In Focus: Culturally-Responsive Telepsychology & mHealth

A Future for Equitable Mental Health Care for Black Youth

In Focus: Culturally-Responsive Telepsychology & mHealth

A Future for Equitable Mental Health Care for Black Youth

By Henry A. Willis, PhD
University of Maryland, College Park

Mental health disparities among Black or African American youth remain a critical issue in the United States. Despite growing awareness of the need for equitable mental health care, systemic barriers such as racism, poverty, and a lack of culturally competent providers continue to limit access to traditional services. In recent years, mobile health (mHealth) interventions have emerged as promising tools to bridge this gap. However, for these digital interventions to be effective, they must be culturally responsive and tailored to address the unique sociocultural risk and protective factors that influence mental health outcomes for Black youth. By centering sociocultural risk and protective factors in digital intervention design, we can harness technology to promote resilience and well-being in a meaningful and sustainable way. 

The Promise of mHealth and Digital Interventions

Historically, traditional mental health services have failed to meet the needs of minoritized youth due to systemic barriers such as financial constraints, a lack of available and culturally sensitive providers, and cultural stigma due to decades of mistreatment of Black Americans by the U.S. healthcare system (Castro-Ramirez et al., 2021; Rodgers et al., 2022; Roulston et al., 2023). For example, Black youth often perceive that they are at a disadvantage when seeking mental health services compared to their White peers, citing experiences such as being unable to find therapists of color in their community when they needed mental health support (Willis & Neblett, 2023).

mHealth interventions have shown promise in addressing these disparities in mental healthcare. These interventions reduce maladaptive symptoms (e.g., anxiety, depression, substance abuse, etc.) and promote well-being by providing accessible support (i.e., Donker et al., 2013). However, most current iterations of existing mHealth technologies have failed to include Black youth in their design or development. This means that mHealth to date is not able to address the deep-level sociocultural factors that influence mental health outcomes for Black youth, such as the stress associated with experiences of racial discrimination, or the need for Black youth to develop positive racial identity beliefs. This gap highlights the need for interventions that go beyond surface-level cultural adaptations to address systemic inequities and promote empowerment through focusing on specific sociocultural experiences unique to Black youth. 

Where to Start? – What Sociocultural Risk and Protective Factors can Digital Interventions Target?

To be effective, mHealth interventions must target sociocultural risk and protective factors that influence mental health outcomes for Black youth. Racial discrimination, both online and offline, is a significant stressor for Black youth. Research has shown that racial discrimination is associated with anxiety, depression, PTSD, and even suicidal ideation (Schmitt et al., 2014). The rise of online racial discrimination (ORD) has introduced new challenges for Black youth, especially since they are more likely to be online constantly and use social media at higher rates than their White peers. Because of this, Black youth in particular are more likely to experience ORD than their peers. Studies have found that in recent years, Black youths’ exposure to ORD has increased significantly, with some youth reporting more than five racist encounters per day on average, most of which occurred online (English et al., 2020). To make matters worse, these experiences have been linked to a variety of adverse mental health outcomes for Black youth, such as increased anxiety, depression, substance abuse, PTSD symptoms, and suicidal ideation (Tynes et al., 2019; Del Toro & Wang, 2023).

Despite the challenges that racial discrimination and ORD present, racial identity beliefs can serve as a protective factor for Black youth. Racial identity beliefs—defined as the significance and meaning individuals attach to their racial group—can buffer against the negative effects of discrimination and promote better psychological well-being (Brondolo et al., 2009). For example, studies have shown that higher levels of racial centrality beliefs (i.e., the importance of race to one’s self-concept) and private regard beliefs (i.e., how proud you are to be a member of your racial/cultural group) are associated with lower levels of psychological distress (Lee & Ahn, 2013).  

