Introduction

In America, Black males across the life span have unique gender, cultural, and social stressors that impact their physical health and mental health (Elder and Griffith 2016; Koenig 2012; Robinson and Cheng 2014). From high rates in infant mortality, high school dropout, incarceration, homelessness, unemployment, cardiovascular disease, cancer, HIV, depression, substance abuse to homicide, Black males have poor health outcomes and the lowest life expectancy than any other race or gender (Bond and Herman 2016; Flaskerud 2014; Heron 2016). Until recently, research addressing the health of Black males had been low and infrequent (Williams et al. 2003).

Life course health inequities and health disparities impacting Black males have persisted for decades (Hankerson et al. 2015a). Their physical and psychological morbidities have often taken a backseat to health policy, planning and programming that preference maternal, child and older adult health issues ((Bond and Herman 2016; Levin et al. 2005; Williams 2003). Particularly as it relates to mental health, recent discussions and research aimed at systematically addressing the health and well-being of Black males in the USA are long overdue (Gilbert et al. 2016). This article explores the role the Black Church could play in facilitating spiritually sensitive, culturally relevant, and gender-specific services to address the mental health and well-being of Black males. The positive coping potential of religion and mental health, current status of Black male mental health, historical role of the Black Church in mental health service delivery, and promising theoretical perspectives and recommendations are outlined to aid the Black Church in establishing social support networks that promote healthy Black male mental health.

Religion, spirituality, and mental health are complex matters to define and decipher, let alone to synthesize (Bergin 1991; Sharma et al. 2009; Zinnbauer et al. 1997). The complexity and variance between religion and spirituality have been well documented (Hill et al. 2000; Koenig 2012). Religion has been defined as a cultural system of beliefs, practices, and rituals that govern the universe, while spirituality is associated with a person’s connectivity to the transcendent and supernatural (Clark 1958; Koenig 2012). The World Health Organization (WHO) defines mental health as, “as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community” (WHO 2014, para.1). Affiliation with religion and spirituality were found to correlate with individuals that were challenged with mental health illnesses as well as those with healthy mental health (Corrigan et al. 2003; Hill and Pargament 2003). Abraham Maslow, a respected psychologist, valued and endorsed religion and spirituality in his hierarchal construct to human self-actualization (Maslow 1964).

Pragmatic philosophers (e.g., David Hume and John Dewy) and psychologists (e.g., Sigmund Freud and B. K. Skinner) were skeptical of the role religion had in mental health (Koenig 2009; Masters and Bergin 1992; Stark et al. 1996). During the eighteenth century, David Hume was one of the first philosophers to question the validity and benefit of religion in addressing mental health (Stark 1999). John Dewey, a world-renowned philosopher and psychologist, embraced the supernatural intersectionality of the body and mind, but questioned the existence of absolute truth and power of God (Phillips 2002). Sigmund Freud believed religion was a dangerous subjective construct aimed to control humans (Freud 1961). Similarly, B. K. Skinner warned of the psychosocial manipulative impact religion has on human behavior and their mental health as well (Seybold 2007).

Numerous empirical studies reported that the connectivity of religion and mental health was insignificant (Ellis 1980; Koenig and Larson 2001). The premise remained unchallenged until Allen Bergin, a noted psychologist, reassessed previous empirical studies and identified research bias, outcomes ambiguities and the absence of subcultural considerations that may have confounded the studies’ outcomes (Bergin 1983; Ellis 1980). After Bergin’s research, the connectivity and relevance of mental well-being and religion slowly began to emerge in the peer-reviewed literature (Jones 1994; Koenig and Larson 2001; Miller and Thoresen 2003).

However, even prior to Bergin, Cannon, and Locke implied that being Black in America had a negative impact on Black mental health (Cannon and Locke 1977). In 1994, the relevance of religion and cultural sensitivity were formally recognized and included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) 4th Edition (Levin et al. 2005; Turner et al. 1995). For Blacks, the paradigm shifts offered legitimacy to their traditions and social support networks that endorsed the positive coping impact of religion with physical and mental health (Brown and Gary 1987).

