination, provider bias and access to mental health care, the Black church, social
justice in mental health, and the 2019 pandemic and mental health. This chapter will
provide the purpose of this study and its methodology. The design, research questions,
setting, participants, sampling, procedures, the researcher’s role, instruments, and data
collection will be introduced to uncover the mental health perceptions and attitudes of
first-generation African American students and graduates.
Design
The research design is a qualitative study, including a holistic understanding. A
holistic understanding explains the problem while involving multiple perspectives and the
factors within the situation (Creswell & Creswell, 2018). The qualitative research
allowed the researcher to capture African Americans’ perceptions and experiences
towards mental health resources. This qualitative study examined the culture of a group
of people, perceptions, and lived experiences. Teherani et al. (2015) stated, “When using
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the qualitative research method, the phenomena can include, but are not limited to, how
people experience aspects of their lives, how individuals and groups behave, how
organizations function, and how interactions shape relationships” which are aligned with
the research (p. 1).
Qualitative research relies on humans’ social phenomena and experiences within
their daily lives instead of statistics and numeric patterns. Human phenomena in
qualitative methodology may include ethnology, case studies, phenomenology,
biographies, grounded theory, and historical analysis. Qualitative research is used to gain
a systematic scientific inquiry, providing a descriptive narrative to inform the
researcher’s understanding of a social or cultural phenomenon (Astalin, 2013). It also
traditionally includes a variety of interviews, documents, and observations. It is essential
to have this type of data when understanding the social or cultural phenomenon being
researched. In qualitative research, the interaction between variables is critical (Astalin,
2013).
Research Questions
The research questions were developed to uncover the attitudes, perspectives,
experiences, and impact of seeking mental health resources on first-generation African
American college students and graduates. The research questions were as follows:
RQ1. What are the perceptions of seeking mental health services among first-
RQ2. What are the experiences of seeking mental health services among first-

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Setting
The qualitative research setting was an HBCU. This setting was located in the
midlands area of South Carolina. The setting was chosen based on the research questions.
The student population of HBCUs comprises about 75% African Americans. This
sampling included a portion of the African American community and was separated into
two groups. One group consists of the participants who have received mental health
services, and the second group has not received mental health services. (Creswell &
Creswell, 2018).
Participants
The data were collected from first-generation African American college students
and graduates aged 18 to 35. The age used for the research was based on the age
population available at the university. There was a total of 28 participants for the research
setting. Participants were selected by response via email requesting age, gender, and the
type of mental health resources.
There were 14 participants interviewed based on not receiving mental health
services within their lifetime from a mental health professional. The ages of the
participants ranged from 20 to 35, with a median age of 30 and a mean age of 31.
Fourteen participants received mental health services from a mental health professional
within their lifetime. The ages ranged from 18 to 35, with a median age of 28 and a mean
age of 30.
Sampling
The type of sampling was stratified sampling. Thomas (2023) contended that
researchers use stratified sampling to divide participants into subgroups called strata
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based on their shared characteristics (e.g., race, gender identity, or educational
attainment). The sample of first-generation undergraduate and graduate students from an
HBCU in the midlands area of South Carolina consisted of 28 students and graduates.
The participants in this sample were between 18 and 35 years of age. The sample
included
• Seven males who sought mental health services,
• Seven males who had not sought mental health services,
• Seven females who sought mental health services and
• Seven females who had not sought mental health services.
This method required the population to be separated into subgroups to include their
gender and type of mental health services used (only used for participants who had
received mental health services). The researcher selected the participants from the strata.
The sample allowed the researcher to have an adequate size from each stratum (Elfil &
Negida, 2017). The participants received a $10 gift certificate from a local restaurant
after participating in the interview.
Procedures
Prior to analysis, each participant completed a demographic questionnaire. The
questionnaires were emailed to students and graduates by email from the HBCU student
affairs department, which the HBCU institution approved. The questionnaire was emailed
to the HBCU’s alumni association to obtain participants. The participants completed the
questionnaire online using Qualtrics, a software package. Informed consent was included
in the survey.
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Participants had to agree with the consent statement before completing the survey
(Appendix C). After potential participants completed the survey, the researcher analyzed
the data and chose the participants using stratified sampling. Depending on their
preference, the researcher contacted each participant via email or phone. Each participant
received a copy of the consent and the interview protocol. The researcher then scheduled
the interviews with the participants. Each participant was allowed to participate in their
interview via Google Meetings or in person.
The researcher conducted 28 recorded interviews via Google Meetings. The
researcher conducted interviews from their in-home office to ensure confidentiality and
privacy. The length of each interview ranged from 20 to 35 minutes. The researcher used
a password-protected digitally-activated recorder, recorded each interview, and carefully
listened to each recording several times to ensure validity. As the researcher listened to
the recordings, the interviews were transcribed. Once the interviews were transcribed, the
researcher reviewed the transcripts by listening to the audio recordings and reviewing the
transcripts to correct any content or grammatical errors made.
Data collection methods are essential in showing how the information is used, and
the methodology and analytical approach determine the explanations it can generate that
the researcher applies (Paradis et al., 2016). Outlined is a step-by-step of how research
data was received:
1. The researcher received approval from the dissertation committee.
2. The researcher applied for Institutional Review Board (IRB) approval.

68
3. The researcher secured site approval from the HBCU institution to conduct
the research using emails from the alumni association and professors from the
university location.
4. Once IRB and location were approved, an email from the researcher with a
link to the demographic survey (see Appendix C) was sent to professors and
the alumni association from the HBCU campus.
5. The survey required participants to disclose their age, race, and the type of
mental health services received (if any).
6. Once the survey was received, the researcher chose 28 participants (14 males
and 14 females). Participants were notified via email and phone to discuss the
research, the informed consent form, and their preference of how they would
like to be interviewed (in person or virtually).
7. Once all informed consent forms were received, the researcher met with each
participant individually for interviews.
8. The researcher interviewed and recorded each participant. Once all
participants were interviewed and recorded, the researcher transcribed each
interview to uncover themes.
9. The researcher analyzed the coding and themes to conclude the research.
The Researcher’s Role
The role of the researcher was to examine why events occur, what happens, and
what those events meant to the participants studied (Teherani et al., 2015). The researcher
accessed the thoughts and feelings of study participants while following specific
procedures to ensure the accuracy of the findings and validity. The researcher ensured
69
reliability by providing a consistent qualitative approach compared to other researchers
and studies (Creswell & Creswell, 2018).
Instruments
Each participant was emailed a copy of the informed consent (see Appendix B).
Participants were given the researcher’s and the researcher’s dissertation chairperson’s
(employee and professor of Charleston Southern University) contact information if they
wanted to discontinue the study. The researcher used open-ended interview questions and
observations to uncover multiple perspectives from participants and detailed descriptions
of their perspectives and experiences of seeking mental health resources (see Appendices
D and E).
The researcher designed guiding interview questions to collect the data. Utilizing
the researcher’s guiding interview questions allowed the researcher to examine first-
generation African American college students and graduates’ experiences and
perceptions of seeking mental health services in Historical Black Colleges and
Universities (HBCUs) in the midlands of South Carolina. The researcher conducted in-
depth interviews that served as the primary tool for collecting data. This method is
primary data (Ajayi, 2017; Castillo-Montoya, 2016; Roberts, 2020).
The researcher collects data firsthand to gather information on the intended
research (Ajayi, 2017). The researcher used two sets of questions. The first five questions
were used with participants who had not received mental health services. The second five
questions were used with participants who had received mental health services.
The first set of questions asked of participants who had not received mental health
services was as follows:

70
1. What are your perceptions on seeking mental health services or treatment?
2. Do you feel you have an understanding of trauma or mental health conditions?
Explain.
3. Do you feel you have experienced any mental health issues?
4. What factors do you contribute to your mental health?
5. What coping mechanisms do you use for your mental health?
The second set of questions asked of participants who had received mental health
services was as follows:
1. What did you feel was the presenting problem when seeking and receiving
mental health services?
2. What has been your experience with the mental health services you have
received?
3. How were the services you received found?
4. Did anyone encourage you to continue or stop using mental health services?
What was their explanation?
5. Did you have a preference regarding the demographics of your therapist?
What is your reasoning?
Interview Protocol
An interview protocol (see Appendices D & E) was created for the semi-
structured interviews. The protocol served as a guide for the interview to include what the
researcher said before the interviews, such as introductions, topics, how the participant’s
consent was collected, the questions for the interview, and what was said at the end. The
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researcher used an interview protocol to ensure all interviews were similarly conducted.
The protocol helped with increasing reliability and validity and minimizing biases.
Data Collection
After the researcher received permission from the Charleston Southern University
Institutional Review Board (IRB) and site approval from the Historically Black College
and University (HBCU), the researcher sent an email request for participants (see
Appendix A), an informed consent email (see Appendix B), and a demographic survey
(see Appendix C) to students and graduates. Stratified sampling was used to select the
participants that were interviewed. Thomas (2023) contended that researchers use
stratified sampling to divide participants into subgroups called strata based on their
shared characteristics (e.g., race, gender identity, or educational attainment). The
interviews were used to gather information from African Americans between the ages of
18 and 35 at an HBCU while using predetermined questions (Paradis et al., 2016).
The age used for the research is based on the age population available at the
university. There were 28 participants needed for the research setting. The interviews
were recorded and transcribed. The interview questions invited interviewees to express
themselves freely and uncover the contributing factors of mental health resources used
among first-generation African American college students and graduates (Paradis et al.,
2016)
Interviews. The researcher created open-ended interview questions. The
questions allowed participants to share their perceptions, thoughts, and experiences
regarding seeking or receiving mental illness and services. Participants were allowed to
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complete the interviews in person on the college’s campus or virtually through a Google
Meeting.
The data collected was kept confidential. The participants’ responses were only
shared with the researcher. The demographic information was collected to analyze the
statistical significance of the study. Each interview ranged from 20 to 35 minutes, with a
mean of 23 minutes and a median of 24 minutes.
After each interview, the researcher provided each participant with a copy
(including their pseudonym created by the researcher) of their transcription to review for
accuracy and to ensure that their thoughts and perceptions were appropriately captured.
Research data were stored on Charleston Southern University’s One-Drive server and in a
password-protected, locked file cabinet in a secured location in the researcher’s home.
Data were encrypted due to sensitive data research. The data will be destroyed three years
after it has been analyzed.
Data Analysis
The data analysis in a qualitative study focuses on codes and themes collected
through interviews and observations. This study’s analysis examined the perceptions and
experiences of the contributing factors of mental health resources among first-generation
African American students and graduates. The researcher organized the data, made notes
on the transcriptions, and coded the data to examine familiar themes (Busetto et al.,
2020).
The researcher used an ethnographic approach, a qualitative method for collecting
data often used in the social and behavioral sciences. Data were collected through
interviews. All interviews were manually coded. The researcher coded and analyzed each
73
interview based on the participant’s responses and then categorized the responses into
themes. The researcher also uploaded the transcripts into the computer software to
analyze and provide themes of the data. The software tool used was Quirkos, which is a
computer-assisted qualitative data analysis software (CAQDAS) package.
Trustworthiness
The researcher demonstrated the trustworthiness of this qualitative study while
ensuring the data analysis was conducted consistently and precisely (Nowell et al., 2017).
The researcher ensured trustworthiness through member checks, a strategy used while
interviewing the participants to determine accuracy. The researcher summarized
information provided by the participants and shared it with each participant involved in
the research study. The researcher has also provided evidence of the primary criteria to
further ensure trustworthiness within this qualitative research study, including credibility,
dependability, confirmability, transferability, and triangulation (Forero et al., 2018).
Credibility
Credibility is essential to all qualitative research studies as it is a fundamental tool
to ensure that the participants' perspectives, emotions, and experiences are trustworthy
and reliable (Forero et al., 2018). Triangulation was used in this study, which helped
establish the credibility of this research. For this qualitative study, methodological
triangulation was used. Methodical triangulation uses several methods of data collection.
The researcher used data from transcript audits, interview protocols, and observations,
which all focused on the same phenomenon (Stahl & King, 2022). The researcher
interviewed and observed the participants virtually via Google Meetings (Noble & Heale,
74
2019). This study helped to understand how the findings within the responses from the
participants shared a relationship (Stahl & King, 2022).
Triangulation. The data were triangulated by documenting evidence through
interviews, clarity, and richness of the research study (DeVault, 2019). There were 28
participants used to collect data while using interviewing methods and observations of the
participants (DeVault, 2019). Virtual interviews were conducted through Google
Meetings with all participants. The researcher took handwritten notes and remained
transparent throughout each interview. For this qualitative study, methodological
triangulation was used. An interview protocol was provided to the interviewee, allowing
each participant to review before participating. Participants were also given an
opportunity to review their interview transcripts to ensure their thoughts, perceptions, and
experiences were accurately captured.
Dependability and Confirmability
Dependability refers to the research being reliable and consistent. Dependability
also ensures the research findings are repeatable if this study occurs again with the same
group of participants and context. The researcher provided a rich description of the
methodology used, established interview protocols, developed a data collection process,
and ensured the accuracy of the interview transcripts from each participant.
Confirmability is based on the participant's shared narratives, which shaped the
findings of the qualitative study. The researcher demonstrated confirmability by
documenting the procedures for checking and rechecking the research data to ensure the
findings were free from conscious or unconscious bias (Nowell et al., 2017). The
researcher also used the reflexivity technique, which is used when collecting and
75
analyzing data. In addition, the researcher was aware of their background to understand
how these aspects may influence the data process (Forero et al., 2018).
Transferability
Transferability measures where the research study’s results can be applied in
other contexts, settings, or studies. (Creswell & Poth, 2018). The researcher used
transferability to provide rich descriptions of the research findings, which helped the
reader identify whether experiences aligned with the research study (Hesse-Biber &
Leavy, 2011).
Ethical Considerations
The participants in this study contributed to understanding the perceptions and
experiences of seeking mental health services. Participants were made aware that all their
participation during the study was voluntary, and they could remove themselves from the
questionnaires if they felt uncomfortable at any time (Muraglia et al., 2020). In addition,
the participants’ rights were protected as the researcher received approval from the IRB,
obtained consent from the participants before participating in the study, and maintained
the confidentiality of the participants. The privacy of the participants was essential in this
study. The researcher disassociated the participants’ names from the responses given to
the interview questions. In addition, the researcher used pseudonyms for the participants
and the institution to protect their identities and confidentiality.
Delimitations
Delimitations are factors known by the researcher and consciously set by the
researcher. A delimitation of this study was that the sample was limited to one college or
university rather than using multiple institutions. Secondly, participants in this study were
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African American college students from an HBCU in the US. The research also only
focused on participants aged 18-35. The participants may not have represented all
African Americans in the US or all African American college students; the sample may
have differed from the general population.
Summary
This chapter included the methodology used for this study and explanations of the
research designs incorporated in this study. This chapter provided a detailed description
of the qualitative research design. A detailed description of the study’s procedures, how
participants were recruited, and the instruments used were included. Participants for this
research study volunteered and were recruited from an HBCU in the midlands area of
South Carolina.
Procedures were explained to all participants as they completed the survey
through Qualtrics. The researcher organized the data, made notes on the transcriptions,
and coded the data to examine common themes. In addition, a description of credibility,
dependability, confirmability, transferability, triangulation, ethical considerations, and
delimitations was provided. Chapter Four will provide the findings from the data
collection and summarize them through themes.