Designing Culturally-Responsive mHealth

With these sociocultural factors in mind, efforts to design effective culturally-responsive mHealth interventions must go beyond surface-level cultural adaptations. Instead, interventions should be built from the ground up with deep-level modifications that reflect the lived experiences of Black youth and target things such as ORD and racial identity beliefs. These efforts should also be led by Black youth and Black communities. This “For Us, By Us (FUBU)” approach, influenced by Afrofuturist Developmental Theory (Tynes et al., 2023), emphasizes the need for Black youth to envision, create, and engage with technologies that affirm their identities and experiences. By utilizing this approach, my work has uncovered how to best design mHealth for the mental health needs of Black adolescents and emerging adults (i.e., Willis et al., 2022; Willis et al., 2023).

Based on this work, some of the desired features and content that should be included in culturally-responsive mHealth interventions include:

• Racial Identity Exploration Tools: Activities and psychoeducation that help Black youth develop a positive racial identity and process experiences of discrimination.
• Community and Peer Support Forums: Safe spaces for Black youth to connect with each other to share their experiences with mental health and discrimination, and to provide mutual support.
• Mental Health Resources for Racism: Information about mental health symptoms that are tailored to the unique stressors faced by Black youth, including coping strategies for online and offline racism or how racism-related factors influence their mental health.
• Empowering and Culturally Relevant Content: Inspirational quotes about Blackness and Black mental health from current popular figures in Black culture (e.g., Doechii, Kendrick Lamar, etc.), historical references and narratives that center Black joy and resilience, and “counter narratives” to help Black youth challenge stereotypes.

Community-Centered Design and Policy Interventions

Integrating culturally-responsive mHealth into clinical research and future policy interventions is essential for ensuring sustainability and scalability. Moving forward, researchers and practitioners must integrate community-centered methodologies in developing and disseminating such mHealth interventions. Key recommendations for advancing the field include:

• Flexible Research Approaches: Researchers must adopt iterative, community-driven methods that allow for continuous feedback and adaptation. Traditional data collection methods may not allow Black youth to bring their “full selves” into the space. Finding ways to modify our research approaches to integrate positive cultural practices and anti-racism will be essential (i.e., co-creating the research design and evaluating initial findings alongside a “youth advisory council”).
• Collaborative Partnerships: Engaging Black youth, caregivers, clinicians, and technologists in the development of interventions ensures relevance and effectiveness. It will also be important to collaborate across disciplines – computer scientists, social workers, nurses, school administrators, etc. are all key partners in increasing the effectiveness and sustainability of mHealth. This community-based knowledge can be combined with clinical science to improve digital intervention development.
• Policy Integration: Findings from mHealth research should inform health policies that prioritize the funding and integration of evidence-based and culturally-tailored digital mental health solutions in Black and other minoritized communities. This also includes policies that will protect youth online, such as requiring technology companies to restrict how they will use and monitor Black youths’ data on any digital intervention. Health policy efforts can also target the source of sociocultural risk factors, or support potential protective factors that are relevant to Black youth. For example, future policies should prioritize the prevention of online racism (e.g., increased moderation of social media).

Conclusion: Toward Equitable Mental Health Care

Digital health solutions hold immense potential to address disparities in mental healthcare, but their success depends on the extent to which they are culturally responsive and community-centered. By designing interventions that acknowledge the unique challenges and strengths of Black youth, we can create tools that not only mitigate the harms of racism but also foster empowerment and healing. The future of mHealth lies in deep-level, anti-racist adaptations that are developed in collaboration with the very communities they aim to serve.

References:

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Castro-Ramirez, F., Al-Suwaidi, M., Garcia, P., Rankin, O., Ricard, J. R., & Nock, M. K. (2021).  Racism and poverty are barriers to the treatment of youth mental health concerns. Journal of Clinical Child & Adolescent Psychology, 50(4), 534-546. https://doi.org/10.1080/15374416.2021.1941058

Del Toro, J., & Wang, M.-T. (2023). Online racism and mental health among Black American adolescents in 2020. Journal of the American Academy of Child & Adolescent Psychiatry, 62(1), 25-36.e8. https://doi.org/10.1016/j.jaac.2022.07.004

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