In 1983, a national research study assessed the mental health of Blacks and found that prayer was an important mechanism to relieve stress (Neighbors et al. 1983). Research studies that juxtaposed religion, spirituality, and health in the Black community have primarily targeted Black females, and the majority of the studies viewed religion or spirituality as a distressor (Krause et al. 2001; Mattis 2002; Newlin et al. 2008; Taylor et al. 2000). Only a few studies in the extant literature examined Black males, religion and health (Brown et al. 1990; Brown and Gary 1994). Research studies that examined psychosocial factors of Black racial identity, perceived racism, and medical mistrust on Black male mental health were limited (Cannon and Locke 1977; Hammond 2010; Rosenfield 2012; Whaley 2001; Williams, and Williams-Morris 2000). Some studies attributed poor mental health outcomes and the underutilization of mental health treatment among Black males to medical mistrust, sociodemographic, and socioeconomic factors (Hankerson et al. 2015a; Rosenfield 2012).

Environmental and Cultural Factors that Influence Help-Seeking Behaviors of African American Males

Research indicates that African Americans seek formal service help for their mental illness such as depression, at significantly lower rates compared to White Americans (Alegría et al. 2008; Cheng and Robinson 2013; Masuda et al. 2009). For example, despite evidence that indicates that African American college students experience similar levels of distress as students from other ethnic backgrounds (Ayalon and Young 2009), a study conducted among African American college students (n = 182, 85% female) found that in comparison with European Americans, African American students scored lower on psychological service utilization, help-seeking attitudes, and recognition of personal need for psychological services (Masuda et al. 2009). Furthermore, multiple scholars affirm that in comparison with females of most ethnic or racial groups and non-Hispanic White males, African American males significantly have the least likelihood to seek help for health-related issues (Möller-Leimkühler 2002; Neighbors et al. 2007; Zoratti et al. 1998).

Research on African American men’s help-seeking behaviors yields variable factors that influence whether help will be sought for their mental or physical health. Culture is believed to have an integral role in an individual’s beliefs, values, and perceptions about what is considered an illness and how they cope with it (Campbell and Long 2014; Olafsdottir and Pescosolido 2009). Cultural expectations about male behavior such as emotional toughness, pride, autonomous coping, and maintaining self-control despite adverse health experiences tend to encourage males to avoid help seeking (Fish et al. 2015; Powell et al. 2016). For instance, beliefs such as depression is not a mental illness, is a sign of weakness, or depression is not a Black man’s disease and is something that does not need medical intervention but can be dealt with alone, have been found to be common in African American culture (Anglin et al. 2008; Campbell and Long 2014; Robinson et al. 2011; Thompson et al. 2004).

In addition to cultural factors, environmental influences to help seeking include factors such as historical and institutional racism (Whitley et al. 2005), inadequate health insurance (Ford et al. 2006; Griffith et al. 2007), lack of health materials that are culturally relevant (Allen et al. 2007), and financial constraints (Ravenell et al. 2008). A recent quantitative study (Powell et al. 2016) conducted among 458 African American men found that men who were exposed to frequent racial discrimination in their daily lives reported more barriers to help seeking. The study also found that masculinity norms also mitigated African American men’s help seeking. These results corroborate with the previous findings of a meta-synthesis study (Watkins et al. 2009) of qualitative research on Black men’s health and well-being. Results from this study indicated that economic status, male gender socialization, and issues pertaining to race played a significant role in African American men’s behaviors regarding mental health.

Other factors such as fear of negative diagnosis (Wexler et al. 2009), mistrust of the healthcare system, and concerns about work absences (Allen et al. 2007) have also been found to influence African American men’s help-seeking behaviors. These findings indicate that barriers to African American males help seeking are socially determined than they are genetic dispositions to delay help seeking. Thus, environmental and cultural considerations should be made in understanding findings that indicate underutilization of professional psychological services (Masuda et al. 2009) and a preference for the use of non-mental health professionals such as clergy and family members among the African American population (Ayalon and Young 2005; Campbell and Long 2014).