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Chapter Four: Findings
Overview
This chapter presents findings from the data collected from 28 first-generation
African American college graduates and their perceptions and experiences of seeking
mental health services during their lifetime. The literature provided the history of mental
health and factors of mental health as they may relate to African Americans and their
communities. This chapter contains findings of the ethnography theory methodology
study conducted to answer the following research questions:
The primary purpose of this chapter is to present the research study’s findings.
The process used to analyze transcripts from the 28 individual interviews conducted to
uncover codes and themes is described in detail in this chapter. The findings were
organized into themes and subthemes from the interviews of first-generation African
American college students and graduates from an HBCU. The semi-structured interviews
included demographic questionnaires and field notes to uncover themes and patterns.
Chapter Four is organized into the following: data collection, study participants, results,
and summary.
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Data Collection
The researcher followed the interview protocol as the data were collected for the
research study. The researcher conducted 28 recorded interviews via Google Meetings.
All participants could complete the interviews in person or via Google Meetings.
The researcher conducted interviews from an in-home office to ensure
confidentiality and privacy. Each interview ranged from 20 to 35 minutes, with a mean of
23 minutes and a median of 24 minutes. The researcher used a password -protected,
digitally-activated recorder.
Once the interviews were transcribed, the researcher reviewed the transcripts by
listening to the audio recordings and reviewing the transcripts to correct any content or
grammatical errors made by the researcher. The researcher used a pseudonym instead of
the participant’s name on the study’s data. Interviews took place in a private office or
Google Meetings. The researcher de-identified audio tapes of the participants made
during the study. The researcher stored research data on Charleston Southern University’s
One-Drive server. The research data was stored in a password -protected, locked cabinet
with restricted access in a secured location in the researcher’s home.
Data were encrypted due to the sensitive nature of the data collected and will be
destroyed three years after analysis. This study unveiled the importance of seeking
mental health services by providing findings and investigating participants’ personal
stories through their perceptions and experiences. This study provided findings and
analyzed the perceptions and experiences of African American first-generation college
students’ views of seeking mental health resources. The researcher used open-ended
interview questions and observations to compartmentalize, unearth, and convey multiple

79
perspectives from participants and detailed descriptions of their views and experiences
regarding seeking mental health resources.
The researcher collected data using researcher’s-designed guiding interview
questions. Utilizing the researcher’s-designed guiding interview questions allowed the
researcher to examine first-generation African American college students and graduates’
experiences and perceptions of seeking mental health services in an HBCU in the
midlands of South Carolina. The researcher conducted in-depth interviews that served as
the primary tool for collecting data. This method is primary data (Ajayi, 2017; Castillo-
Montoya, 2016; Roberts, 2020).
The researcher collects data firsthand to gather information on the intended
research (Ajayi, 2017). The researcher used two sets of questions. The first five questions
were used with participants who had not received mental health services. The second five
questions were used with participants who had received mental health services.
The interview questions were developed for participants without mental health
services. They were asked the following open-ended interview questions:
Explain.
4. What factors do you feel have contributed to your mental health?
5. What coping mechanisms do you use for your mental health?
The researcher created the second set of interview questions for

80
participants receiving mental health services. Participants were asked the following open-
ended interview questions:
received?
Participants of the Study
There were 28 African American first-generation college students and graduates
from an HBCU. The researcher provided the participants with pseudonyms selected to
ensure anonymity. In addition to pseudonyms, demographics obtained included the type
of therapy services received, age, gender, and race. All participants completed a
demographic survey (see Appendix C) before their interview session, of which seven
males and seven females received mental health therapy services, and seven females and
seven males had not received mental health services. The researcher delineated each
participant’s demographics in the respective table. Table 1 comprises 14 participants who
had not received mental health services. The ages of the participants ranged from 20 to
35, and the median age was 30.

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Table 1
Participants’ Demographics Who Had Not Received Mental Health Services
Pseudonym Therapy Services Age Gender Race
Shawn None 35 Male African American
Dontae None 34 Male African American
Raheem None 34 Male African American
Anthony None 35 Male African American
Oscar None 33 Male African American
Manuel None 22 Male African American
Akai None 35 Male African American
Priscilla None 35 Female African American
Breonna None 30 Female African American
Atatiana None 33 Female African American
Aura None 34 Female African American
Gabriella None 35 Female African American
Michelle None 21 Female African American
India None 18 Female African American

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Table 2 comprises 14 participants who received mental health services. The ages
ranged from 18 to 35, with a median age of 28.
Table 2
Participants’ Demographics Who Had Received Mental Health Services
Pseudonym Therapy Services Age Gender Race
Trayvon Individual Therapy 31 Male African American

Family Therapy
Tony Individual Therapy 34 Male African American

Family Therapy
Ruben Individual therapy 35 Male African American

Family therapy
Derrick Individual therapy 33 Male African American
Jarvis Individual therapy 34 Male African American
Stephon Individual Therapy 23 Male African American

Family Therapy
Michael Individual therapy 24 Male African American
Kourtnee Individual therapy 30 Female African American
LaToya Individual therapy 30 Female African American
Ma’Khia Individual therapy 31 Female African American
Dominique Individual therapy 34 Female African American
Monica Individual therapy 35 Female African American
Tanisha Individual therapy 20 Female African American
Yvette Individual therapy 22 Female African American

Family therapy
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Results
The study aimed to understand the perceptions and experiences of first-generation
African American college students and graduates seeking mental health services. The
data from the interviews were separated into two groups. The first group included males
and females who had received mental health services. The second group of participants
had not received any mental health services. Tables 3 and 4 include each interview
question and the themes found in the participants’ responses. As a result of the study, 19
themes emerged from the participants who had received mental health services, and 23
themes emerged from the participants who had not received mental health services. The
researcher found that some themes were consistent with the literature review. Similar
themes include mental health literacy, cultural competency, spirituality and religion, and
social injustice.
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Table 3
General Themes Found from Interviews with Participants Who Had Not Received Mental
Health Services
Interview Questions General Themes Interview Responses
What are your perceptions on Theme 1.1.1 Perceived as Helpful and

seeking mental health services Needed
or treatment? Theme 1.1.2 Perceived Weak
Theme 1.1.3 Not Needed in Personal Life.
Do you feel you understand Theme 1.2.1 Knowledgeable due to

trauma or mental health Personal Experience
conditions? Explain. Theme 1.2.2 Knowledgeable due to my
Work Experience
Theme 1.2.3 Knowledgeable of Mental
Health
Do you feel you have Theme 1.3.1 Experienced Mental Health

experienced any mental health issues due to Environmental
issues? Explain. Experiences
Theme 1.3.2 Does not have Experience
with Mental Health Issues
Theme 1.3.3 Anxiety
Theme 1.3.4 Being an African American
What factors do you feel have Theme 1.4.1 Negative Family Dynamics
contributed to your mental Theme 1.4.2 Positive Family Dynamics
health? Theme 1.4.3 COVID-19 Pandemic
Theme 1.4.4 Social Injustice
Theme 1.4.5 My Race and Gender
What coping mechanisms do Theme 1.5.1 Using Unhealthy Coping

you use for your personal Mechanisms
mental health? Theme 1.5.2 Spiritual and Religious
Beliefs
Theme 1.5.3 Self-care
Theme 1.5.4 Exercising
Theme 1.5.5 Friends and Family
Theme 1.5.6 Traveling
Theme 1.5.7 Isolation
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Table 4
General Themes Found from Interviews with Participants Who Had Not Received Mental
Health Services
What are your perceptions on Males

seeking mental health services Theme 1.1.1 Perceived as Helpful and
or treatment? Needed
Theme 1.1.2 Perceived Weak
Theme 1.1.3 Not Needed in Personal Life
Females
Theme 1.1.1 Perceived as Helpful and
Needed
Theme 1.1.2 Perceived Weak
Theme 1.1.3 Not Needed in Personal Life
Do you feel you understand Males

trauma or mental health Theme 1.2.1 Knowledgeable due to
conditions? Explain. Personal Experience
Theme 1.2.2 Knowledgeable due to my
Work Experience
Health
Females
Theme 1.2.1 Knowledgeable due to
Personal Experience
Theme 1.2.2 Knowledgeable due to my
Work Experience
Health
Do you feel you have Males

experienced any mental health Theme 1.3.1 Experienced Mental Health
issues? issues due to Environmental
Experiences
Theme 1.3.3 Anxiety
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Table 4 continued
Do you feel you have Females

experienced any mental health Theme 1.3.1 Experienced Mental Health
issues? due to Environmental
Experiences
Theme 1.3.3 Anxiety
What factors do you feel have Males

contributed to your mental Theme 1.4.1 Negative Family Dynamics
health? Theme 1.4.2 Positive Family Dynamics
Theme 1.4.3 COVID-19 Pandemic
Females
Theme 1.4.1 Negative Family Dynamics
Theme 1.4.2 Positive Family Dynamics
Theme 1.4.3 COVID-19 Pandemic
What coping mechanisms do Males

you use for your personal Theme 1.5.1 Using Unhealthy Coping
mental health? Mechanisms
Theme 1.5.2 Spiritual and Religious
Beliefs
Theme 1.5.5 Family and Friends
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Table 4 continued
What coping mechanisms do Females

you use for your personal Theme 1.5.1 Using Unhealthy Coping
mental health? Mechanisms
Theme 1.5.2 Spiritual and Religious
Beliefs
Theme 1.5.5 Friends and Family
Interview 1: Question 1
The first question of this interview was, What are your perceptions on seeking
mental health services or treatment? This question served as one of the main questions
related to the research question—this question aimed to learn how the participants viewed
mental health services based on personal senses.
Theme 1.1.1: Perceived as Helpful and Needed. Mental health services are
designed to be helpful to the client while addressing their needs. Most participants felt
mental health services could be beneficial and necessary for those in need.
Gender Theme 1.1.1: Perceived as Helpful and Needed. Three males felt
mental health services were needed or would be helpful. Five females responded that
mental health services would be helpful and necessary (see Table 5).
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Table 5
Theme 1.1.1: Perceived as Helpful and Needed
Pseudonym Responses
Anthony I feel like it is necessary and helpful for people to do.
Oscar It is much needed; although it may be frowned upon, living a better and
happier life is beneficial.
Priscilla I feel it is essential. I am all about seeking mental health, being mentally
healthy, and understanding what that means for you because it looks
different for everyone. Every person’s mental health journey is different.
I also think knowing how your mental health affects others is important.
Breonna I feel that it is crucial. I talked to friends about it and thought I had to do
the same thing.
Atatiana I think mental health services are very helpful, and I like the changes
made within the last couple of years, bringing awareness and showing
how mental health can help others [sic].
Aura My perception is that I think it’s a needed resource and a positive

