Weaving Through the Challenges

The ABCs of finding paths to ACB mental health care

My son asked me for help to see a therapist, and from where I sit that was a win. He recognized that he needed help, which speaks to his intelligence and self-awareness. Colour me a proud mom.

Not everyone can spot when they’re in trouble, and in the heavy machismo often promoted to young Black men through music and fashion, self-awareness is a powerful tool. That he could ask his mom for help makes me feel like I’ve done something right as a parent. I hate that he is hurting but love that he can see it and ask for support.

Less fun was moving through the conversation with him and realizing that he wanted a therapist he could relate to: an ACB (African, Caribbean, and Black) male. Don’t get me wrong. It’s a reasonable request. It’s just that finding a Black therapist in Canada is like finding a winning lottery ticket. They exist, but they’re few and far between.

So, I began the process of looking. At least I’m lucky enough to know some people who know some people. Maybe one of them can get me a lead on a therapist. But there’s also the wonder of Google. Believe it or not, Googling often works, and I soon found myself on the Canadian Psychology Today portal looking at an array of ACB therapists. The next hurdle was trying to figure out who would be the right fit. It’s not enough to be ACB, you’ve also got to have the right experience. But before I could even figure that much out, I found myself wondering what the difference was between a social worker and a psychotherapist, which seemed to be the main options. Are they the same? What’s the difference?

Big bucks and barriers to access
Price comes into it of course, and it ranges between $100 and $200 per session. It doesn’t seem like much for health care, but for many people this is an out-of-pocket expense. If you’re lucky, you’ll have some benefits, but mental health coverage varies widely. While some employers supplement coverage or provide different ways of accessing care, other programs come with fee limits or caps on the number of sessions.

If we consider the distribution of wealth in this country, we know that if you are part of an ACB community — in fact, part of any racialized community — you have less. Less income, less savings, less access. Actually, it sometimes feels as if the only thing we have more of is unemployment.

Adding to the cost is the fact that therapy is rarely a one-and-done process. You must engage, build rapport with the right therapist, and incorporate therapy into your regular life over time. Some studies suggest 12-16 weekly sessions, though in practice many therapists and patients prefer more, perhaps six months and 20 to 30 sessions. The full 12- to 30-week range translates to $1,200 to $6,000. That’s hardly small change. But there’s also another question: How do you decide what price will deliver the right service for you? Do people think of therapy the way they do wine: The more you pay, the better the therapist?

It leaves me wondering what happens if cognitive therapy isn’t enough. What if my son needs a prescription? Do I start the search for that rare beast — a family doctor — or do I look for the even more elusive psychiatrist? How will I help him cover the cost of medication?

I keep reminding myself that at least he had the confidence and comfort to ask for help, which is often the biggest hurdle to accessing care. But this is far from the case with many ACB families. Beyond economic constraints, they face lots of barriers to accessing mental health care — not the least of which is being discouraged by others’ misconceptions about mental illness. These fallacies include things like ‘mental health support is for people experiencing severe mental illness, not someone trying to deal with emotions or improve the quality of their lives’; ‘mental health problems will get better if you just leave them alone’; and — my personal favourite — ‘Black people who seek professional help have less faith in God’. There’s nothing like the added burden of cultural and emotional guilt when looking for such help. It all seems so complicated. The act of finding the right support is challenging for everyone, but doing it through an ACB lens can feel overwhelming.

Not black and white
Fortunately, people like Nicole Franklin, a Black therapist who believes representation in mental health matters, have started to create the paths we need to do so. Her clinic, Live Free Counselling Service, provides therapy and resources to members of racialized communities in Toronto and the Greater Toronto Area. For those outside Toronto, she provides information on Black-licensed social workers and therapists from across Canada who also practice under a trauma-informed, culturally responsive, and self-care-first lens.

While she advises that the “best time to go to therapy was yesterday,” she also cautions that “therapy is not a quick fix.”

Franklin suggests seeing a therapist once every week, month, or quarter (if you’re able), while understanding that affording a therapist, especially seeing one on a regular basis, can be a financial barrier.

Some clinics set no mandatory fees for service, while others can offer significantly reduced rates, if you are open to seeing a therapist-in-training (usually, a graduate student in psychotherapy or a counselling student completing practical hours for their internship). Other clinics can even adjust fees based on your current financial budget or income, whether you’re employed, in school, or between jobs.

Franklin also recommends due diligence when seeking services from any mental health professional. “Don’t be afraid to ask your therapist questions about their experience, and how they work with certain issues.”

Other areas you might ask about to help determine whether a particular therapist is right for you and your situation include their counselling education or training, service fees, professional values, personal beliefs, and overall therapeutic approach.

Not all client-therapist relationships work out the first time. So it may take a few tries before finding the best solution. According to Franklin, “It’s OK to end a therapeutic relationship that’s not a good fit, no matter what season of life you’re in.”

Some suggestions
My son’s dad and I help support his mental health journey. We give him what he needs financially and emotionally. But if we begin to falter, we are lucky to have a rich network of knowledgeable people to call on for support. If you or someone you know is tackling the challenge of finding therapy without that kind of help, consider the following advice from Franklin.

• Look for a counselling service or network that subscribes to trauma-informed care.
  A trauma-informed approach or TIA recognizes the link between trauma, violence, and negative health outcomes. TIA aims to enhance feelings of empowerment, resilience, and safety to help clients with a history of trauma (or who are experiencing traumatic events) take back control of their lives. See the trauma-informed care fact sheet on this holistic health care practice.
• Consider a therapist who holds anti-oppressive values.
  Anti-oppression psychotherapy helps clients reduce the effects of feelings and experiences related to trauma and violence so that they become empowered through the therapeutic healing journey.
• Seek a therapist who deals with the issues you’re working on.
  Establishing a client-therapist connection on common ground will help put your relationship on a stronger foundation. This is especially true if you’re meeting your therapist in a virtual setting. “If doing online therapy,” Franklin suggests, “consider if you might have another safer, private space to regularly engage in open and honest conversations.”
• Shortlist and pre-interview therapists you’re considering.
  “Look online and consult with more than one therapist — it’s like finding a relationship. You often need more than one date to find a good connection.”
• Find a mental health provider who has received cultural competency or implicit bias training.
  Do so if you’re unable to find an appropriate Black therapist in your neighbourhood or online.

ACB and BIPOC therapy resources and counselling services to consider

• The Black Therapist Collective is a team of Black therapists in Ontario with networks across Canada. BTC also provides the Black Mental Health Fund, a donation-based resource offering subsidized services on a sliding fee scale to assist people in need.
• The Black Therapist List is a directory of professional Black counsellors, life coaches, psychotherapists, psychiatrists, psychologists, and social workers in Canada and the U.S.
• Healing in Colour offers a directory of BIPOC therapists across Canada who are committed to honouring their Statement of Values, which includes an anti-oppressive approach.
• Psychology Today now lets you search for Canadian Black therapists based on your postal code.
• Therapy for Black Girls, while headquartered in the U.S., this resource offers a searchable directory of virtual and in-office Canadian therapists based on your postal code.

Related articles in The Catalyst
Rallying While Black
Black Like Whom? Why We Use ‘ACB’ Over ‘Black’:
Fabiola’s Story

MHCC resources
Shining a Light on Mental Health in Black Communities