The Role of the Black Church/Black Minister in Mental Health Service Delivery

The first known formal Black Church was established between 1750 and 1773 and soon after others followed (Lincoln and Mamiya 1990; Moore 2011). These early churches were responsible for the eventual formation of African American seminaries, Black colleges and academies, the NAACP and The Civil Rights Movement of the 1960s (Lincoln and Mamiya 1990; McKether 2011). Since the establishment of the Black Church 265 year ago, the size of many African American church congregations has significantly grown so much so that some Black Churches have a membership of 2000 or more congregants popularly termed mega-churches. This is particularly true with younger pastors who are either millennials or Gen-Xers, who have been able to grow ministries that are able to appeal to those of their cohort (Banks 2015).As such, the Black Church is in a strategic position to attract Black men and younger members and to be useful in ameliorating a plethora of social problems and conditions that plague the African American community. Some of these social problems include but not limited to drug addiction, single fatherhood, and unemployment, poor self-esteem issues as a result of negative stereotyping and marginalization, and police brutality.

According to the 2015 U.S. Religious Landscape Survey, conducted by the Pew Research Center’s Forum on Religion and Public Life, 92% of African Americans who attend weekly religious services believe in God, of those persons, 93% indicate that religion is very important in their everyday life, and 47% indicate that they attend religious services weekly (http://www.pewforum.org/2015/11/03/u-s-public-becoming-less-religious/). Among African Americans who attend religious services weekly 38% are male. Further, 21% of those males are 18–29 years of age, 35% are 30–49 years of age, 27% are 50–64 years of age, and 17% are 65 years and older (Cooperman 2015). Consequently, church attendance is an important consideration for those who seek to meet the mental health needs of African Americans males because it has been found that those who attend church often look for the heads of their church for assistance with spiritual and personal problems (Taylor et al. 2011). Further, within the African American community, mental health treatment is often viewed with stigma compared to how it is viewed by Whites. Therefore, discussing psychological difficulty and associated treatment options within the church environment may not feel as intimidating as in other settings (Fisher et al. 2014).

Despite the significant influential position of the African American church, some suggest it has failed its members in its response to many critical social issues. Fulton (2011) argues that the timorous response of the African American church to various social problems has damaged the status of the church among Black people. This is particularly troubling given that the church according to Brown and Brown (2003) is the second most influential institution in the African American community. In a qualitative study of 13 focus groups inquiring about the extent of African American ministerial support, the researchers (Mattis et al. 2007) found many social problems were not addressed by ministers.

Alternatively, contrary to these findings, others find that the Black Church is potent and very active in the African American community and maintains a pivotal role in the lives of Black people (Collins and Perry 2015). It is significant that Black males attend church because it is there that they can be mentored toward their potential for greatness, receive affirmation, and receive social support, counseling, and other services that mitigate against mental health problems that sometimes result from negative life circumstances (Taylor et al. 2000; Allen et al. 2010; Rowland and Isaac-Savage 2014; Collins and Perry 2015). As previously stated, the Black Church has always played an indispensable role in the life of Black people that has fostered a continuing strong Black religious uniqueness, and it has been able to retain its members through community outreach, social movements such as “Black Lives Matter” and special projects like “Brother’s Keeper” among others.

Promising Theoretical Perspectives

Black male mental health in the Black Church must move beyond health education and health promotion events. Forthright dialogues that confront societal and male-specific stressors like racism and masculinity must be openly and continuously addressed. Recently, the literature has identified Black masculinity as an important variable to study when assessing Black male mental health (Elder and Griffith 2016; Griffith 2015). For the Black Church, the psychosocial influences of slavery, violence, unemployment, police brutality, homelessness, sexuality, sexual abuse, child support, and depression on Black males are uncomfortable topics, and therefore theoretical frameworks to facilitate these discussions must be evidence based, culturally relevant, and spiritually grounded (Chandra et al. 2013; Lewis et al. 2015; Moore et al. 2016).