resource.
Gabriella I feel it is very necessary. I always used to feel like it was for certain
people simply because of the influences or the people around me never
received it.
Akai I think the services are essential. People deal with suicide, depression, or
stress. I think it is to talk to someone instead of trying to figure out
everything independently.
Theme 1.1.2: Perceived as Weak. Seeking mental health services may make
some feel weak or unable to handle situations independently. The participants discussed
why seeking mental health services may make them feel weak.
Gender Theme 1.1.2: Perceived as Weak. Three males and two females
described being perceived as weak if they sought and received mental health services.
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The males described gender roles and explained what they felt the expectations of men
should be, such as having strength and not having to depend on others. The females
described always having to use strength in their lives and did not want to be perceived as
weak for seeking mental health services or support (see Table 6).
Table 6
Theme 1.1.2: Perceived as Weak
Pseudonym Responses
Shawn People are viewed as weak and do not know mental health services exist.
Oscar I also think that is needed in the Black community; especially while I was
growing up, therapy was frowned upon. We looked at it as you being
crazy or weak.
Manuel If I am being honest, I felt weak. As a Black man, I felt like I carried so
much weight on my shoulders. I just always felt that as a man, it was
okay, and I could make it all happen until I could not, and it would make
me feel so weak if I had to ask for help.
Aura Being a Black woman [sic], it is perceived as a sign of weakness to ask

for help [sic].
Michelle In my family, I have always been viewed as the strong one. Sometimes it
is hard [sic]. Seeking mental health services has always been a significant
stigma in my family, and I feel weak considering looking for services.
Theme 1.1.3: Not Needed in Personal Life. Mental health services are not
something that all people feel is necessary in their personal lives. Some participants felt
they could use other coping skills to better deal with situations rather than seeking mental
health services.
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Gender Theme 1.1.3: Not Needed in Personal Life. Two males felt services
were not needed in their personal lives, and one female felt she did not need mental
health services (see Table 7).
Table 7
Theme 1.1.3: Not Needed in Personal Life
Pseudonym Responses
Raheem I have never thought about services for myself. I do not

think I need services for myself. Nor do I feel like I have
been in a situation where my mental health is out of
control. Am I seeking mental health counseling? No, it is
not a thing for me [sic].
Manuel I do not need this. I have family and friends. I will not
share my information with anyone, especially a stranger.
India I do not think this is something I need. I have been

taught to pray, which is good enough for me.
The second question was, Do you feel you have an understanding of trauma or
mental health conditions? Explain. This question aimed to discover how the participants
understood mental health conditions and trauma. This question showed whether or not
participants had a sense of mental health literacy.
Theme 1.2.1: Knowledgeable Due to Personal Experiences. Some people often
face life experiences that have shaped who they are or who they may become.
Participants within this theme may have felt they understood traumas or other mental
health conditions due to their personal experiences.

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Gender Theme 1.2.1: Knowledgeable Due to Personal Experiences. Three
males and two females described their knowledge of mental health conditions based on
their personal experiences. Both genders described family dynamics in their childhoods
(see Table 8).
Table 8
Theme 1.2.1: Knowledgeable Due to Personal Experiences
Pseudonym Responses
Shawn I do. I believe mental health conditions are lived experiences. I think that
mental health or poor mental health can be inherited from parents. Over
time, I have watched my aunt, mom, and older sister, and they remind me
of each other. When it comes to mental health and just watching them
operate over time, all three make many of the same irrational decisions,
even when I have conversations with them [sic]. It is clear that they are
not in the best state of mind. As far as trauma, I think that has to do with
more live experiences than inheritance.
Priscilla I do because of the way I was raised. My parents did not raise me. My
grandparents raised me, and when I visited my parents, there was much
domestic violence in the home. I chose to live with my Grandmother and
lived apart from my siblings.
Atatiana For sure, for sure [sic]. Yeah. Furthermore, it just took years because
there was trauma with my mom related to the military; she did not want
anything else to do with it. I watched her deal with PTSD and then finally
have it diagnosed. She had trauma from her childhood and with her
parents. She just had trauma on top of trauma.
Manuel I think I am somewhat knowledgeable. I have seen what mental health

issues can do to people, especially considering my family dynamics.
Akai I can remember when I was younger, I was diagnosed with ADHD, and I
talked to a doctor about it. However, it was a weird situation. My family
thought it was not a good idea, so I never utilized any offered services.
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Theme 1.2.2: Knowledgeable Due to My Work Experiences. Participants
shared that they were aware of trauma and other mental health conditions due to career
experiences. Some of their careers have provided professional workshops or worked
closely with various mental health conditions.
Gender Theme 1.2.2: Knowledgeable Due to My Work Experiences. Two
males and three females shared that their knowledge of mental health was gained based
on their careers and professional training (see Table 9).
Table 9
Theme 1.2.2: Knowledgeable Due to My Work Experiences
Pseudonym Responses
Anthony I feel like I have a low level of understanding. I work with low-
income students myself. Sometimes, I can see that they are going
through things, and we have a system in place where we can
recommend them to counselors on campus, but I cannot identify all
triggers, so I utilize my team to help me out.
Oscar I see patterns. However, now, as an adult, I feel like I sometimes

have some anxiety, and certain things spark it, and I have to tell
myself to chill out or relax. Much of this I know from working
education [sic].
Breonna I do feel like I have a better understanding of trauma and mental

health, but that is only because of my career field; before that, I do
not think I had a big understanding of what it was, but now, since I
work with it, I think I understand more [sic].
Gabriella Professional development (PD) has been good in my school district,

but this information should present itself in college. We had classes
like human growth and development, but they did not explain them.
Michelle I think I have a good idea of traumas and mental health conditions,
but it is only because of my profession and major, psychology [sic].
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Theme 1.2.3: Knowledgeable of Mental Health Conditions. The participants
felt they had some knowledge of trauma and mental health conditions. The participants
felt they knew the essential information. Some felt they lacked mental health literacy and
needed to learn more.
Gender Theme 1.2.3: Knowledgeable of Mental Health Conditions. Three
males and one female described having some knowledge of mental health conditions,
such as stress, depression, and anxiety (see Table 10).
Table 10
Theme 1.2.3: Knowledgeable of Mental Health Conditions
Pseudonym Responses
Dontae Yes, I do. I know we all have traumas that can be

triggered, but we have to be cognitive of those
triggers.
Raheem I understand that my different traumas would mean

different types of mental health counseling.
Akai I know the basics, like stress, depression, and anxiety,

but I do not think I know enough.
India Yes, I do; I know trauma can shape how different

people react. I have very little knowledge of
depression and anxiety.
The third question was, have you experienced any mental health issues? This
question was related to question two: Do you feel you have an understanding of trauma
or mental health conditions? Explain. This question aimed to understand participants’

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feelings about mental health issues based on their perceptions of mental health issues or
conditions.
Theme 1.3.1: Experienced Mental Health Issues Due to Environmental
Conditions Family Life. The participants shared that life experiences have contributed to
their mental health.
Gender Theme 1.3.1: Experienced Mental Health Issues Due to
Environmental Conditions Family Life: Three males described their environmental
conditions as factors affecting their mental distress. Two males discussed not having a
father figure and how it affected their lives. Three females felt they had experienced
mental health issues due to environmental factors. One female talked about pregnancy
and its challenges. The other two females described their upbringings (see Table 11).
Table 11
Theme 1.3.1: Experienced Mental Health Issues Due to Environmental Conditions and
Family Life
Pseudonym Responses
Shawn Yes, definitely. I feel that I have been depressed at times

throughout my life. I try to understand [sic]. However, it is
mainly because of my lack of support, the questions I asked,
and not asking questions about my life, growing up as an
orphan and living with 11 different families until my senior
year of high school. I think the most critical years of my life
were not having support and going through trauma, such as
homelessness or living in areas where the conditions were
not the best.
Anthony A father figure was absent, and I think it could be

considered mental health trauma.
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Table 11 continued
Pseudonym Responses
Oscar My past traumas and what I have seen in my household

affected me. Even in our generation, you see people
together and then fall apart. I also watch my parents.
Although they married for 13 years, it was unhealthy
[sic].
Breonna My brother and mom were on depression meds, but I

did not take it seriously and did not think I needed the
pills. However, following the birth of my son, I dealt
with postpartum depression–during my pregnancy. My
family has contributed to my mental health. I have
ignored issues between my mom and me and things
that I have ignored and now looking at it [sic].
Atatiana Yes, for sure. Like, I feel, and I did not identify it like,
you know, how we grew up [sic].
Aura Upbringing. I had a mother and father who had their

issues. Traumas of being a bigger Black woman: I have
always been taller and more prominent, so I stood out.
Theme 1.3.2: Does Not Have Experience with Mental Health Issues. Three
participants felt they had not experienced any mental health issues.
Gender Theme 1.3.2: Does Not Have Experience with Mental Health Issues.
Two males and one female felt they had not experienced any mental health conditions
(see Table 12).

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Table 12
Theme 1.3.2: Does Not Have Experience with Mental Health Issues
Pseudonym Responses
Dontae No.
Raheem No. I feel like the things I went through were normal, and I
could handle it, and it was not necessarily a mental health issue
[sic].
India No, I do not think so.
Theme 1.3.3 Anxiety. The participants felt they had experienced anxiety, which
is fear of everyday situations.
Gender Theme 1.3.3 Anxiety. One male and three females felt they had
experienced anxiety in some form (see Table 13).
Table 13
Theme 1.3.3 Anxiety
Pseudonym Responses
Oscar Now, as an adult, I feel like I have some anxiety at times, and certain
things I have to tell myself to chill out or relax [sic].
Priscilla Anxiety. I believed I had more of a neurodivergent mental health

issue, ADHD.
Atatiana I think I have anxiety about certain things like just it, kind of like,
you know, how we grew up. Issues they had, but when I got older, I
realized I have anxiety about certain things [sic].
Gabriella As I got older, I realized I had to have some anxiety. Sometimes, it

gets hard to handle, and I worry about everything.
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Theme 1.3.4: Being an African American. Participants felt that being a part of
the African American culture affected their mental health. Participants mentioned that
seeing social injustice in the media, discrimination, and racism made them feel mistreated
and caused insecurities.
Gender Theme 1.3.4: Being an African American. Two males and three
females described how being an African American contributed to their mental health or
well-being. The males stated they do not always feel safe and do not have the same
privileges as White Americans. The females shared not feeling safe enough to speak up
for themselves, the pressures of constantly feeling the need to be strong, and trying to fit
in with society (see Table 14).

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Table 14
Theme 1.3.4: Being an African American
Pseudonym Responses
Anthony Just being African American male and not feeling safe. I have to
watch what I say; I have to watch what I do, make sure I act a certain
way, and make sure that I always stay inside of the lines because I do
not have the privilege to be myself all the time [sic].
Priscilla Being Black sometimes affects me, as I stated earlier, when I was
younger, going to a school where I knew everyone. It was more like a
community. Everyone looked like me. My kindergarten teacher and
dad went to school together, and he dated her best friend, so like I
said, it was a community. I felt weird when I went to a new school; I
remember the bus driver calling me the n-word. My parents had to
have that “talk” with me [sic].
Aura Being a Black woman. I was always told to “sit down and be quiet
because I was Black, tall and yellow.” I felt like I could not be myself.
As a Black woman, it is a sign of weakness to ask for help, so I
learned how to push through and help others.
Michelle Being a Black woman plays a lot in my mental health. There is just so
much pressure sometimes and so much I have to change about myself
to fit in with society, and it becomes frustrating and unfair.
Akai Being a Black man is sometimes difficult, and I am also very tall, so
sometimes, I come off as intimidating to others. Things like that affect
your mental health because sometimes you think something is wrong
with you.
The fourth question was, what factors do you feel have contributed to your mental
health? This question aimed to learn the contributing factors linked to the participant’s
mental health.
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Theme 1.4.1: Negative Family Dynamics. Negative family dynamics have
contributed to some participants’ mental health conditions.
Gender Theme 1.4.1: Negative Family Dynamics. Five males and two females
shared how negative family dynamics have contributed to their mental health. They all
described some of the negative family dynamics they had faced . Three males talked about
not having a father figure and how it had contributed to their mental health (see Table
15).
Table 15
Theme 1.4.1: Negative Family Dynamics
Pseudonym Responses
Shawn The lack of family dynamics or normal family dynamics some people
have has affected me. I grew up without a mother and a father. I did not
have either. I never met my biological father.
Anthony On the negative side, I grew up in a single-parent household and figured

things out as a man alone.
Oscar When it comes to healthy relationships and marriage and what that would
look like for me, it is because of past trauma and what I have seen in my
household.
Priscilla I had to call 911 for my mom after being abused by my dad at four years
old [sic]. I remember that vividly, although I was four years old. I
remember running to my neighbor’s house because my mom was
bleeding, and blood was all over the ground from domestic abuse.
Breonna My family has contributed to my mental health. Issues between my mom

