Annmarie Desravines didn't take phone calls from family, cried "at the drop of a dime," and said she was barely getting up in time for the first of her two part-time jobs as a cook.
After she lost her health insurance and then was diagnosed with lupus, "I got to the point of where I would go to work, come home and get in my bed. I didn't want to eat. I didn't want to drink. I didn't want to do anything," said Desravines, 41, of Central Islip. "I knew I was depressed."
Three months passed before Desravines, an African-American woman, sought a therapist.
"I think it starts with pride," she said of cultural barriers to seeking mental health treatment. "We're so strong that we are afraid for people to see the weak side of us."
African-Americans' access to mental health care can be affected by lack of financial resources, and their approach to such care is influenced by deep historical underpinnings, including stigma, suspicion of medical professionals and reliance on religion, experts say.
"Historically, we've been abused in the health care system and used for very unethical research, and often we feel that we don't get the same type of treatment," said Dr. Alvin F. Poussaint, professor of psychiatry at Harvard Medical School and co-author of "Lay My Burden Down: Suicide and the Mental Health Crisis among African-Americans."
The holiday season can exacerbate mental health conditions for some people, said Dr. Sidney Hankerson, a psychiatrist and research fellow at Columbia University.
"For people who are socially isolated, it [the holiday period] highlights the fact that they are alone. That can lead to depression."
The Patient Characteristics Survey, conducted every two years and required for programs licensed or funded by the New York State Office of Mental Health, sheds light on local disparities.
"We look to the afterlife for salvation, thinking that what we're going to experience down here is going to be awful anyway," Poussaint said. "So if you think that the expectation is that you're just going to be down and out . . . you may not feel that's a reason to go see a doctor."
The issues of mental illness and mental-health treatment among African-Americans have been underscored this year by deaths and violent actions that made headlines nationally and around the globe.
The suicides of African-American celebrities -- two this year were "Soul Train" founder Don Cornelius and Chris Lighty, former manager of hip-hop stars such as LL Cool J and Diddy -- shocked many. Mental health concerns came to the forefront after Rudy Eugene, a Miami man, assaulted a homeless man and ate part of his face, and Darrius H. Kennedy, a Hempstead man, wielded a knife in Times Square. Both were shot and killed by police.
According to the 2011 survey, about 16 percent of people enrolled in mental health treatment in Suffolk County were African-American, compared with 66.1 percent who were white. In Nassau, 23.2 percent of those enrolled in mental health treatment were African-American, compared with 58.7 percent who were white.
The state Office of Mental Health, in its 2011 report on unmet needs, recommended addressing racial treatment gaps by clinician training in cultural competency, screening for mental disorders by primary care doctors, and community-based campaigns dispensing mental health information.
Local officials said that they've taken such steps and worked with churches, community groups and schools to better reach African-Americans.
"People avail themselves to mental health services when the service is convenient and where they feel comfortable," said Dr. James R. Dolan Jr., director of the Nassau County Office of Mental Health, Chemical Dependency and Developmental Disabilities Services.
The office has overseen a program for about three years within Nassau University Medical Center health clinics in Hempstead, Elmont and New Cassel in which a family advocate educates clients on mental health services, he said. In 2010, the Division of Community Mental Hygiene within Suffolk's Department of Health Services began conducting standardized depression screenings across its primary-care health center network, the division's director, Arthur Flescher, said in a statement.
But Colleen Merlo, director of the Mental Health Association in Suffolk County Inc., said: "A lot of physicians are fearful of doing depression screenings because there aren't enough resources. One of the things they say is . . . if someone screens positive, where do they send them?"
Therapy cost prohibitive
The nonprofit group tries to help clients locate services. "Clinics have very long wait lists. There's very few counselors that take Medicaid privately," Merlo said. "People definitely feel desperate, and the services that they need aren't readily available."
Desravines said she called a three-page list of therapists recommended by Stony Brook Health Outreach and Medical Education, a student-run free clinic. Almost every office said the price for uninsured clients ranged from $1,500 to $2,000 for the first session, and $600 to $800 for each additional one, she said.
"I was like, 'I can't even afford that. That's more than my rent,' " Desravines said.
"Most of us are not going to call three pages of doctors to be told no ... After the first three, you're going to say, 'OK, look, I give up. Nobody wants to see me. I can't afford it. There's no help.' "
Experts say African-Americans are more likely to put off seeking treatment for mental health needs until they've reached a crisis point.
