Black Men Don’t Go to Therapy — And the Silence Is Killing Them at 4X the Rate

Here is what the strong Black man does with his pain: he carries it. He carries it to work, where he performs competence and composure for colleagues who have no idea that he has not slept in three days. He carries it to the barbershop, where the conversation turns to sports and women and money but never, under any circumstances, to the thing that is eating him alive. He carries it to church on Sunday, where the pastor tells him to give it to God, and he nods, because nodding is easier than admitting that he gave it to God last Sunday and the Sunday before that and the weight has not decreased by a single ounce. He carries it home, where his children see a father who is present in body and absent in every other dimension, a man who provides but does not connect, who disciplines but does not comfort, who is there but is not really there in the way that children need their fathers to be there. And eventually — in a proportion that is rising at a rate that should constitute a national emergency — he stops carrying it. Because a human being can only carry so much, and the strong Black man has been told, by every institution and cultural signal in his life, that the alternative to carrying it is weakness, and weakness is the one thing he is not permitted to be.

The data on Black male mental health is not a footnote in a public health report. It is a crisis that has been accelerating for two decades while the institutions that should be sounding the alarm have been looking in the other direction. Black men are the demographic group least likely to seek mental health treatment in the United States. According to the Substance Abuse and Mental Health Services Administration, only about 26% of Black men with a diagnosable mental health condition receive treatment, compared to approximately 46% of white men. A survey by the National Alliance on Mental Illness found that 63% of Black men consider mental health conditions a sign of personal weakness — not a treatable medical condition, but a character defect, a failure of will, a betrayal of the expectation that a Black man must be, above all other things, strong.

The Numbers That Should Be Headlines

The suicide rate among Black men has increased by approximately 60% since 2000. This is not a gradual trend. It is an acceleration, and it is most pronounced among the youngest. The CDC has documented that Black boys aged 5 to 11 are dying by suicide at approximately twice the rate of their white peers — a reversal of the historical pattern, in which Black youth suicide rates were consistently lower than white rates. Among Black men aged 15 to 24, suicide is the third leading cause of death. Among all Black men, it is the sixteenth — but this ranking obscures the fact that the rate has been climbing while rates for most other demographic groups have stabilized or declined.

These numbers exist in a context that makes them even more devastating. Black men in urban environments are exposed to community violence at rates that, in any other population, would be classified as a mass trauma event. A study by Breslau and colleagues found that approximately 67% of Black men living in high-poverty urban areas meet the diagnostic criteria for post-traumatic stress disorder based on their cumulative exposure to violence — not as perpetrators, but as witnesses, as victims, as people who have watched friends and family members die and who carry that witnessing in their bodies every day of their lives. This is not metaphorical PTSD. It is the clinical condition, with the same neurological markers, the same hypervigilance, the same emotional numbing, the same intrusive memories that are diagnosed and treated in combat veterans. Except that combat veterans receive treatment. Black men, by and large, do not.

“Not everything that is faced can be changed, but nothing can be changed until it is faced.”
— James Baldwin, 1962

The Cultural Fortress

The barriers that prevent Black men from seeking mental health treatment are not primarily economic, although economic barriers are real and significant. They are cultural, and they are reinforced by every institution that Black men encounter, from childhood through adulthood, in a comprehensive architecture of emotional suppression that would be recognized as pathological if it were imposed on any other group.

The first barrier is the masculinity norm — the “strong Black man” archetype that pervades Black culture and that conflates emotional invulnerability with manhood. This is not unique to Black men; toxic masculinity norms affect men across all racial groups. But the Black version carries a specific historical weight: the understanding, transmitted through generations, that a Black man who shows vulnerability in a hostile world will be destroyed by it. The enslaved man who wept was punished. The Jim Crow-era man who showed fear was targeted. The contemporary Black man who admits he is struggling risks being perceived as failing the community, his family, and the legacy of ancestors who endured worse without complaint. The archetype was forged in survival. It has become an instrument of destruction.

The second barrier is the Black church — or rather, the particular strain of theology within some Black churches that treats mental illness as a spiritual problem rather than a medical one. “Pray it away” is not a treatment plan. It is a formula for suffering in silence while believing that the silence is holy. This is not a critique of faith or of the Black church as an institution, which has been the most important stabilizing force in Black American life for two centuries. It is a critique of the specific, identifiable theological position that depression is a failure of faith, that anxiety is a lack of trust in God, and that therapy is a secular substitute for prayer that a truly faithful person would not need. This position is not universal in Black churches, but it is prevalent enough to constitute a significant barrier to treatment, particularly among older Black men for whom the church is the primary community institution.

The Distrust That Is Earned

The third barrier is distrust of the mental health system, and this distrust is not irrational. It is earned. The history of American psychiatry’s treatment of Black people is a history of weaponization. In the 1850s, Samuel Cartwright invented “drapetomania” — a supposed mental illness that caused enslaved people to flee captivity, pathologizing the desire for freedom itself. In the 1960s and 1970s, schizophrenia diagnoses for Black men spiked dramatically, driven not by changes in actual prevalence but by a diagnostic culture that interpreted Black anger and political dissent as psychotic symptoms. Jonathan Metzl’s research has documented how the definition of schizophrenia was broadened specifically to encompass the behaviors associated with Black militancy, turning a psychiatric diagnosis into a tool of social control.