and me and stuff that I have ignored, and now, looking at it, I realize that
that was an issue.
Akai I watched my best friend die in my arms. I was the last person to talk to
him. I grew up without a father figure. Now, I am raising my children
without that role model [sic].
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Theme 1.4.2: Positive Family Dynamics. Positive family dynamics contributed
to the participants’ mental health conditions.
Gender Theme 1.4.2: Positive Family Dynamics. Three males and one female
shared how positive family dynamics contributed to their mental health and well-being
(see Table 16).
Table 16
Theme 1.4.2: Positive Family Dynamics
Pseudonym Responses
Shawn My family instilled different things in my life. One of the biggest things
was prayer.
Raheem I think I can live a good life because I am from a small town and making
it from that small town and being a successful Black man and being from
a small town. I came from a place where we did not know whether or not
I could go to college [sic]. Thus, people from my town always say, Oh
my gosh, you are doing a great job [sic]. Being able to get a job you did
not think you would ever be qualified for [sic].
Anthony On the positive side, I have a strong support system with my family and
friends. I have people I can go to if I need to.
India On the positive side, my family and friends keep pushing me and
reminding me that I can do great things.
Theme 1.4.3: COVID 19 Pandemic. Five participants felt that COVID-19
affected their mental health. The participants shared their experiences with losing family
members, the ongoing information transmitted through the media, and becoming anxious
about the uncertainties.
Gender Theme 1.4.3: COVID-19 Pandemic. Two males and three females
shared how the impact of the COVID-19 pandemic affected their mental health. The
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males shared how more things changed online and how they had to pay attention to the
news. The females shared anxiety and losing family members (see Table 17).
Table 17
Theme 1.4.3: COVID-19 Pandemic
Pseudonym Responses
Oscar I think about it; the pandemic contributed because I had to learn how
to do my job online, and there was no preparation for it; I felt like I
was losing my mind. Because of that, everything has changed. I
mean, like how we live my job, everything protocols, everything.
Manuel I almost forgot about the pandemic. I was okay being isolated for a
while, but it was to pay attention to what was going on in the news
and watch all of the different deaths, and there was so much going on
with Black Lives Matter. It was just a lot that was also the time when
George Floyd was killed; I had to cut the TV off for a while [sic].
Atatiana The pandemic. I know I had never experienced anything like that
before.
Michelle The pandemic! So, I have asthma, so I started to think that I was
getting sick when it was in my mind, so I guess you would say that
my anxiety was triggered [sic]. I was not diagnosed with anxiety, and
it was scary.
India I remember I was in school, still trying to graduate, and this came
along. Having to navigate everything online was difficult, yes. I have
taken classes online before, but this one was uncertain [sic]. We did
not know what graduation was going to look like. I felt like I was
going into a deep depression and anger. There was nothing that I
could do.
Theme 1.4.4: Social Injustice. Four participants felt that social injustices within
the African American culture affected their mental health at some point. The participants
described being discriminated against, which occurs when a group or individual is
mistreated compared to another group or individual (Fibbi et al., 2021).

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Gender Theme 1.4.4: Social Injustice. Two males and two females felt social
injustices seen in the media, and personal experiences contributed to their mental health.
The males talked about seeing themselves in social injustices. One talked specifically
about personal injustices he has experienced. The females spoke about how emotional it
makes them as they watch documentaries and videos shown by the media (see Table 18).
Table 18
Theme 1.4.4: Social Injustice
Pseudonym Responses
Manuel I try not to get so wrapped up in the media, but it is hard. It is even harder
watching countless videos of racial profiling and social injustice.
Especially the most recent with Tyree, whom my people killed, and it
hurts.
Akai I have seen firsthand what social injustice feels like, even as a kid or
teenager, getting in trouble with the law as a first-time offender and
watching others not have to go through what I went through. However,
my family taught me early that the system was not built for people like
me. Just look at what they did to George Floyd.
Michelle Social injustice gets me every time. I watch many documentaries. So, I
watched and learned how we have been used as guinea pigs when
African Americans were enslaved, even with the Henrietta Lacks story.
Sometimes, it gets me down, but I am expected to keep going [sic].
India I want to say their names. However, I get emotional every time. I get so
angry, but what do we do? What can we do? There are so many videos.
Breanna Taylor looked like me, and they did nothing [sic]. It sometimes
made me feel so low, so I went to school to study.
Theme 1.4.5: My Race or Gender. Four participants described how their gender
and race affected their mental health issues. Some discussed racial injustice and described
The Strong Black Woman Schema (SBWS).

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Theme 1.4.5: My Race or Gender. Two males and two females explained how
their race and gender contributed to their mental health issues. The males stated they felt
HBCUs had given them a safe space to be themselves; however, watching the media has
caused them to remain self-aware of racial injustices. The females talked about feeling
they have two demographic characteristics against them as they are African American
and women (see Table 19).
Table 19
Theme 1.4.4: My Race or Gender
Pseudonym Responses
Anthony I grew older, aware, and alert. I was navigating being an African
American male in today’s society. Watching the media with the constant
racial injustice and having to change who I am sometimes.
Manuel As a Black man, I feel thankful that I am at an HBCU. I say that because
it is hard when I am the only Black male in situations. There are so many
stories I could talk about being racially profiled. Furthermore, just
watching people who look like I lose their lives simply because of their
skin color, sometimes I will be angry [sic].
Atatiana Just being, you know, in America and being Black or and being a woman
and that already like that is already a heavy weight to carry [sic].
Gabriella As I mentioned, being an African American and a woman is like a double

minority. It is all because of that I have experienced social or racial
injustice.
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The fifth question was, what coping mechanisms do you use for your personal
mental health? This question aimed to learn how the participants manage their mental
health and how it may put them in a better mindset.
Theme 1.5.1: Address Mental Health Issues by Using Unsafe Coping
Mechanisms. Three participants used Cannabidiol (CBD), alcohol, or other drugs to cope
with their mental health.
Gender Theme 1.5.1: Address Mental Health Issues by Using Unsafe Coping
Mechanisms. One male talked about using CBD drugs for relaxation when feeling
stressed or anxious. Two females stated they consumed alcoholic beverages as a coping
technique (see Table 20).
Table 20
Theme 1.5.1: Using Unsafe Coping Mechanisms
Pseudonym Responses
Oscar Sometimes, I use CBD; it helps with my anxiety and grounds me.
Aura I have a drink now and then.
Manuel Sometimes, I will go out and have a drink.
Theme 1.5.2: Spiritual and Religious Beliefs. Five participants had religious
beliefs and faith in a higher power. They utilized their spiritual beliefs as coping
mechanisms.
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Gender Theme 1.5.2: Spiritual and Religious Beliefs. Three males and three
females relied on their relationship with God and spirituality as coping mechanisms (see
Table 21).
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Table 21
Theme 1.5.2: Spiritual and Religious Beliefs
Pseudonym Responses
Shawn My spirituality plays a significant part in my coping. My spirituality has

helped me cope with many of my mental health issues.
Dontae Prayer.
Akai My relationship with God.
Breonna I try not to necessarily meditate but try to calm down, pray, and take time
to myself and think things through.
Gabriella My daily prayer is, “Help me walk more in your light, God, and walk
your path; help me to order my steps.” ... that is pretty much it. That is
how I have been dealing with it.
India Prayer and church have helped.
Theme 1.5.2 Self-Care. Self-care is the ability to care for oneself through
awareness, self-control, and self-reliance to achieve, maintain, or promote optimal health
and well-being. Three participants described how they used self-care to cope with their
issues.
Gender Theme 1.5.2 Self-Care. One male and two females shared that they used
self-care as their coping mechanism (see Table 22).

107
Table 22
Theme 1.5.2 Self-Care
Pseudonym Responses
Anthony I surround myself with family and friends. However, I am not a big self-
care person, but I guess being with my family would be my form of self-
care.
Priscilla I have been exercising and drinking more water. Self-care has been a big
thing for me. I have been diving into self-care. Mind-body and spirit have
been big things for me.
India Self-Care. Self-care is caring for my mind, body, and spirit.
Theme 1.5.3: Exercising. Five participants used to work out, exercise, or do yoga
as coping mechanisms for their mental health issues.
Gender Theme 1.5.3: Exercising. Two males and three females shared that they
exercise as a coping mechanism (see Table 23).
Table 23
Theme 1.5.3: Exercising
Pseudonym Responses
Oscar Working out helps get my mind off things.
Priscilla Recently, I have been exercising and drinking water more.
Aura I try to do yoga.
Gabriella The gym.
Akai I go to the gym and exercise.

108
Theme 1.5.4: Friends and Family. Five participants described how their families
and friends have served as a support and coping mechanism when handling their mental
health issues.
Gender Theme 1.5.4: Friends and Family. Two males and three females shared
that their friends and family have been their way to cope, whether spending time with
them or using them for support (see Table 24).
Table 24
Theme 1.5.4: Friends and Family
Pseudonym Responses
Anthony I surround myself with family and friends. However, I am not a big self-
care person, but I guess being with my family would be a form of self-
care.
Oscar Working out helps get my mind off things.
Priscilla I reach out to my good friends.
Atatiana I have a supportive husband.
Gabriella I enjoy being with friends.
Theme 1.5.5: Traveling. Three participants described how traveling had been a
coping mechanism when handling their mental health issues.
Gender Theme 1.5.5: Traveling. Two males and one female stated they travel as
a coping mechanism (see Table 25).

109
Table 25
Theme 1.5.5: Traveling
Pseudonym Responses
Raheem I enjoy taking trips.
Oscar I travel and get away.
Gabriella I try to get away (traveling).
Theme 1.5.6: Isolation. Four participants described how isolation or removing
themselves from situations and being alone had been a coping mechanism for their
mental health issues.
Gender Theme 1.5.6: Isolation. There were three males and one female who
used isolation as a method to cope with their feelings (see Table 26).
Table 26
Theme 1.5.6: Isolation
Pseudonym Responses
Donte Sometimes, I enjoy my time alone.
Anthony I take a step back and gather my thoughts alone.
Akai I go into isolation to clear my mind.
India Being alone helps me and gives me time to think and understand how to
ground myself.
110
Table 27 shows the general themes from the participants’ interviews who had
received mental health services.
Table 27
General Themes Found from Interviews with Participants Who Had Received Mental
Health Services
What did you feel was the Theme 2.1.1 Relationship Issues
presenting problem when Theme 2.1.2 Loss of a Loved One
seeking and receiving mental Theme 2.1.3 Anxiety
health services? Theme 2.1.4 Stress
Theme 2.1.5 Postpartum Depression
Theme 2.1.6 Suicide
What has been your experience Theme 2. 2.1 Positive – Help a Lot
with the mental health services Theme 2.2.2 Positive – Help Some
you have received? Theme 2.2.3 Negative – Did Not Help
How were the services you Theme 2.3.1 Sought Services Online
received found? Theme 2.3.2 Recommended by the Court
Theme 2.3.3 Recommended by a
Professional Outside of the
Mental Health Field
Did anyone encourage you to Theme 2.4.1 Encouraged by Friends and

continue or stop using mental Family
health services? What was their Theme 2.4.2 No one Encouraged to Stop
explanation? or Continue
Theme 2.4.3 Parents or Family did not
Understand or Believe in the
Services
Did you have a preference Theme 2.5.1 No preference

regarding the demographics of Theme 2.5.2 Yes, I Preferred Someone of
your therapist? What is your my Racial background
reasoning? Theme 2.5.3 Yes, I Preferred Someone of a
Specific Racial Background and
Gender
Theme 2.5.4 Yes, I Preferred Someone of the
Same Gender as I am
111
Table 28 shows gender themes from the interviews with participants who had not
received mental health services.
Table 28
Gender Themes Found from Interviews with Participants Who Have Not Received Mental
Health Services
Interview Questions Gender Themes Interview Responses
What did you feel was the Male

presenting problem when Theme 2.1.1 Relationship Issues
seeking and receiving mental Theme 2.1.2 Loss of a Loved One
health services? Theme 2.1.3 Anxiety
Theme 2.1.4 Stress
Theme 2.1.5 Postpartum Depression
Theme 2.1.6 Suicide
Female
Theme 2.1.1 Relationship Issues
Theme 2.1.2 Loss of a Loved One
Theme 2.1.3 Anxiety
Theme 2.1.4 Stress
Theme 2.1.5 Postpartum
Theme 2.1.6 Suicide
What has been your experience Male

with the mental health services Theme 2.2.1 Positive–Help a Lot
you have received? Theme 2.2.2 Positive–Help Some
Theme 2.2.3 Negative–Did Not Help
Female
Theme 2.2.1 Positive–Help a Lot
Theme 2.2.2 Positive–Help Some
How were the services you Male

received found? Theme 2.3.1 Sought Services Online
Theme 2.3.2 Recommended by the Court
Mental Health
112
Table 28 continued
How were the services you Female

received found? Theme 2.3.1 Sought Services Online
Theme 2.3.2 Recommended by the Court
Mental Health
Did anyone encourage you to Male

