Cognitive Behavioural Therapy (CBT), an evidence based intervention for mental health challenges such as anxiety and depression (Hoffman et al., 2012) is highly effective for people from most cultural backgrounds. However, research indicates that adapting CBT to meet the needs of specific groups ensures its effectiveness is equitable.  

Adaption of CBT often entails working with communities to understand their illness models, their language of distress and to ensure that the touch and feel of therapy, including the examples that are presented, resonate and are welcoming.  There is also work with therapists to understand what modifications to the implementation and presentation of therapy could improve community access.  

Mental Health Disparities in Black Populations

Socio-political contexts have historically and currently disadvantage and exclude Black populations from reaching their full health potential. This includes oppression, colonialism, racism, and segregation, much of which extends to the experience of mental health care inequity today (Mental Health Commission of Canada, 2021).

These experiences have contributed to and have further exacerbated the mental health disparities of Black populations.  Cénat et al., 2023 found that 95.1% of Black people in Canada are subject to at least one traumatic event during their lifetime with those born in Canada experiencing an increased likelihood of being exposed to trauma as compared to those born outside Canada. 

Many studies over the years have reports that everyday racial discrimination is linked with mental health problems (Mental Health Commission of Canada, 2016) For instance, those experiencing a high level of racial discrimination were more than 36 times more likely to have severe depressive symptoms when compared to those reporting a low level of discrimination (Cénat et al., 2021).

Individuals from Black populations continue to face systemic inequities in terms of:

• Income - According to the 2021 census, despite Canadian-born Black population having similar educational attainment to the Canadian-born non-racialized population, they earn only $0.76 cents for every dollar earned by the latter (Wall & Wood 2023).
• Food insecurity – Among racialized groups, Black Canadians had the highest rate of food insecurity, with almost four in ten (38%) reporting being food insecure and those having a disability were the most at risk with more than one-half (55%) reporting food insecurity (Uppal, S. 2023).
• Social exclusion – Black individuals are disproportionately represented in correctional and forensic mental health settings.  Despite only representing 4% of adults in Canada, 9% of offenders under federal jurisdiction were Black (Statistics Canada, 2023).   

According to a 2020 Statistics Canada survey, 32% of individuals from Black communities compared to 24% White counterparts reported to experience symptoms of anxiety (Mental Health Commission of Canada, 2021).
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Addressing inequities:

Despite the disparities, only 38.3% of Black Canadian residents with poor or fair self-reported mental health used mental health services compared with 50.8% white Canadian residents (between 2001 and 2014). In a 2018 survey of 328 Black Canadian residents, 95.1% felt that the underutilization of mental health services by Black Canadian residents was an issue that needed to be addressed (FAHMAS Foundation, 2020). 

Addressing these disparities requires multi-faceted and systems-wide interventions which include the social determinants of health.  However, there is much that health systems can do to improve access to and outcomes from treatment.  Partnerships between CAMH and community-based organizations, such as the Wellness Connection, are a proven model that have shown promising results. This model successfully leveraged targeted culturally adapted programs and psychotherapy services leading to improved experiences and outcomes for Black clients.  Learnings from such work have informed the launch of a revised manual on Culturally Adapted CBT or Black populations which aims to provide one avenue to advance mental health equity in Canada (Mental Health Commission of Canada, 2016).