Contemporary disparities in diagnosis and treatment reinforce this distrust. Black patients are more likely than white patients to be diagnosed with schizophrenia and less likely to be diagnosed with depression or anxiety disorders, even when presenting with identical symptoms. They are more likely to be prescribed antipsychotic medications and less likely to be offered talk therapy. They are more likely to receive treatment involuntarily, through emergency rooms and the criminal justice system, and less likely to receive treatment voluntarily, through outpatient services and community mental health centers. These are not historical relics. They are current patterns, documented in peer-reviewed research, and they provide a rational basis for the suspicion that many Black men feel toward a system that has historically treated their minds as problems to be managed rather than as persons to be healed.

What Actually Works

The solutions to this crisis exist. They are not theoretical. They have been tested, measured, and proven effective in pilot programs and research studies across the country. The challenge is not a lack of knowledge about what works. The challenge is the absence of political will, funding, and cultural infrastructure to scale what works into what is available.

Barbershop-based therapy may be the most important innovation in Black male mental health in a generation. The concept is deceptively simple: place mental health professionals in barbershops — the one community space where Black men gather regularly, where conversation is normalized, where the setting is trusted and familiar. Pilot programs in cities including Philadelphia, Detroit, and Los Angeles have demonstrated that Black men who will not walk into a therapist’s office will sit in a barber’s chair and talk to a counselor who is present in the space, who is introduced casually, who begins with conversation rather than clinical intake forms, and who meets men where they are rather than requiring them to come to where therapy has traditionally been.

The results are striking. Lorenzo Lewis’s Confess Project, which trains barbers as mental health advocates, has reached over 1,000 barbers in 15 states. The Therapy for Black Men initiative has partnered with barbershops in multiple cities to provide free or low-cost sessions in a setting that removes the stigma associated with clinical environments. Research from the University of Pennsylvania found that when health interventions are delivered through barbershops, engagement rates increase dramatically — a finding that has been demonstrated for cardiovascular health and that mental health researchers are now applying with comparable results.

The Black male therapist pipeline is perhaps the most critical long-term solution, and it is the most underfunded. Approximately 4% of psychologists in the United States are Black, and the proportion of Black male psychologists is smaller still. The research on racial concordance in therapy is clear: Black men are significantly more likely to engage in treatment, to remain in treatment, and to report positive outcomes when their therapist is a Black man. This is not a commentary on the competence of white therapists. It is an observation about the therapeutic relationship and the reality that trust, which is the foundation of all effective therapy, is easier to build when the person across from you has some shared understanding of the world you inhabit.

Training more Black male therapists requires targeted investment: scholarships for Black men in graduate psychology programs, student loan forgiveness for Black mental health professionals who practice in underserved communities, and mentorship programs that connect aspiring Black therapists with practicing ones. The cost of this pipeline is modest compared to the cost of the crisis it would address — but it is a long-term investment, and long-term investments in Black communities have a tendency to lose their funding every time a political cycle changes.

Culturally competent cognitive behavioral therapy has been adapted specifically for Black men and has demonstrated efficacy in clinical trials. The adaptations are not superficial — they involve modifying therapeutic frameworks to account for the specific stressors that Black men face, including racial discrimination, community violence, economic marginalization, and the masculinity norms described above. Culturally adapted CBT does not merely translate existing protocols into different language. It reconceptualizes the therapeutic process to address the reality that a Black man’s distress is not purely individual; it is situated in a social context that is itself a source of ongoing trauma.

Peer support models offer a bridge between formal therapy and the cultural resistance to it. Programs like Brother, You’re on My Mind, developed by the National Institute on Minority Health and Health Disparities, train community members — not clinicians — to recognize signs of mental distress in other Black men and to facilitate conversations about mental health in settings that are natural, non-clinical, and socially embedded. The peer model works because it does not require Black men to identify as patients. It requires them only to identify as men in community with other men, which is something they already are.

The Cost of Silence

The economic cost of untreated mental illness among Black men is staggering, though it is rarely calculated. Lost productivity, emergency room visits for crisis presentations, incarceration for behaviors driven by untreated mental illness, substance abuse as self-medication, domestic violence as the eruption of unprocessed trauma — these costs are borne by families, communities, and taxpayers, and they dwarf the cost of the treatment that would prevent them. The National Institute of Mental Health estimates that serious mental illness costs the United States over $300 billion annually in lost earnings alone. The Black male share of that cost, adjusted for the disproportionate rates of untreated illness, is substantial.

But the cost that matters most is not economic. It is the cost measured in the lives of Black boys who are growing up watching their fathers, their uncles, their older brothers perform a version of manhood that treats pain as something to be endured rather than addressed, treated, and healed. It is the cost measured in the relationships that fracture because one partner cannot or will not acknowledge what is happening inside him. It is the cost measured in the 60% increase in Black male suicide — each percentage point representing real men, with real names, who reached a point where the weight became unbearable and no one had told them, in a way they could hear, that there was another option besides carrying it alone.

Baldwin told us that nothing can be changed until it is faced. We have not faced this. We have not faced the reality that the strong Black man archetype, whatever it meant to the generations who created it, has become a death sentence for the generation that inherited it. We have not faced the reality that telling a man to pray away his depression is as irresponsible as telling him to pray away his diabetes. We have not faced the reality that a community that does not take care of the mental health of its men is a community that has decided, perhaps without knowing it, that the performance of strength is more important than the preservation of life.

It is time to face it. Not with another hashtag. Not with another celebrity confession during Mental Health Awareness Month. With infrastructure. With funding. With barbershop programs in every city, with Black male therapist pipelines in every university, with culturally competent treatment available in every community health center, and with a cultural shift that redefines strength not as the capacity to suffer in silence but as the courage to speak, to ask for help, and to live. The strong Black man has been carrying this weight long enough. It is time to put it down — not because he is weak, but because he deserves to be whole.