continue or stop using mental Theme 2.4.1 Encouraged by Friends and
health services? What was their Family
explanation? Theme 2.4.2 No One Encouraged Me to
Stop or Continue
Theme 2.4.3 Parents or Family Did Not
Services
Female
Theme 2.4.1 Encouraged by Friends and
Family
Theme 2.4.2 No One Encouraged Me to
Stop or Continue
Theme 2.4.3 Parents or Family Did Not
Services
Did you have a preference Male

regarding the demographics of Theme 2.5.1 No preference
your therapist? What is your Theme 2.5.2 Yes, I Preferred Someone of
reasoning? my Racial background
Theme 2.5.3 Yes, I Preferred Someone of
a Specific Racial
Background and Gender
the Same Gender as I am
113
Table 28 continued
Did you have a preference Female

regarding the demographics of Theme 2.5.1 No preference
your therapist? What is your Theme 2.5.2 Yes, I Preferred Someone of
reasoning? my Racial background
a Specific Racial
Background and Gender
the Same Gender as I am
The first question of this interview was, what did you feel was the presenting
problem when seeking and receiving mental health services? The purpose of this question
was to learn about the reason the participants felt mental health services were needed in
their personal lives. The participants discussed the situations that led them to seek mental
health services.
Theme 2.1.1: Relationship Issues. The first theme identified in the research
study was relationship issues. The researcher identified this as a theme through
discussions with the participants regarding their responses to what they felt were their
presenting issues, resulting in them seeking mental health services.
Gender Theme 2.1.1: Relationship Issues. Two males faced relationship issues
and sought professional services to help with emotions they were beginning to have.
Three females were in abusive relationships and decided to seek help (see Table 29).
114
Table 29
Theme 2.1.1: Relationship Issues
Pseudonym Responses
Trayvon The problem for me was when I was dating. We were going through
three years of a relationship. We hit a little rough patch, and I began
acting out of character, which could have led me to go to jail. I woke up
one day and decided to find a way to channel this anger and frustration.
Tony I was going through a divorce then, so I sought my services.
LaToya I went because I was in a bad relationship; I wanted to know why I

always found myself in these toxic and violent domestic relationships. I
can never figure out why, as a woman or what, I was contributing to this
or attracting these types of men.
Dominique I was in an abusive relationship that I could not talk about.
Tanisha I had just exited an abusive relationship and felt like I was losing
myself.
Theme 2.1.2: Loss of a Loved One. Four participants sought and received
mental health services because they experienced the grief of losing a loved one.
Gender Theme 2.1.2: Loss of a Loved One. One male lost a loved one, causing
him to seek mental health services. Three females lost a loved one, resulting in seeking
mental health services. One male lost a parent, two females lost a parent, and one female
lost a friend (see Table 30).

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Table 30
Theme 2.1.2: Loss of a Loved One
Pseudonym Responses
Ruben The loss of my father. I decided to seek mental health because it was
like a grieving process, and I was not myself. I was just down.
Kourtnee The first time I received it, I received it because of a death. My mom
died.
Monica Death was the main thing because I never thought I wanted therapy
until after my dad passed away.
Yvette Loss of a friend [sic]. I had never experienced this type of grief.
Theme 2.1.3: Anxiety. The participants felt they were experiencing anxiety, fear,
or worry about everyday situations, leading to seeking mental health services.
Gender Theme 2.1.3: Anxiety. Three males shared that their anxiety was
intense, and some daily activities were challenging. Two females also stated that anxiety
was causing them to feel uneasy and felt the only thing that would help was seeking
outside help (see Table 31).

116
Table 31
Theme 2.1.3: Anxiety
Pseudonym Responses
Jarvis I think anxiety; I felt out of control and how I responded to situations
when I felt like I was not in control.
Stephon My anxiety became intense, and I did not know how to handle it.
Michael I was worried about everything, and my anxiety made it all worse.
Monica I felt like it was linked to anxiety, being anxious, and death. Death was
the main thing because I never thought I wanted therapy until after my
dad died. I never had those feelings in my life, in my head, or anything
else.
Kourtnee The second time I received, it was more because of stress and anxiety
and trying to navigate the world as an adult.
Theme 2.1.4 Stress. Three participants sought and received mental health
services because they experienced a state of emotional strain or tension in their lives,
leading to stress.
Gender Theme 2.1.4 Stress. Three females shared that they felt stressed, leading
to seeking and receiving mental health services. Only female participants responded,
describing feeling stressed (see Table 32).

117
Table 32
Theme 2.1.4 Stress
Pseudonym Responses
Kourtnee The second time I received services was more because of stress and
anxiety and trying to navigate the world as an adult.
Ma’Khia I was stressed, losing my mind, and about to drop [sic].
Tanisha Stressed with life altogether, it was just so much that I started to feel
overwhelmed [sic].
Theme 2.1.5: Postpartum Depression. Three participants sought and received
mental health services because they felt they were experiencing postpartum depression.
The participants described mood swings, anxiety, and crying spells. Postpartum
depression occurs after a female has given birth.
Gender Theme 2.1.5: Postpartum Depression. Three females sought and
received mental health services due to experiencing postpartum depression after giving
birth to their child or children. Only female participants described postpartum depression
in their responses (see Table 33).

118
Table 33
Theme 2.1.5: Postpartum Depression
Pseudonym Responses
LaToya It helped me because that is going through postpartum depression.
Dominique I was then diagnosed with postpartum depression. I was just

depressed, sad, and crying all the time.
Yvette I felt like I was going through postpartum depression, and when I
started therapy, I found that I was.
Theme 2.1.6 Suicide. Three participants explained there was a time when they
contemplated suicide and self-harming, which led to seeking mental health services.
Gender Theme 2.1.6 Suicide. One male and two females began to have suicidal
thoughts and self-harm. Participants explained they wanted to live, leading to seeking
mental health services (see Table 34).
Table 34
Theme 2.1.6 Suicide
Pseudonym Responses
Stephon I started to self-harm to cope, and then my thoughts started taking

over, and I felt suicidal. I had to do something.
Tanisha I was having thoughts of self-harm and suicidal thoughts. I was

terrified.
Yvette I had become so depressed that I contemplated suicide.

119
The second question was, what has been your experience with the mental health
services you have received? The purpose of this question was an extension of the first
question. After the participants shared their reasoning for seeking services, this question
served as a way to understand their experiences with the services while receiving mental
health services.
Theme 2.2.1: Positive–Helped a Lot. Six participants sought and received
mental health services and felt their experiences with mental health services helped them
a lot. Some stated they were in a better place and would continue as needed.
Gender Theme 2.2.1: Positive–Helped a Lot. Two males and four females felt
the services were beneficial (see Table 35).

120
Table 35
Theme 2.2.1: Positive—Helped a Lot
Pseudonym Responses
Trayvon The services I received when I was younger helped a lot. This
experience set a foundation that made me more open to discussing my
issues and made me comfortable.
Stephon It helped me a ton [sic].
Kourtnee The second experience was much better; I still visit her occasionally as
needed. It could have been the age difference. I enjoyed my second
time going to therapy.
LaToya I did find someone else, but it was more on the professional level than
on the personal level. My therapist helped me think more and
challenged me to do things differently. Our sessions were shorter. I feel
like I gained a lot from both individuals, and I was able to relate to both
individuals. However, I became a better person.
Monica The services that I received I thought were beneficial.
Tanisha It helped me greatly; I do not know where I would have been without
it.
Theme 2.2.1: Positive Helped Some. Six participants responded that their
experiences with mental health services helped some with presenting issues.
Gender Theme 2.2.1: Positive–Helped Some. Three males and three females
felt services helped some. One male stated he had to open up to receive help. All males
said they no longer needed mental health services once they got what was needed. The
females stated the services were not what they expected but knew help was needed,
which is why one female participant continued to keep going while the other stopped
attending sessions (see Table 36).

121
Table 36
Theme 2.2.1: Positive–Helped Some
Pseudonym Responses
Tony I think it helped some because, at the time, I was going every week,
and it was becoming redundant. Once I regained my power, I no
longer needed those services.
Derrick It helped some, but it was after I decided to open up.
Jarvis After a few sessions, I felt like I had what I needed. They are about 5
to 6 sessions. I felt like I was in a better place.
LaToya One of my counselors was more me helping her, but really, I was the
one that needed the help. So, it helped some, but we were helping
each other.
Ma’Khia It was not terrible, but it was not what I wanted to do in therapy. I do
not want to go and talk to someone and be judged. I could have just
talked to myself, looked at myself in the mirror, or spoken to one of
my friends.
Yvette It helped me some. I only did a few sessions and stopped.
Theme 2.2.2 Negative–Did Not Help. Five participants who sought and received
mental health services felt they did not have a connection. Reasons included racial
background, not having a rapport with the provider, and the provider not being relatable
to their cultures.
Gender Theme 2.2.2 Negative–Did Not Help. Two males felt the services were
not helpful. Three females did not benefit from the services they received. The males felt
a lack of connection due to the counselor’s racial background, a lack of cultural

122
competence, and a lack of rapport. The females all stated they had White Americans as
counselors and did not feel there was a clinician-patient connection (see Table 37).
Table 37
Pseudonym Responses
Trayvon I did not have a connection with her at all.
Stephon I did not feel a connection with the therapist and felt judged. I did not
feel heard at all.
Kourtnee From the White woman, and there was no connection. I felt it was
generic and unhelpful, and I learned nothing from it.
LaToya The first therapist was a woman, but she was Caucasian, and I cannot
relate to her at all whatsoever. Whenever I said something or
something I had an issue with, she tried to medicate me with various
drugs, which felt weird, so it did not help at all [sic].
Ma’Khia I needed help coping with the stuff I have been through, and it has
been heavy. I could not relate to my therapist; she was a Caucasian
woman. I wanted someone who understood why I do what I do or my
coping mechanisms because she had not been through the same things
that I have been through [sic].
The third question was, how were the services you received found? This question
aimed to understand if participants found it challenging to locate what they needed and
how this may have affected the type of services they received.
Theme 2.3.1: Sought Services Online. Eight participants found their mental
health services by seeking online resources.

123
Gender Theme 2.3.1: Sought Services Online. Five males and three females
found their mental health services by searching online (see Table 38).
Table 38
Theme 2.3.1: Sought Services Online
Pseudonym Responses
Trayvon I went on Google and looked for good therapists in my area.
Tony The family counseling I received was through an online cell phone
application. The phone application set everything up, and it was a
virtual meeting, and it was pretty convenient and easy to use.
Derrick I looked and found services online.
Jarvis I used a Google search. I did not receive a reference from anyone.
Michael I found my services online.
Kourtnee I found services on psychologytoday.com.
LaToya I went on this website. I forgot the website’s name, but I think it
was therapists.com.
Monica I found them online. I believe it was therapyforblackgirls.com.
Theme 2.3.2: Recommended by the Court. Three participants found their
mental health services because they were court-appointed through child services and
family court.
Gender Theme 2.3.2: Recommended by the Court. Two males and one female
received mental health services because they were court-appointed through family court
recommendations (see Table 39).

124
Table 39
Theme 2.3.2: Recommended by the Court
Pseudonym Responses
Trayvon The court appointed the mental health services.
Stephon The family court appointed the first time I received services.
Yvette As a child, I was involved in the Department of Juvenile Justice

(DJJ), and we had to do family counseling.
Theme 2.3.3: Recommended by a Professional Outside of the Mental Health
Field. Five participants found their mental health services from their careers, family
members, or through their schools and institutions.
Gender Theme 2.3.3: Recommended by a Professional Outside of the Mental
Health Field. One male stated he received resources from their job. Four females
received services recommended outside of the mental health field. Two females received
recommendations from their place of employment. One female received a
recommendation from an elementary school professional, and another was recommended
by a college professor (see Table 40).

125
Table 40
Theme 2.3.3: Recommended by a Professional Outside of the Mental Health Field
Pseudonym Responses
Ruben At my last job, they gave out free counseling, all included in your
insurance.
Kourtnee My grandparents found my first therapist at the school because the

therapist would come to me at school.
Ma’Khia My professor recommended the office.
Dominique The first time was through employee relations when I worked at
my job.
Tanisha My job had a listing of local therapists.
The fourth question was, did anyone encourage you to continue or stop using
mental health services? What was their explanation? This question aimed to understand
if others played a part in their influences when receiving mental health services. The
participants shared their experiences with their peers and family while seeking and
receiving mental health services.
Theme 2.4.1: Encouraged by friends and family. Eight participants were
encouraged by their family and friends to continue receiving mental health services.
Gender Theme 2.4.1: Encouraged by friends and family. Four male and four
female participants received encouragement from their friends and family to continue
receiving mental health services (see Table 41).