To this end therefore, the Body, Mind, Spirit, Environment, Social, Transcendent (BMSEST) and Health, Illness, Men and Masculinities (HIMM) are two theoretical frameworks that may assist the Black Church to be effective support networks for healthy Black male mental health. Succinctly, the BMSEST theoretical framework supports a holistic view of health, spirit, and religion (Anandarajah 2008). Grounded in Maslow’s hierarchy of self-actualization, the BMSEST framework is a competency-based curriculum that could be used in inter-professional education settings (Anandarajah et al. 2010; Keyes 2009). Moreover, BMSEST broadly defines spirituality, yet like Maslow’s hierarchy, it acknowledges the intersectionality of spirituality to psychological well-being (Anandarajah 2008; Ivtzan et al. 2013). Furthermore, BMSEST is adaptable to diverse genders, religions, and cultures, and it posed to complement the healing and cultural aspects of the Black Church (Anandarajah 2008; Jacobs 1990).

Similarly, the Health, Illness, Men and Masculinities (HIMM) is another promising theoretical framework that may aid the Black Church with promoting healthy Black male mental health (Evans et al. 2011). The HIMM framework not only addresses male health from historical and psychosocial perspectives, but it also recognizes health disparities and views masculinity as a determinant of health (Evans et al. 2011). The HIMM theoretical framework endorses a life course application and may intersect well with Black males of all ages (Hooker et al. 2012). Even though HIMM does not specifically address religion or spirituality, its gender-specific ecological inclusion of race, ethnicity, sexuality, education, community, socioeconomic status, geography, employment, and ability are important factors that impact Black male mental health. Both BMSEST and HIMM have noteworthy features that may improve the Black Church capacity to address Black male mental health.

Discussion

Nearly every neighborhood in North America has at least one church, particularly in urban Black communities (Lincoln 1989; Yearbook of American and Canadian Churches 2012). Furthermore, among people living in urban Black communities, the majority attend church and report being involved in church-related activities (Davis 2004). Because of their status as pillars of Black communities, churches are uniquely positioned to provide information, services, and interventions related to mental health to individuals who are otherwise not reached by mental health-focused resources. Specifically, the church, in its capacity as an existing social hub and community center for service and outreach to Black men (Chatters et al. 1999; Hays 2015; Mattis et al. 2004), can address issues of mental health in Black men, by providing emotional social support, but also an instrumental support to address underlying determinants of physical and mental health described earlier.

This paper has highlighted the importance of addressing mental health in Black men, the links between religion and mental health, and the potential opportunity for the Black Church to play a greater role in addressing mental health needs of Black men at the community-level. However, several unanswered questions remain, including: (a) what areas of mental health are Black Churches best suited to deal with, and (b) who is best suited to address mental health in the church setting? Previous studies have revealed that Black churchgoers experience a range of mental health challenges, including (but not limited to) stress, grief, depression, suicidality, alcoholism and other substance abuse (Young et al. 2003). Furthermore, pastors and ministers are the most likely figures to be the counselors to whom congregants present with mental health challenges (Young et al. 2003). Studies have additionally shown that while pastors of Black Churches show adequate literacy around mental health (i.e., can recognize signs of depression), the majority reports the need for additional education and access to referral resources (Anthony et al. 2015). Thus, an important consideration in augmenting the capacity of the Black Church to address mental health in Black men is how to provide training, informational and referral support for the range of mental health challenges that are likely to present in the church setting.

While much of the literature on mental health counseling in Black Churches has focused on ministers and pastors, emerging literature suggests it may be prudent to expand the range of potential interventionists for Black men. Health ministries or committees within churches are one potential source of interventionists. These ministries often include congregants who are interested in health and health professionals who attend church but are not necessarily clergy. A recent study examined an intervention delivered by non-clergy and lay health advisors who serve as health coaches to deliver counseling to congregants (Lancaster et al. 2014; Schoenthaler et al. 2015). Other studies have demonstrated that non-clergy can effectively screen for depression in Black Churches using validated instruments and that this approach can be particularly powerful for detecting depression in Black men (Hankerson et al. 2015b).

