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Following several nationally publicized police killings of unarmed Black Americans in the United States, Eva L., a fitness instructor who identifies as Black, started to experience what she describes as “immense paranoia.” She would often call in sick, because she feared risking an encounter with police upon leaving her house. She also started to second-guess her and her husband’s decision to have children. “Seeing Black bodies murdered and physical/emotional violence online and on the news” was a trauma she could no longer bear, Eva says. “I was terrified of bringing a child into the world we live in and experience as Black people. I thought not having kids was a truer sign of love than risk them being harmed by this world.”

A recent  sponsored by the University of Pennsylvania—released just before the anniversaries of the deaths of Eric Garner (2014), Michael Brown (2014), John Crawford (2014), and Philando Castile (2016)—found that there could be millions like Eva, for whom these killings have been a mental health trigger. Research included data from the database for police killings between 2013 and 2016 and information from the of over 103,000 Black Americans. The results indicate that police killings of unarmed Black Americans are having a population-level impact on the mental health of Black Americans.

According to researchers, the incidents may contribute to 1.7 additional poor mental health days per person every year, or 55 million more poor mental health days every year among Black Americans across the United States. That means the mental health burden for African Americans caused by police killings of unarmed Black victims is nearly as great as the mental health burden associated with diabetes. African Americans have some of the , which contributes annually to 75 million days of poor mental health among them.

African Americans 13 percent of the U.S. population but they accounted for 26 percent of in 2015 and 2016. While the death of a loved one can be tragic for the family and community of any police-shooting victim regardless of race, the study reveals that there is a deeper trauma for African Americans, related to the victim or not. Eva started seeing a therapist who diagnosed her as having generalized anxiety and post-traumatic stress disorder. It’s been two years now, and she admits that her progress toward healing has been slow, yet steady. Jacob Bor, co-author of the study and assistant professor at the Boston University School of Public Health, says the responses in his social circle to police killings of unarmed Black victims is what interested him in conducting this study. Bor noticed that White people were able to comprehend “the injustice on an intellectual level but did not experience the same level of trauma.”

The study findings confirmed Bor’s personal observations. The research team did not observe spillover mental health effects in White respondents from police killings. It should also be noted that among respondents of either race, there were no spillover effects for police killings of unarmed White people or killings of armed Black people. The research is essential in considering our own personal experiences, says Bor, adding that the findings speak to the overall “value of different people’s lives.” This society “has a long history of state-sanctioned violence” toward racially marginalized groups, he says. The mental health sector is only now researching the impact of police brutality, a concern that has affected African Americans for decades. “Clinicians can go through medical school without [gaining] any experience in treating the effects of racism,” Bor says. Studies like his, he adds, can help to create long overdue critical mainstream discussions about the effects of racism on mental health, such as, “How do we in public health, society, and among the clinical and mental health services support people when these incidents occur?” and “Can a by White providers effectively treat the emotional struggles of ‘living while Black’ in this country?” According to Bor, these discussions are needed to implement change. “Among many White Americans, there is an empathy gap … and a failure to believe when people of color say ‘this hurts me,’” he says.

“Mental health is the ultimate intersectional concern.”

Adding to the deficiency of culturally competent therapists, poverty and other formidable socio-economic challenges—also stemming from structural racism—remain steadfast barriers to African Americans accessing mental health care, according to . New York City’s first lady, Chirlane McCray, has also become a passionate advocate for what she describes as a movement for “culturally competent mental health care.” “When you talk about people of color, who are obviously facing discrimination and legacy of racism and poverty in huge numbers, you are talking about something that is really tough to overcome,” McCray says. Inadequate care undermines benefits from policies and resources designed to mitigate the burdens of systemic oppression. “Mental illness along with substance abuse disorders are hardship multipliers,” she says. Struggling unsupported with “mental illness can make everything that much harder.” For example, holding on to affordable housing, staying enrolled in college, and even surviving encounters with law enforcement can be extremely more difficult for those suffering from mental illness or trauma, McCray says. In fact, the most from the Washington Post’s database of fatal police-shooting victims indicate that “nearly 1 in 4 of those shot was described as experiencing some form of mental distress at the time of the encounter with police.” “Mental health is the ultimate intersectional concern,” McCray says. “It is reflected in all of our policies … education, housing, school, relationships.” In 2015, she and her spouse, Mayor Bill de Blasio, launched Thrive NYC, a program that incorporates 54 initiatives. Among the program’s several core objectives is the aim to address the stigma around mental illness and increase access to treatment across the city. McCray believes that ThriveNYC’s community focused approach is one of several necessary steps toward reaching historically underserved groups. “Culturally competent care to me is all about trust,” McCray says. “It improves early identification, accessibility, and outcomes.” Also, she says, “People have to be seen.” From her advocacy experience she has observed that “people have to feel that they can turn to someone that they trust.” Connecting people with the appropriate resources, however, means surmounting many challenges. “There is great deal of work to be done to eliminate the stigma,” McCray says. There is also the matter of affordability and infrastructure. “We’ve never had a well-coordinated mental health system in our country—ever. People who have the money find ways to manage.” She says she wants to fight for everyone to get the resources they need to cope. Eva recognizes that her path to healing has taken a significant amount of work and support beyond the means of many African Americans. “Access to therapy is a privilege,” she says. “I know that most people can’t afford weekly sessions at $150-plus.” Yet, she adds, “[going through therapy] is the only reason why I’m OK planning for kids at 32.”