126
Table 41
Theme 2.4.1: Encouraged by Friends and Family
Pseudonym Responses
Trayvon It was always my friends, and I told them exactly what was
happening. They told me I needed to continue if I wanted to start
seeing progress.
Ruben My cousin was the person who encouraged me because he was in

the same predicament; he had lost his mother, who was my aunt
and my dad’s baby sister. So, he encouraged me because he knew
how it was, and he was a “mama’s boy” and blindsided by her
death.
Derrick I did have a friend who was working in the medical field who
encouraged me to continue going to see my progress.
Michael My family and friends were very supportive of my decisions.
Kourtnee As an adult, my friends encouraged me.
LaToya When I initially went to my mom about it, surprisingly, she was
supportive. My friends tried it too, so they were like encouraging
too.
Monica I guess everybody around me encouraged me even though only

about five people knew that I was seeing anyone. Moreover, the
people around me did not even know I was in therapy, but they
still encouraged me to talk to someone about my situation or to
encourage me.
Yvette My family and friends have always been super supportive.
Theme 2.4.2: No One Encouraged to Stop or Continue. Four participants were
not encouraged to stop or continue receiving mental health services, mainly because they
did not share with anyone that they were receiving services.
127
Gender Theme 2.4.2: No One Encouraged to Stop or Continue. Three male
participants were not encouraged to stop or continue using mental health services. One
female participant was not encouraged to stop or continue using mental health services.
Neither the males nor females shared with their friends nor family that they were seeking
and receiving services (see Table 42).
Table 42
Theme 2.4.2: No One Encouraged to Stop or Continue
Pseudonym Responses
Tony No one encouraged me to stop or continue services because I did

not tell anyone.
Jarvis No one encouraged me to stop or continue because I did not think

anyone knew. After all, I did it alone.
Stephon No one encouraged or stopped me because I did not tell anyone.
Dominique Well, I did not tell anyone. I did not feel embarrassed, but it was
just something I did not want anyone to know [sic].
Theme 2.4.3: Parents Did Not Understand or Believe in the Services. Six
participants felt discouraged by their parents when seeking and receiving mental health
services mainly because the parents did not understand or did not feel the issue was real.
Gender Theme 2.4.3: Parents Did Not Understand or Believe in the Services.
One male participant shared that their parent did not understand and discouraged them
from continuing mental health services. Five female participants were discouraged by
their parents or grandparents from continuing to use mental health services (see Table
43).
128
Table 43
Theme 2.4.3: Parents or Family Did Not Understand or Believe in the Services
Pseudonym Responses
Ruben My mom discouraged me at first. My mom wanted to give it to God,

and that is it [sic].
Kourtnee My Grandmother told me to stop because the therapist said I was not
saying anything or opening up.
LaToya My dad was not entirely supportive. I feel like most African
American men are against therapy, so he could not understand why I
was going, and it was hard to explain why I was going, but he never
said to stop. He could not understand why.
Ma’Khia I told my dad, and he felt I did not need to talk to anybody. He
responded, “What do you need a shrink for?” [sic].
Dominique “My mom told me that I did not need services. I told her I had been
diagnosed with postpartum depression, and she told me it was not
real. She told me that I was attention-seeking.
Tanisha My parents tried to discourage me, telling me it was all in my head

[sic].
The fifth question was, did you have a preference regarding the demographics of
your therapist? What is your reasoning? This question aimed to understand the
participants’ thoughts regarding demographics and if they would affect the experiences
received.
Theme 2.5.1: No Preference. Three participants did not have a preference for the
demographics when receiving mental health services.

129
Gender Theme 2.5.1: No Preference. Two males described not having a
preference regarding the demographics of the counselor or therapist. The participants felt
their issues were not gender or race-specific (see Table 44).
Table 44
Theme 2.5.1: No Preference
Pseudonym Responses
Ruben I did not have a preference at that time. My counselor was Asian and
a good dude; [sic] he was a stranger, so he could not judge me; that is
how I looked at it.
Jarvis Initially, I preferred a Black male therapist, but then I realized the
issues I wanted to address were not race-specific or gender-specific,
so I settled for a white therapist. I think the whole idea of therapy in
the Black community is new, so we can feel that we can only benefit
from someone who looks like us. I used to agree, but my situation
was not gender or race-specific.
Theme 2.5.2 Yes–Preferred Someone of My Racial Background. Seven
participants felt they would benefit from having a mental health service provider who
was African American themselves. The majority of the participants felt that it would
provide cultural competency.
Gender Theme 2.5.2 Yes–Preferred Someone of My Racial Background. Five
male participants felt a particular racial background was necessary when seeking mental
health services. The five male participants stated that they would prefer an African
American counselor. Three female participants also felt that racial background was
necessary when receiving mental health services. All three female participants preferred
an African American counselor (see Table 45).

130
Table 45
Theme 2.5.2 Yes–Preferred Someone of My Racial Background
Pseudonym Responses
Trayvon I prefer a Black female.
Derrick I wanted someone to be of the same culture as me. It

did not matter if the therapist was male or female.
That made a difference because to understand who I
am, I have to understand the challenges I could have
faced and the potential understanding because they
were of the same culture.
Stephon There are just things in the Black community that

other cultures do not understand, and also as a man.
I felt I needed a Black male counselor because of
my race and racial discrimination.
Michael I told myself that if I was going to seek these

services, I needed someone to identify with my
community and me. It did not matter if it were male
or female. I just needed someone I could relate to.
Someone who was Black [sic].
Kourtnee Yes, I did have a preference, and my reasoning was

because of my previous experience having a
therapist who was not the same color as me. With
everything going on in the world, I just wanted
someone who could relate to or somewhat relate to
me. I feel we experience things other races do not
experience as Black women.
LaToya So, I wanted to go to an African-American woman

so she could relate to me [sic].
Monica I did. I only looked for Black women within a

particular age category, and the reason why was
because I felt like Black women could relate to me
more than Caucasian, and I also did not have
anything against male therapists just as long as they
were Black.
131
Theme 2.5.3 Yes–Preferred Someone of a Specific Racial Background and
Gender. Five participants felt they would benefit from a specific gender and an African
American mental health provider. The participants felt a female would not judge them;
the female would understand female issues and cultural competency regarding the
demographic request of being African American.
Gender Theme 2.5.3 Yes–Preferred Someone of a Specific Racial
Background and Gender. Two male participants preferred a specific race and gender.
One male participant preferred an African American female counselor, while the other
male participant preferred an African American male counselor. Three female
participants preferred a specific racial background and gender. All three female
participants preferred an African-American woman as a counselor. The female
participants felt that having a specific racial background and gender would help with
cultural competencies and understanding women’s struggles, such as pregnancy (see
Table 46).
132
Table 46
Theme 2.5.3 Yes–Preferred Someone of a Specific Racial Background and Gender
Pseudonym Responses
Trayvon I prefer a Black female because I work in education and never get
along with Black male principals, typically my supervisors. It was
always the Black females who seemed to mesh with me most. So, I
said, “Why not seek a Black woman since that is who I connect well
with.” I also feel that because of my orientation, I have connected
more with Black females than Black males because men have been
so judgmental in my experience.
Stephon There are just things in the Black community that other cultures do
not understand, and also as a man. I wanted a Black male. I felt this
because of my racial experiences. I felt I needed a Black male
counselor because of my race and racial discrimination.
LaToya So, I wanted to go to an African American woman so she could

relate to me, but I was open to Black males too [sic].
Ma’Khia The culture piece is critical to me because even in my career, I do

not want to explain certain things. Having the culture piece from a
Black female therapist, they would understand better because they
understand my culture.
Tanisha I just needed help. I wanted someone who understood my culture,

language, and struggles. I was okay with males or females, but I
wanted them to be Black.
Theme 2.5.4: Preferred Someone of the Same Race and Gender as I Am.
Four participants specifically requested the same gender and race as themselves when
receiving mental health services.
Gender Theme 2.5.4: Preferred Someone of the Same Race and Gender as I
Am. Two male participants stated they would prefer a counselor with the same racial
background and gender. The male participants felt an African American male counselor
133
would understand them and the struggles of their environments, including their race and
discrimination. Two female participants felt it was essential for the counselor to share the
same race and gender as they were. The participants explained that having someone look
like them would provide a stronger clinician-patient relationship (see Table 47).
Table 47
Theme 2.5.4: Yes–I Preferred Someone of the Same Gender as I Am
Pseudonym Responses
Tony Yes, I did have a preference. I wanted a Black male. At the time, I
felt I needed someone like me to understand me. Someone who
came from my environment to understand me.
Stephon There are just things in the Black community that other cultures do
not understand, and also as a man. I felt I needed a Black male
counselor because of my race and racial discrimination.
Dominique I prefer someone of the same race and gender as I am. I do feel like
sometimes folks that look like me would relate to what I am going
through. I have only met with women, so maybe I am a little biased,
but they were women and moms, and they could relate to some of
the things I was going through [sic].
Yvette I wanted a therapist with the same gender and racial background as
me. I was going through postpartum depression, and I wanted
someone who could relate to my culture and being a woman and a
Black woman.
Summary
This chapter highlighted themes supporting the perceptions and experiences of
first-generation African American students and graduates from an HBCU. Twenty-three
themes emerged from the participants who had not received mental health services, and
19 emerged from those who received mental health services. The themes help guide the
understanding of the research questions from the study. The participants shared
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differences and similarities through their experiences and perceptions of seeking mental
health services throughout their lifetime. This chapter included the research results and
the consistency of the responses from the participants. Chapter Five discusses the
findings of this qualitative study and the connections between the themes and research
questions.
135
Chapter Five: Discussion and Conclusion
Overview
This study aimed to explore African American first-generation college students
and graduates’ experiences and perceptions of seeking mental health resources. The
researcher strived to give meaning to the participants’ perceptions and experiences when
seeking mental health services. The researcher also made an effort to help better
understand the relationship between the mental health field and African Americans. This
concluding chapter discusses the summary of findings, discussion, implications,
limitations, recommendations for further research, and summary.
Summary of Findings
Chapter Four included findings from the 28 interviews with first-generation
African American students and graduates from an HBCU in the midlands of South
Carolina. The HBCU culture is a subset of a more incredible culture deeply rooted in
African-American culture. Subsequently, this organizational culture presents itself as an
outstanding subject and amalgamation of cultural values, perceptions, traditions, beliefs,
and behaviors that guide the lifestyles of the participants, in particular, their mental health
(Hamedani & Markus, 2019).
The researcher conducted interviews via Google Meetings. Each interview lasted
between 20 to 35 minutes, with a mean interview of 23 minutes. With permission from
the participants, each interview was recorded through Google Meetings and with a digital
voice recorder. The interview questions were aligned with the research questions. The
study aimed to answer the following two research questions:

136
The first research question (RQ1) sought to discover the participants’ perceptions
of seeking mental health services. Most participants felt mental health services were
necessary, especially in the Black community. Participants shared how they felt it would
be a benefit if they sought mental health services and how it could contribute to healthier
lifestyles. Participants described a sense of feeling weak and did not want to have help
from others. Participants also shared feelings about personal experiences with mental
health conditions because of their upbringings and professional education.
Some participants shared that there is a link between racism, stereotypes, and
social injustice as it relates to mental conditions. Participants felt their race of being an
African American has contributed to mental health issues due to experiencing and
witnessing racial inequalities. Participants shared feelings about watching and hearing the
media about racism and police brutality towards African Americans. Participants also
shared facing stigmas in the Black community. Participants felt that being strong has
made it difficult to ask for or seek help without feeling weak.
The second research question (RQ2) sought to discover the participants’
experiences seeking mental health services. Participants shared that seeking mental health
services was not difficult because they could find services through online platforms. They
were more concerned about whether their insurance would cover the cost of the sessions.
137
Participants sought services when facing challenges, such as relationships, losing a loved
one, and specific mental health conditions.
Participants shared that it was helpful to have people encourage them to continue
to seek mental health services. When participants were encouraged to stop using mental
health services, it usually came from a family member or parents much older than the
participant. Some shared that they did not understand the purpose of talking to someone
else about their problems or not having the mental health literacy components. Some
participants did not feel the services needed to continue due to a negative tone of feelings.
One participant stated that, as the client, she provided the clinician with help and
guidance. Another participant felt they were rehashing the same issues, which started to
become repetitive, and they relived the trauma. Another participant stated that they did
not feel the clinician was knowledgeable of other coping mechanisms outside of taking
medications.
Most participants explained that cultural competency is essential when receiving
mental health services. Participants shared that they wanted to have a sense of comfort to
foster positive relationships between the clinician and the client. Some participants felt
more comfortable having a counselor or therapist with the same race and cultural
experiences.
Participants shared that the services they received were helpful because of the
mental health professional’s cultural competence and an understanding of their
environmental issues. As a result of the study, 23 themes emerged from the participants
who had not received mental health services, and 19 emerged from those who received
138
mental health services. The researcher found the themes consistent with the literature
review’s research.
Discussion
This study focused on the perceptions and experiences of seeking mental health
services among African American first-generation college students and graduates. As the
participants shared their stories about their perceptions of seeking mental health services,
23 themes emerged. As the participants shared their experiences when seeking and
receiving mental health services, 19 themes emerged from the interview responses.
Participants shared their perceptions and experiences based on receiving or not receiving
mental health services.
Interview Questions: Set One
The first participants were first-generation college students or graduates without
mental health services. Each participant shared their perceptions and experiences of
seeking mental health services. As the researcher transcribed each interview, 23 themes
emerged. There were 14 individuals interviewed with this set, consisting of seven females
and seven males.
The first question was, what are your perceptions on seeking mental health
services or treatment? The themes uncovered from the first interview questions were
perceived as helpful and needed, perceived as weak, and not needed in personal life. The
first theme was perceived as helpful and needed. Participants shared their perceptions of
mental health services and how mental health services could benefit others. The
participants’ responses related to mental health literacy as they applied prior knowledge
to understand mental health care and how to advocate for health improvements (Fusar-
139
Poli et al., 2020). Of the participants interviewed, three males and five females responded
that using mental health services would be helpful and necessary.
The second theme was perceived as weak. Participants felt that seeking mental
health services was associated with being weak. The lack of mental health literacy may
make individuals perceive mental health conditions or illnesses as weak (Tambling et al.,
2021). Two females felt that, as Black women, they would have to be strong, thereby
supporting the SBWS as an emerging construct highlighting the impact of race and
gender on the identity of Black women. With this, the SBWS construct arguably plays an
essential role in the stress and health of Black women (Castelin & White, 2022). Two
male participants felt that seeking mental health services would weaken them. Some men
are encouraged to use self-reliance while caring for their health needs rather than seeking
proper treatment. Society’s gender roles may increase fear and shame, increasing stigma
among males (Coveney, 2022). African American men may have been accustomed to
social norms, leading them to struggle with being vulnerable and open to sharing their
feelings and emotions (Hoskin, 2022).
The final theme from this question was not needed in my personal life.
Participants felt they had the necessary skills to avoid seeking mental health services.
According to the literature review in Chapter Two, African American men have
exemplified high levels of resilience when faced with adversity. Self-resilience is a
coping mechanism for mental health concerns (Bauer et al., 2022).
The second interview question was, do you feel you have an understanding of
trauma or mental health conditions? Explain. Within this interview question, there were
three themes from the responses: knowledgeable due to personal experiences,