Hakeem Rahim, 31, of Hempstead, was diagnosed with bipolar disorder in 2000, his sophomore year as a psychology student at Harvard University, after he was rushed to the emergency room. He said he spent two weeks in a psychiatric ward. Looking back, he sees what must have been signs of his illness. During a manic episode, he said, he began to hallucinate, believing he saw Jesus and could do stunts from "The Matrix."
"I thought I was fully functional, but the main thing -- at one point, I felt like I lost control of my mind," Rahim said.
Another barrier African-Americans report is finding a therapist who is aware of cultural nuances. African-Americans represented about 4.9 percent of psychiatrists across the country in 2010, the American Psychiatric Association said, and about 5 percent of psychologists, according to Bureau of Labor Statistics' 2011 data.
Mike Veny, a professional drummer and mental health speaker who grew up in Hempstead, said he had mixed experiences with therapists. Veny, 33, who now lives in Astoria, has been diagnosed with depression, obsessive compulsive disorder, anxiety and anger issues.
To be effective, therapists need to be plugged into their patients' day-to-day reality. "You need to go hang out and eat in the neighborhood regularly . . . to get it," Veny said.
Dr. Gregson Pigott, director of Suffolk's Office of Minority Health in the Department of Health Services, said his office has been trying to do precisely that -- even networking with barbershops, Laundromats and hair salons.
"The trust factor, you have to build that," Pigott said. "You have to develop what I call street cred."
Mental health organizations reach out to churches and religious groups to help bridge the divide.
"Churches are seeing mental health as an illness, and seeking mental health therapy is not an alternative to your spirituality," said the Rev. Nellie Taylor-Walthrust, a minister at Westbury Gospel Tabernacle and director of The Leeds Place, of North Shore Child and Family Guidance Center, an outpatient mental health and chemical dependency clinic in Westbury.
No more shame
Removing shame is key to greater acceptance, said Bassey Ikpi, writer and founder of The Siwe Project, a nonprofit dedicated to reducing stigma about mental health care in the Washington, D.C., area.
Founded last year, the organization launched a "No Shame Day" campaign in July during National Minority Mental Health Month. About 90,000 participants shared personal stories of mental health battles or experiences with family members via social media.
"It told me that people want to talk about it," said Ikpi, 36, of Lanham, Md. "People don't want to be ashamed and closed off."
This month, Ikpi is founding The Siwe Project in her native Nigeria.
Her journey was a long road from her diagnosis with bipolar II disorder in 2004, following a manic episode while on tour across the country with "Russell Simmons Presents Def Poetry Jam."
She exhibited behavioral extremes -- spending thousands of dollars on clothes or other people's rent, yet paranoid that people were mad at her. On stage, Ikpi exuded confidence. But leading up to performances, she said, she would lie on hotel room floors and cry into the carpet. Ikpi likened the experience to being on a Ferris wheel.
"You get to the very top of the Ferris wheel, you can see everything. It's exciting; you're almost giddy," she said. "You're there for two hours, and then it starts getting scary ... You become paralyzed, paranoid, you're never going to get down ... You're awake now for two or three days ... and everything is your fault."
At first Ikpi lied to doctors about her symptoms "because I just wanted them to tell me I was normal," she said. But once diagnosed, "It was this odd feeling of knowing that I had something and it had a name . . . I felt so relieved."
Veny said he stopped taking medication when he was 15, because he didn't feel like himself and the drug's controlling effects hurt his music. But Ikpi and Rahim each took several years to find a combination of medications that work best for them.
"Life doesn't end with your mental illness . . . that's not your total story," said Rahim, who graduated from Harvard and received a master's degree from Columbia University's Teachers College. "You have a mental illness, but you're not the mental illness."
Response of Suffolk County Inc. 631-751-7500; Crisis intervention/referral line, 24 hours, 7 days a week
Long Island Crisis Center 516-679-1111; confidential help line, 24 hours, 7 days a week
Mental Health Association of Nassau County 516-504-HELP; 9 a.m.-6 p.m., everyday
REFERRALS ON MENTAL HEALTH SERVICES
Nassau County Mental Health Office 516-227-7057
Mental Health Association in Suffolk County Inc. 631-226-3900