The need to focus on service and policy barriers to mental health service delivery for African Americans remains critical. The purpose of this article is to review nineteenth century care as a method for understanding contemporary service and policy barriers. A case study strategy is used to compare the efforts of Pennsylvania and South Carolina using primary and secondary sources to document these developments through a political economy perspective. These findings suggest that the prevailing social, political and economic realities have created mental health disparities along racial lines. Existing barriers are likely rooted in this same reality.
Key words: Mental health, African Americans; historical; service; policy; barriers
Mental health service and policy measures often neglect the needs of African Americans. Recognized patterns of misdiagnosis, over reliance on medication and restricted forms of care and disparities in service utilization have been documented for this population (Lawson et al., 1994; Loring & Powell, 1988; Mandercheid & Sonnenshein, 1987; Neighbors, 1985; Neighbors et al., 1989; Segal et al., 1996; Snowden & Cheung, 1990; Zito et al., 1998). Such service patterns produce not only a sense of mistrust (Brown, et al., 1999; Sussman et al., 1987), but also result in service disengagement and alternate pathways to care (Davis, 1997; Garland & Besinger, 1997). Consequently, the aggregated effect of such experiences may lead to the under-utilization of services (U.S. Department of Health and Human Services [DHHS], 2001). Given the vulnerable status of African Americans, it remains critical that we continue to focus on barriers that detract from and/or prevent access to service. In fact, widely available mental health services did not exist for African Americans until the desegregation of state hospitals in 1965, which was a requirement for funding with the expansion of the Social Security Act that provided health care to seniors (Prudhomme & Musto, 1973). Since then, although managed care has changed the landscape of mental health care, it is imperative that social workers, and all mental health providers, remain vigilant relative to potential barriers.
The nineteenth century for African Americans can be described as a period filled with contradictions. Of course, during this period most were either enslaved or disenfranchised, but some were free and thriving. As the enlightenment movement took hold, most northern states had either abandoned the lawful practice of state sanctioned slavery or at least were phasing it out. Despite these trends, southern states experienced dramatic increases in their slave holdings and thus, wealth (Johnson & Smith, 1998). As a result, the South became more dependent on slave labor and inventories of African Americans/chattel were major asset in the determination of economic wealth. Mental health care historically has always been vulnerable to the social, political, and economic environments, but for African Americans this link is magnified (Turner & Singleton, 1978). As Grob (1994) suggest, social, political, scientific and economic factors stratified service and policy practices along racial lines. Thus, the provisions of mental health care emerged as a function of the society's racial beliefs and practices (Davis, 1997; Griffith & Bakers, 1993).
A historical review of service and policy barriers can inform contemporary public policy makers and providers of potential problems associated with the legacy of neglect to African Americans who need mental health services (President' Commission on Mental Health, 1978). A two state case study of 1800s mental health service and policy strategies in the states of Pennsylvania and South Carolina is presented as an expression of care through the lenses of a political economy perspective. Information was collected from primary and secondary sources in the form of published literature and The 19th Century African American Newspaper collection database. …