140
knowledgeable due to my work experience, and knowledgeable of mental health.
Participants believed they knew about mental health trauma and conditions based on
their personal experiences. The influences of culture may influence an individual’s
symptoms, how one may cope with mental health challenges, and their willingness to
seek services or treatment (Ogundare, 2020).
Three males felt they knew about mental health conditions based on their personal
experiences. Two females felt they knew about mental health conditions based on
personal experiences. Individuals exposed to trauma increased the impact of developing
mental health disorders (Bauer et al., 2022). Some participants believed they only
understood mental health due to their work experiences, and their careers were linked to
their knowledge and understanding of mental health literacy.
The final theme of this question was knowledgeable of mental issues. Most of the
participants believed they knew the primary mental health conditions. They identified
stress, anxiety, depression, and how traumas can develop. This theme was also related to
mental health literacy, as discussed in Chapter Two’s literature review.
The third question was, do you feel you have experienced any mental health
issues? There were four themes from this interview question. The first theme was
experiencing mental health issues due to environmental experiences. Some participants
described their experiences growing up or situations that caused ongoing trauma, which
relates to how environmental experiences can lead to mental health issues. According to
the literature, daily activities such as work environment relationships, everyday living,
and being social with friends and family can be affected when one suffers from common
mental disorders (Rancans et al., 2020).

141
Studies show that four in 10 adults reported depressive disorder or anxiety
symptoms (Panchal et al., 2021). Some participants felt they had no experience with
mental health issues in their lifetime. Some participants described anxiety as a mental
health issue and their experiences over their lifetime. Finally, the last theme was being an
African-American. The literature suggested African American women were part of a
double minority status, leading to psychological experiences (Castelin & White, 2022).
These experiences included gendered racial microaggressions and mental health stigma
(Liao et al., 2019). Male participants shared their struggles with social injustices in
society. Social inequality and racial discrimination are risk factors for African American
men’s mental health (Adams et al., 2021).
While listening to the interviews of the participants regarding this complex
construct, they described racism, discrimination, and social injustice. Some explained
how they did not feel they could be themselves, often making them angry or insufficient.
Race-related stress refers to the psychological distress that is racially related between
groups and their environment. Others shared how the videos and media showing
discrimination affected all of them (Mouzon & Brock, 2022). The recurring videos and
images of African Americans killed by law enforcement cause continuous psychological
damage due to systemic racism. The videos and photos may cause one to feel
overwhelmed, leading to mental health conditions due to exposure (Boynton, 2020;
Downs, 2016; Graham et al., 2017).
The fourth interview question was what factors do you contribute to your mental
health? There were four themes linked to this interview question. The first theme was
negative family dynamics. Participants felt their family dynamics had affected their
142
mental health. The second theme was positive family dynamics. Participants shared that
having positivity from their families helped their mental health flourish. The third theme
was the COVID-19 pandemic. Some participants disclosed that they had no experience
with the challenges of the pandemic. Some participants shared that they lost loved ones,
saw protests regarding the lives of African American mistreatment, and dealt with
isolation and ongoing anxiety. The research from Chapter Two stated that the COVID-19
pandemic brought several worldwide challenges, including social, health, and economic.
Research shows a high prevalence of anxiety, stress, and depression symptoms. During
the COVID-19 pandemic, individuals faced an increased risk of suicide, domestic
violence, substance use, and grief (dos Santos et al., 2020).
The fourth theme was social injustice. Participants shared social injustices they
learned about in their African American community and experiences they had in their
own lives. The final theme was my race and gender. The participants described their
experiences as African American males or females. The literature stated that African
American women face race and social injustices rooted in the history of their culture.
African American women may face sexism, racism, and financial inequities (Frye, 2019;
Richards, 2021). Social inequality and racial discrimination are risk factors for African
American men’s mental health. African American men have a lower prevalence of major
depressive disorder than African American women and men of other ethnicities (Adams
et al., 2021).
The fifth interview question was What coping mechanisms do you use for your
mental health? The first theme of this interview question was using unhealthy coping
mechanisms such as CBD or alcohol. The second theme was spiritual and religious
143
beliefs. The literature stated that historically, African Americans have a deep connection
with the Black church. In the Black community, churches are a place to repair any
personal or mental health conditions. The Black church is also used as an institution to
provide individuals with religious, social, and spiritual needs (Samuel, 2019). The third
theme was self-care. The participants described this as a way to care for themselves and
focus on their minds, bodies, and souls. The second theme was exercising. The fourth
theme was friends and family. The fifth theme was traveling, and the final theme was
isolation. These last few themes fell under the umbrella of self-care; however,
participants specifically named the activities they used to help cope with their mental
health issues.
Interview Questions: Set Two
The second set of participants were first-generation college students or graduates
who had received mental health services. Each participant shared their perceptions and
experiences of receiving mental health services. As the researcher transcribed each
interview, 19 themes emerged. There were 14 individuals interviewed during this set,
consisting of seven females and seven males. The first interview question was What did
you feel was the presenting problem when seeking and receiving mental health services?
The themes from this question were relationship issues, loss of a loved one, anxiety,
stress, and postpartum depression. The final theme was suicide. According to the
literature, common mental health disorders’ risk factors for psychological distress are
depression, anxiety, and suicidal ideations (Bezerra et al., 2021). The suicide rate among
African Americans increased by 30% (from 5.7 to 7.4 per 100,000 individuals) between
2014 and 2019 (Ramchand et al., 2021).

144
The second interview question was what has been your experience with the
mental health services you have received? Three themes were linked to this question:
positive–helped a lot, positive–helped some, and negative–did not help. These three
themes were connected with the topic of mental health literacy. Mental health literacy
consists of applying one’s prior knowledge to understand mental health care and how to
advocate for health improvements (Fusar-Poli et al., 2020). (Fusar-Poli et al., 2020).
The third interview question was how were the services you received found? Most
of the participants found services through online websites. Recommended by the court
was the second theme. The participants discussed not having a choice to choose their
therapists. They did not have a say in their therapist because they were younger, and their
parents or guardians made the decision. Participants also mentioned feeling
uncomfortable at times. However, one participant stated he probably was too young to
understand but felt it provided him with a foundation for coping with mental health
obstacles. The final theme was recommended by a professional outside the mental health
field. These participants seemed grateful for the resources available and felt it was not
difficult to find what they needed.
The fourth interview question was, did anyone encourage you to continue or stop
using mental health services? What was their explanation? The first theme linked to this
interview question was friend and family encouragement. The second theme was that no
one was encouraged to stop or continue. Participants stated they did not receive any
encouragement because they did not share with others that they sought mental health
services. The final theme was that parents and families did not understand or believe in
the services. This theme relates to stigma. Stigma is one of the barriers causing
145
individuals not to seek and receive proper treatment. Mental health stigma causes
discouragement in seeking help for behaviors and lessens the likelihood of appropriate
use of mental health services (Minichil et al., 2021). The cause of stigma may stem from
family, cultural, personal, and social sources. Research revealed that mental illness
stigma can arise from a lack of knowledge and understanding (da Silva et al., 2020).
The fifth interview question was: Did you have a preference regarding the
demographics of your therapist? What is your reasoning? The first theme was no
preference. Two males felt their issues were not gender or race-specific. All the
participants associated with this theme were male. The other themes linked to this
question were yes–preferred someone of my racial background, yes–preferred someone
of the same gender and race as I am, and yes–preferred someone of the same gender as I
am.
The remaining themes were linked to cultural competency. The literature from
Chapter Two explained that cultural competence is awareness of values, attitudes, and
policies that enable the knowledge of one’s cultural history and how they may differ from
other cultures. Cultural competence can be a lifelong journey of learning and
understanding various cultures. Clinicians can benefit from being culturally competent as
it can help communicate effectively between patients and caregivers (Ogundare, 2020).
Cultural competence may help define problems and plan interventions that are best for a
patient’s treatment plans. Physicians and patients sharing similar cultural backgrounds
can help understand symptoms and make the proper diagnoses without making
assumptions (Ogundare, 2020).

146
Implications
Understanding ethnic backgrounds is essential when receiving mental health
services due to a need for cultural competency as it relates to the Black community.
Participants shared that some therapists did not relate to their cultural backgrounds,
leading to the termination of services. Other participants shared the importance of having
someone to understand their cultural background and racial experiences. Those planning
to provide mental health services should be required to complete cultural competency
courses for practitioners, which may help provide context on African American history
related to race and their mental health experiences.
Requiring cultural competency courses for mental health professionals will assist
in providing effective and efficient services while understanding various cultures and
customs. In addition, requiring professional training for mental health professionals to
help understand critical race theory and its relation to health care could assist in providing
effective and efficient services. Significant historical traumas may be linked to African
Americans and their perceptions of seeking mental health services. The course
requirements could come from state, local, and national agencies to help incorporate
guidelines and implement programs for minority families, children, and adults.
The second implication would be to add MHL courses to curriculums. Such
curriculums should start as students enter public or private elementary schools and last
throughout high school. The knowledge would be enhanced each year, providing students
with the essential mental health principles and how to receive and locate services when
needed. Mental health literacy courses would add value to schools and give knowledge to
help with the various stigmas associated with mental health. MHL could also contribute
147
to strong relationships with others and help understand the causes of negative impacts
students may face. All participants shared the gained MHL through their collegiate
experiences, careers, family dynamics, or environmental factors. This implication will
help strengthen MHL, promote proper coping methods, and encourage seeking services
earlier.
Another implication would be employing licensed professional counselors within
or associated with Black churches. This implication is crucial as five participants shared
that religion is a significant part of their coping mechanism. In addition, the literature
from Chapter Two explains the impact of the Black church on African Americans. Using
religion has been a common coping mechanism for African Americans as they face stress
(Mouzon & Brock, 2022). Research has found that 90.4% of African Americans continue
to seek advisement from their place of worship to deal with their mental health conditions
(Armstrong, 2021; Seervai & Shah, 2022).
Employing mental health professionals within the Black church could help bridge
the gap, provide adequate mental health services, help minimize mental health stigmas,
and strengthen mental health literacy among African Americans. Finally, providing
services in rural areas and making services more accessible for those with unmet needs to
make appointments could ensure that mental health services are accessible and nearby.
Providing services in areas in which populations are underrepresented would include
adding community-based services that policymakers and clinicians could adopt.
Limitations
The design of this study was subject to two limitations. The first limitation was
the sample size. This study aimed to engage 40 African American males and females who
148
were first-generation college students or graduates from an HBCU in South Carolina. The
researcher was able to engage with 28 participants during the study. A larger sample size
would have been scientifically more productive for this study and strengthened the
explanations (Vasileiou et al., 2018). The second limitation was possible cultural bias due
to the researcher’s cultural background. The researcher is an African American female
with a career in the mental health field. Finally, this study would not generalize to those
over 35 and under 18.
Recommendations for Further Research
The results of this research study provided critical information for understanding
African Americans’ needs, perceptions, and experiences regarding seeking mental health
services. However, more research can be conducted to help contribute to this body of
research. There are several recommendations for future research. The first
recommendation would include various geographic locations and a larger sample size. A
larger sample would provide a better representation of the population and would hence
offer more accurate results (Andrade, 2020).
While analyzing the data, six participants shared difficulties explaining their
purpose in seeking mental health services to their parents and family members. Their
parents did not understand why such services were necessary. The second
recommendation is that the researcher examine a different age group of the African
American population to understand their perceptions and experiences of seeking mental
health treatment. Examining this population would provide research on their personal
experiences to understand their health literacy.

