By Casey Murray | OBSERVER Staff Writer
Had Leslie Napper not finally been seen by a Black health professional, she’s not sure she’d be alive.
Napper is now a passionate advocate for health equity and works defending and advising Californians with disabilities through her job at Disability Rights California as a peer professional in Sacramento. But in the early 2000s she was lost on her own wellness journey.
“I had been cycling through the hospital back and forth for a little while – it was like my third stay in the hospital,” Napper said. “These are not three-day stays. I was there for two weeks or more each time, and it was because there was no one that identified with my Black experience.”
Napper’s journey highlights the fact that simply having access to medical care often isn’t enough.
In Sacramento County, and in California at large, Black people have high rates of health insurance enrollment. In Sacramento County in 2021, about 96% of Black residents had health insurance coverage, according to the U.S. Census. That’s the same as White residents.
The number of Black people with insurance has risen steadily over the last several years along with state-wide efforts to expand Medi-Cal, and while it’s a proud achievement, it hasn’t solved health disparities.
Experts say access is only the first step in addressing gaps in care that impact Black Sacramentans. To achieve equity requires a much wider effort to address bias and structural racism in health care.
‘Treatment But Not Care’
When Napper started to really struggle with her mental health, she went to the emergency room. There, she said, she waited days to be officially evaluated and then was moved to a locked mental health facility.
The fact that she was sent to such a facility so quickly, as a person experiencing a severe mental health crisis for the first time, speaks to many of the fears Black people, who are more likely to be involuntarily committed for mental health crises, have when they seek help for mental illness.
Napper did not feel heard or seen, and she did not feel she was given any choice in getting a treatment plan that really worked for her.
“One of the most harmful things that happened with me, and I find with others, is that all of a sudden I’m in a locked facility but I didn’t do anything wrong,” she said. ”I was mentally ill, I didn’t understand exactly what’s happening with me, and they did not treat me with any care.”
Her trust in the doctors she saw was broken, but she had nowhere else to go. The therapy and treatment she had received didn’t help her.
But then, Napper was seen by a Black peer professional, or a person who helps patients navigate the healthcare system as another person who has lived with mental illness. It changed everything.
“Finally, someone there sent this wonderful angel that saw me,” Napper said. “She understood me.”
After so many frustrating experiences trying to get help, it felt like a godsend.
The woman helped put Napper in touch with an outpatient care team that also included Black women. They helped Napper design treatment options she felt comfortable with, and she felt safe knowing they understood her experience in the world. Napper never had to return to an inpatient treatment facility again, and she said her journey to wellness started when she was treated by that team.
“It took that reflective service and that understanding of my lived experience as a Black person, and the impact to my wellness, for me to get to where I am today,” she said. “Not very many of us are fortunate to have that experience, but how do we create that system for others? Because it’s that important.”
Researchers working with the California Health Care Foundation found many similar stories when they surveyed hundreds of Black Californians. Through a survey and in-depth interviews asking about their experiences receiving care, they found that about a third of Black patients said they had been discriminated against because of their race while seeking care. About one fourth of respondents also said they had avoided care because they were worried about being treated unfairly, and another third said they modified the way they talked or dressed to try and avoid being treated differently when they went to the doctor.
Katherine Haynes is a senior program officer at the California Health Care Foundation who leads the organization’s Advancing Black Health Equity work.
“It’s going to be a long road to building trust in the system and the system has to change in order to do it, not Black people,” Haynes said.
She said the research illuminated how frequently Black patients still face discrimination, with Black patients who are also part of the LGBTQ community, are women or who also have a disability being more likely to have such adverse experiences.
The research also illuminated that Black patients are working to prioritize their health even when they don’t feel listened to or cared for in the system. A vast majority of respondents had a primary care physician, had been to the doctor in the past year and had utilized preventative screenings.
“Black people are expending an awful lot of effort to preserve and pursue good health,” she said. “And that flies in the face of the stereotypes.”
What Black people need, then, to achieve health equity is, in part, simply to be heard.
“We do have a regular source of care, but I think it’s very transactional,” Haynes said. “It militates treatment, but not care. Not caring.”
The respondents pointed out several key changes they wanted to see made to make the health care system more accessible and equitable to Black people. They wanted more Black physicians, more relationship- and community-based care, a more holistic approach to health and more accountability for those who treat them badly.
Culturally Reflective Care in Sacramento
Those changes mirror what Napper wished she’d had all those years ago, before she understood how to advocate for herself and others. But, luckily, she believes Sacramento County has been doing much more than in the past to get care where it needs to be.
“We have Safe Black Space, we have other other types of provisions that help us address historical trauma,” Napper said.
Safe Black Space offers healing and community development services to help Black Sacramentans access a safe space and, if needed, be connected to mental health services.
Dr. Kristee Haggins is the executive director and founder of Safe Black Space. She developed the nonprofit after the killing of Stephon Clark by the Sacramento Police Department in 2018.
“We exist to address anti-Blackness, the effects of it in particular in terms of our mental health and wellness as a Black community,” she said.
Dr. Haggins said the need for such a space was evident after Clark’s shooting. She understands, as a Black woman herself, the need for a space where people don’t feel they have to pretend.
Among Safe Black Space’s main services are healing circles, but it also does Kwanzaa events and a book study.
“It’s this whole idea of being able to come here — and this is basically [an attendee’s] words — and let their hair down and be their full, authentic Black self without having to censor themselves, without having to monitor what they say, without having to worry about somebody else’s feelings,” she said.
That feeling is why Dr. Haggins said access to Black health professionals, but specifically Black mental health professionals, can be so important. If a therapist doesn’t understand the Black experience, they might accidentally cause greater harm.
Because Napper was finally able to access the care she needed, she’s doing well, and using her wellness to fight for others.
“I feel really fortunate to be with Disability Rights California as an advocate, to work to continue to advocate for the rights of people living with disability, and working with the mental health team to continue to advocate on behalf of others, so not one person else has to deal with what I had to just to receive care for a mental illness,” she said.
In her work now she often sees there’s still great need for more community-based clinics. Though she readily acknowledges the progress the county has made, she also said more needs to be done.
“I think it’s not really access,” she said. “It’s really the lack of culturally reflective therapists, culturally responsive service, understanding the needs of the African American, the Black American experiences.”
While culturally reflective and responsive care isn’t the only obstacle to health equity, making the health care system more responsive to Black patients would eliminate some of the barriers to actually seeking care. Haynes recognized this as part of the California Health Care Foundation’s research.
“The things that are very concerning are avoiding care, delaying care, putting off care, not asking questions, so you’re not labeled a difficult patient — I think that those things keep people from getting the full benefit of the health care system,” Haynes said.
EDITOR’S NOTE: Casey Murray is a Report For America Corp Member and a Data Reporter for The Sacramento OBSERVER.