Implications and Recommendations

The implications of this paper for social work practice, research, and education are manifold. First, the time is now to focus on the mental health challenges of Black males. Accordingly, Black social workers and Black health professionals must with urgency answer the call of duty of researching more and recommending best practices and evidence to mitigate the unacceptable plight, and understudied area of Black male mental health.

Second, we recommend that a systematic review and synthesis of dispersed published studies on Black male mental health should be the starting point. Research synthesis methodology will provide a panoramic overview of extant best practices, knowledge gaps, and the available evidence of what works on the disparately published studies and dissertations on Black male mental health. Our proposed research synthesis is similar to the study of Hays and Aranda (2015) which synthesized faith-based mental health interventions with African Americans.

Third, and in tandem with the clergy of the Black Churches Black social workers, or health professionals should collaborate on identifying culturally sensitive, educationally appropriate, and best practices mental health interventions that specifically addresses Black mental health challenges within the continuum of prevention and treatment. As part of this recommended collaborative initiative, Black social workers and health professionals should take the lead in the training of the clergy in Black Churches as has been previously suggested in previous studies looking at the collaboration between health professionals and the clergy (Collins and Perry 2015; Hays 2015; Hays and Aranda 2015).

Moreover, and number four, the leadership of the Black Church should once and for all confront the elephant in the room of Black men’s mental health and overcome the taboo of mentioning or addressing the reality of the plethora of mental health problems that assail Black men. To this end, we recommend that boys’ clubs, young men’s fellowship and elderly men’s fellowship in Black Churches must begin to discuss mental health challenges, and promising interventions that daily confront Black males. We also suggest that such meetings should be facilitated by mental health professionals whose faith, belief, and socioeconomic and cultural experiences align with, or are similar to daily stressors, and triggers of the mental health stressors of Black males.

Five, closely following the discussion of the spectrum of cause and prevention of mental health challenges of Black males, we propose that regular mental health screening, referrals, and treatment should be hosted in Black Churches. It is anticipated that such mental health screenings will be acceptable to Black males who may otherwise be suspicious of conducting such mental health screenings, and seeking treatment in conventional medical settings such as hospitals.

In addition to the five recommendations discussed above, our sixth recommendation is that Black health professionals, and the Black Church leadership can design culturally appropriate and spiritually sensitive educational messages, bible studies, mental health screening, and prevention strategies all of which can be deployed using the ubiquitous avenue of social media, and the traditional outlets of Black newspapers, and such trusted outlets and barber shops.

Seven, we propose that Black social work professionals, students, and academicians avail themselves of funding opportunities provided to fund mental health research (both qualitatively and quantitatively) such as the Council on Social Work (CSWE) mental health and substance abuse fellowship program (MHSAFP). Such funding mechanisms (as well other funding streams) should be dedicated to understanding better the etiology, epidemiology, and best practices interventions related to Black mental health.

Finally our eighth recommendation is that we expect that the convergence of the aforementioned will result in hosting special tracks focusing in Black males’ mental health challenges in high profile professional conferences in social work such as the annual program meeting of the CSWE for instance. It is anticipated that advocacy and policy interventions at the state, regional, and national levels will ultimately eventuate to address the mental health challenges of Black males.

Conclusion

As a cornerstone in the Black community, the Black Church has a responsibility to address the growing concern of Black men’s mental health. The Black Church infrastructure is already present and research has shown that the church can be an effective conduit in addressing the mental health concerns of this population. The authors introduced two promising theoretical perspectives to support this claim, and offer eight viable solutions for the Black Church to address Black men’s mental health needs. Moreover, this is a call to action for Black social workers and Black mental health professionals as many are members of Black Churches and thus have first-hand knowledge of the inner workings of the Black Church, and consequently, they are best equipped to introduce a plan of action to address the mental health needs of Black men.