149
The third recommendation for further research would be to engage with African
American pastors. This study showed that many participants leaned on prayer and
spirituality to help them cope with mental health issues. A study to understand how
pastors address mental health crises and their experiences and discuss how mental health
has emerged in their congregations may be in order.
Finally, the researcher could examine the Hispanic and Latino American
populations. The Hispanic and Latino populations are unrepresented in the medical and
mental health fields. According to Hostetter and Klein (2018), “Hispanics are less likely
to receive treatment for depression, anxiety, and other behavioral problems than White
patients because of barriers to accessing care and stigma surrounding behavioral health
problems” (p. 2).
Summary
Mental health has become a growing topic over the last five years. However,
adverse mental conditions are on the rise. According to the WHO, more people in the US
will have mental health issues than ever before. The increase is due to the rise in social
media, the COVID-19 pandemic, and societal trends that have resulted in smaller family
units and less community involvement. This study sought to explore the experiences and
perceptions of seeking mental health within the Black community.
This study uncovered African Americans’ experiences and perceptions toward
seeking mental health professionals and resources. The study focused on college students
and graduates’ responses. This study investigated the impact of mental health literacy,
possible stigma, discrimination, cultural implications, disparities, and critical race theory
regarding mental health treatment.

150
The research addressed internalized racial biases. This study also highlighted the
cultural competencies, attitudes, and beliefs regarding mental health, the stigma related to
mental health, social injustice, and spiritual religions. This current study contributes to
the mental health field by providing valuable knowledge about the importance of
understanding mental health through the lens of African Americans as they have shared
their stories through lived experiences and perceptions.
The participants of this study were first-generation African American students and
graduates from an HBCU. The participants shared how their mental health was affected
by positive and negative family dynamics, environmental structures, social and racial
injustice, and the COVID-19 pandemic. Family, friends, and personal self-concerns
influenced their decisions to seek mental health services. Courts and child and social
services mandated some participation in mental health services.
The effects of the services received varied from successful, somewhat successful,
or no success at all. The aspects contributing to successful services were clinician-client
rapport, cultural competency, and knowledge of the participants’ mental history.
Participants indicated several coping mechanisms to address their mental well-being,
which included exercising, traveling, religious or spiritual beliefs, isolation, and self-care.
Some utilized unhealthy coping mechanisms such as alcohol and the use of CBD.
Historically, many African Americans have been reluctant to seek mental health
treatment. The reasons include distrust, accessibility, discouragement from family and
friends, and past experiences, especially with the inequity of medical services provided
by health professionals. Instead, some African Americans have relied heavily on the
Black church, family, and friends to offer support when needed. However, the church,
151
family, and friends are not necessarily equipped to handle or address mental health
issues.
Increasing MHL would help African Americans make good choices about their
mental health and seek mental health services when they notice symptoms or have
concerns. MHL would also allow individuals to recognize when others around them have
symptoms or issues that would benefit from the services of a mental health provider. In
addition, increased MHL will help dispel the many stigmas surrounding mental health
issues. As the world becomes more technologically advanced and social media becomes
more prevalent, people may become more independent, detached, or isolated, which
explains the critical need to know the availability and access to mental health services.
152
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Appendix A
Email Request for Participants
To: Staff/Students
Subject: Request for participants in research regarding perceptions and experiences of

seeking mental health services
From: Sherree M. Davis
My name is Sherree M. Davis, and I am a doctoral student at Charleston Southern

University. The title of my dissertation is The Perspectives and Experiences of Seeking
Mental Health Services through the Lens of the Black Community: A Qualitative Study.
This qualitative study explores African Americans' experiences and perceptions toward
seeking mental health resources among first-generation college students. In my study, I
am seeking participants who are:
• African Americans
• First-generation college students
• Age 18-35
• received any type of mental services, and those who have not received mental
health services
If you choose to participate in my study, you will be asked to
• Correspond via email to complete the survey

• Participate in 20- 35-minute interviews to examine your perspectives and
experiences of seeking mental health among first-generation African American
college student
• Review emailed interview transcripts for accuracy (20–35 minutes).
Confidentiality will be maintained for participants by providing pseudonyms.

Data in digital form will be keyed on an external hard drive in a locked room in a secured
location and destroyed three years after it has been analyzed. Your participation is
voluntary, and your refusal to participate in this study will involve no penalty.
Participants can withdraw at any time without any repercussions. Participants may
contact the researcher at smdavis1@csustudent.net or via telephone at 803-983-2762;
participants may contact the chairperson Dr. Kathy Sobolewski via email at
ksobolewski@csuniv.edu.
Thank you for your time and consideration.

Sincerely,
Sherree M. Davis
Doctoral Candidate
185
Appendix B
Informed Consent for Demographic Survey
The Experiences and Perceptions of Seeking Mental Health. Through the Lens of the
Black Community: A Qualitative Study
My name is Sherree M. Davis, a doctoral candidate at Charleston Southern University.

You are invited to participate in a research study about African Americans' experiences
and perceptions toward seeking mental health resources among first-generation college
students. The study aims to uncover mental health stigma while addressing mental health
policies. The study will provide experiences and perceptions of first-generation African
American college students as they share stories of how mental health may affect them
and their community.
Participation in this study is voluntary. If you agree to participate in this study, you will
be interviewed about your experiences and perceptions of seeking mental health services.
If you are selected for this study and participate, you will receive a 10-dollar gift card to a
local restaurant for your time. Participants can withdraw at any time without any
repercussions. Participants may write to the researcher via email at
smdavis1@csustudent.net or via telephone at 803-983-2762; participants may contact the
chairperson Dr. Kathy Sobolewski via email at ksobolewski@csuniv.edu.
Should you choose to participate in this study, the information you will share will be kept
completely confidential. The researcher will interview participants individually instead of
in groups to minimize confidentiality risks. The researcher will use a pseudonym instead
of the participant’s actual name on the study data. Interviews will take place in a private
office. The researcher will de-identify audio tapes of the participants made during the
study. Research data will be stored on Charleston Southern University’s one-drive server.
The research data will be stored in a password-protected and locked file cabinet with
restricted access to a secured location in the researcher’s home. Data will be encrypted
due to sensitive data research. The data will be d estroyed three years after it has been
analyzed. This study will provide findings and analyze the perceptions and experiences of
African American first-generation college students' views of seeking mental health
resources.\Please note: You must be 18 or older to participate in this study.
Have you read and fully understood the informed consent above? Yes No
By completing this survey, you consent to participate in this study.
Participant Name:
______________________________________Date: _____________________________
Participant Signature:
______________________________________Date: _____________________________
Investigator Signature
______________________________________Date: _____________________________
Faculty Sponsor Signature
______________________________________Date: _____________________________
186
Appendix C
Demographic Survey
Thank you for agreeing to participate in this research exploring the perceptions and
attitudes of seeking mental health among African American first-generation college
students. Before participating in the interview, please complete this survey. If you have
any questions, please email me at smdavis1@csustudent.net.
1. What is your name?
2. What is your email?
3. How old are you?
4. What is your racial/ethnic background?

a. Black or African American
b. Bi-racial, please specify ________
c. Other: Please specify ________
5. Are you a first-generation college student (meaning your parents did not attend
college)?
a. Yes
b. No
6. What gender were you assigned at birth?

a. Female
b. Male
c. Other: Please Specify
7. Have you ever received any mental health services or treatment (including but not
limited to support groups, family therapy, individual therapy, outpatient care, and
inpatient care)?
a. Yes, please specify _______
b. No
187
Appendix D
INTERVIEW PROTOCOL # 1
Date: Place: Start Time: End Time:
Name of Interviewee (pseudonym):
Good afternoon, evening
My name is Sherree M. Davis. I am a doctoral candidate at Charleston Southern
University. I firstly would like to thank you for meeting with me today. I understand how
important your time is. I will ensure our meeting does not exceed an hour; however, if
you need additional time during this interview, this will not be an issue. We are going to
begin by reviewing an informed consent document. This qualitative study examines the
experiences and perceptions of seeking mental health services among first-generation
African American college students and graduates.
This interview will focus on your perceptions of seeking mental health services.
Please remember that your participation is entirely voluntary today. You are permitted to
withdraw from this interview at any time. Our discussion will be audio recorded with a
device, and I will take handwritten notes. Everything you share and discuss will be
confidential, and you will be given a pseudonym to keep your identity confidential.
Are there any questions before we begin?
Explain.

188
4. What factors do you feel have contributed to your mental health?
5. What coping mechanisms do you use for your personal mental health?
Thank you for interviewing with me today. The following steps will include
transcribing our discussion from today. I will provide you with a copy of the transcription
for you to review for accuracy. Please read it over to ensure your thoughts and
perceptions were appropriately captured.

189
Appendix E
INTERVIEW PROTOCOL # 2
Date: Place: Start Time: End Time:
Name of Interviewee (pseudonym):
Good afternoon, evening
My name is Sherree M. Davis. I am a doctoral candidate at Charleston Southern
University. I firstly would like to thank you for meeting with me today. I understand how
important your time is. I will try to ensure our meeting does not exceed an hour; however,
if you need additional time during this interview, this will not be an issue. We are going
to begin by reviewing an informed consent document. This qualitative study examines
the experiences and perceptions of seeking mental health among first-generation African
American college students and graduates.
This interview will focus on your experiences of seeking mental health services.
Please remember that your participation is entirely voluntary today. You are permitted to
withdraw from this interview at any time. Our discussion will be audio recorded with a
device, and I will take handwritten notes. Everything you share and discuss will be
confidential, and you will be given a pseudonym to keep your identity confidential.
Are there any questions before we begin?
received?
190
Thank you for interviewing me today. The following steps will include
transcribing our discussion from today. I will provide you with a copy of the transcription
to review for accuracy. Please read it over to ensure your thoughts and experiences were
appropriately captured.
ProQuest Number: 30694137
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Distributed by ProQuest LLC ( 2023 ).

Copyright of the Dissertation is held by the Author unless otherwise noted.
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THE PERCEPTIONS AND EXPERIENCES OF SEEKING MENTAL HEALTH

SERVICES THROUGH THE LENS OF THE BLACK COMMUNITY: A

Kathy Sobolewski, Ed.D. Committee Chair

Julie Fernandez, Ed.D. Committee Member

A Dissertation Presented in Partial Fulfillment

Charleston Southern University

by Sherree Mellette Davis

A Dissertation Presented in Partial Fulfillment

Charleston Southern University

exploring the first-generation African American college students and graduates’

experiences and perceptions of seeking mental health services in a Historical Black

discrimination, cultural implications, and disparities regarding mental health treatment.

because of their upbringings and professional education.

Keywords: qualitative, mental health, first-generation college students, African

Americans, health disparities, and seeking mental health services

Copyright © 2023 by Sherree Mellette Davis

to him for this.

for a greater purpose. We will change the world—one barrier at a time.

List of Tables .......................................................................................................................x

List of Figures ...................................................................................................................xiii

List of Abbreviations ........................................................................................................xiv

Chapter One: Introduction ...................................................................................................1

Problem Statement ...................................................................................................5

Significance of the Study .........................................................................................6

Research Questions ..................................................................................................7

Introduction to Theoretical Framework ...................................................................7

Chapter Two: Literature Review........................................................................................12

Theoretical Framework ..........................................................................................12

Critical Race Theory ..................................................................................13

Historical Trauma Theory ..........................................................................16

History and Background of Mental Health................................................18

Prevalence of Mental Illnesses...................................................................21

Mental Health Stigma ................................................................................22

Mental Health Literacy ..............................................................................26

Untreated Mental Illness Outcomes ...........................................................29

College Students and Mental Health..........................................................30

Mental Health Gender Differences ............................................................32

Mental Health Gender Differences among African Americans.................36

Cultural Impact and Mental Health............................................................38

The Black Church and Mental Health........................................................46

Discrimination and Mental Health in the African American Community.47

Social Justice and Mental Health among African Americans ...................56

The 2019 Pandemic and Mental Health .....................................................58

Chapter Three: Methodology .............................................................................................63

Research Questions ................................................................................................64

The Researcher’s Role ...............................................................................68

Data Collection ..........................................................................................71

Data Analysis .............................................................................................72

Dependability and Confirmability .............................................................74

Ethical Considerations ...........................................................................................75

Chapter Four: Findings ......................................................................................................77

Data Collection ......................................................................................................78

Participants of the Study ........................................................................................80

Interview 1: Question 1..............................................................................87

Interview 1: Question 2..............................................................................90

Interview 1: Question 3..............................................................................93

Interview 1: Question 4..............................................................................98

Interview 1: Question 5............................................................................104

Interview 2: Question 1............................................................................113