KNOXVILLE, Tenn. — In therapy, the things people talk about range widely. Some people discuss stress from work or issues in their relationships. The experiences they share in a therapist's office are informed and understood through the lens of their own identities.
And usually, therapists are able to understand and help patients cope with their issues. Sometimes though, topics may veer into issues like racism.
Patients may discuss the trauma of a hostile encounter, describing how their race or ethnicity may have shaped the incident. They may speak about their own identity in ways they don't fully understand, describing inner conflicts unique to them and their demographic.
For those conversations, it can be harder for therapists to understand and empathize if they haven't experienced it themselves. If they don't share the same identity, they may be limited in how they can help.
Nationwide, the lack of access to mental health care is its own epidemic. For people of color, it's even harder to find appropriate treatment. There are around 106,000 psychologists across the U.S. Of that number, only around 2% are Black, according to Mental Health America.
Knox County's state of mental health report reflects that same statistic. Many local therapists agree people of color have limited access to culturally appropriate mental health care in East Tennessee.
Reico Hopewell is a therapist and advocate in Knoxville who knows just how important it is to have representation in the mental health field. He said he suffered through various traumas throughout his childhood and his younger years. He grew up an athlete, but off the court, he struggled with his mental health.
"My first suicide attempt was in 1991," he said. "I was in college at Maryville College and I had a suicide attempt. They sent me to a treatment center."
Hopewell had a full-ride scholarship but felt like he couldn't climb out of the hole of depression. At 19 years old, his drug use skyrocketed. Hopewell said his drug use significantly increased after his father was murdered in 1992. That's when he started using crack cocaine.
In all, he tried to overdose and kill himself four times.
"[I just felt like] there was no way," Hopewell said. "I just felt like I was unlovable, that I was a mistake."
Despite all of the trauma that molded his outlook and inflicted so much emotional pain as a child, teenager and adult — he never had a therapist who looked like him.
"That's why therapy was so hard for me because I just really felt that they didn't understand to walk in a Black man's shoes," Hopewell said.
Across the U.S., Mental Health America said 6.8 million Black Americans and African Americans have a mental illness, but only around one-third will seek treatment.
"Traditionally in the Black community, we tend to go to our family members or the community or church," Hopewell said.
The topic is taboo for many, which is another reason it was hard for Hopewell to open up in the therapist's office. Overcoming Believer's Church in East Knoxville is trying to break the stigma between mental illness and the pulpit. Carmeisha Arnold is the senior pastor's wife and a master's level counselor.
"If there's a serious crisis, if there's something that's going on individually or a mental health issue, I don't know that we were given permission in the church, to talk about it or to express it, and so we just a lot of times hold it in," Arnold said.
Arnold said he understands why people may not talk about mental health struggles, and why people would seek treatment. He also said he knows the importance of encouraging others to see the church as a safe place to express emotions without shame.
"It doesn't mean that you don't have enough faith, it doesn't mean that you didn't pray hard enough," Arnold said. "It just means you might need a little bit more support, and that's okay."
Representation in mental health fields makes a difference in race and religion, according to Arnold.
"It's hard to open up to someone who doesn't have any understanding of your other background," Arnold said.
It's something Natasha Daniels with Thriveworks sees with her therapy patients daily as a Black woman.
"We can have cultural training all day long, but if you haven't lived it, that's just it," Daniels said. "That's cultural training, and who's actually doing that training?"
She's seen an influx in therapy patients during the pandemic, much like other mental health professionals. Across the board, she said having culturally appropriate care is crucial for healing and treatment.
"You can just see the weight fall off when they have someone who gets it," Daniels said.
For many people, getting therapy first feels like a challenge. They may view it like a doctor's appointment — a person they can visit once and then immediately feel relief. But Hopewell said that turning his breakdowns into breakthroughs took work, and the work he did with mental health professionals helped him change his trajectory.
"I started going to therapy, I went to a sober living getting counseling. And it really, really, truly changed my trajectory," he said. "Now, as a Black therapist, I want people to see me and identify say, 'Oh, Reico understands, I understand systemic issues. I understand racism, I understand many issues that Black men go through.'"
He said he did not think he would ever be where he is now, sitting on the other side of the therapist's office and helping people work through trauma and stress, and helping them heal.
Anyone who feels ready to visit a therapist, or who needs to speak to a mental health professional immediately, can reach out to any of these organizations in East Tennessee.
People can also dial 988 to be immediately connected to the National Suicide Prevention Lifeline. The lifeline will connect them with someone who will listen to whatever issues they may be facing and help them through crises, while also connecting them with resources.