According to the National Institutes of Health, people of color account for fewer than 10 percent of patients enrolled in clinical trials, though they comprise 40 percent of the population. This disparity is reflected in mental health research and certainly contributes to the lack of programs that reach diverse communities to improve emotional well-being.
Alfiee Breland-Noble, or Dr. Alfiee as she’s widely known, psychiatric researcher and former professor at Georgetown and Duke universities, has devoted her career to trying to change that. Her personal approach helped her develop community interventions that focus on doing away with jargon and are tailored to the unique needs of underserved communities. In fact, she believes that an appreciation of the uniqueness in each of us is the key to connecting across racial, cultural, gender, sexual, and any other types of identity.
As director of The AAKOMA Project, Inc. nonprofit, her mission is to build culturally relevant programs that address the range of psychological issues African American youth and other marginalized young people face today. A popular media personality, she’s been featured on numerous outlets, including NBC, PBS, NPR, A&E, Black Enterprise, and Vice.
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Ryan Howes: What do you think first drew you to your work?
Alfiee Breland-Noble: Growing up in Virginia Beach in the ’80s, a lot of people I knew were struggling emotionally. It seemed that almost everybody had parents who were separating or already divorced, with kids shuttling back and forth between homes. On top of that, there were very few kids of color like me in our school.
Everyone experienced the normal struggles of trying to fit in at that age, but I think it turns into a maladaptive problem when external forces—like being only one of seven black kids in gifted classes—make you feel like you don’t belong. Not many kids have developed the coping skills at that point to deal with the depression and anxiety that often result. I’ve always loved kids, and I was the neighborhood babysitter. I had really good support at home and decided I wanted to replicate that support for other kids.
I went to college wanting to be a pediatrician, but then I decided on studying psychology after my godmother, who has a degree in early childhood development, got me on the path. Soon I found my passion as a researcher focusing on disparities in mental health services for underserved populations. That was back when we were just starting to even talk about it. My research started with African American and black kids specifically. It still includes that population, but it’s really expanded to include any marginalized young person.
RH: So what have you found in your research?
Breland-Noble: First, I’ve found that opening the tent to mental health services isn’t as hard as people think it is. Many researchers say, “We can’t find diverse participants,” or “Black people are afraid to be vulnerable.” But if you ask respectfully,and if you’re consistent and present for people while you’re doing the research, even before you start your study, you increase the likelihood that they’ll participate. Second, people have a lot of really good ideas about what they need to support their mental health. We just don’t ask them enough. Third, there are mechanisms we can use, some of which we developed through my research, to support getting people to make use of mental health services. There are ways to do it, and there’s a science to it.
RH: How do we do that with kids?
Breland-Noble: We speak to them in a language that resonates with them. That means we have to let go of our professional jargon. But it’s also about empathy. The experience of a 15-year-old today is far different from what it was when I was 15. So it’s recognizing a different set of stressors these days.
I remember Katrina, a nemesis of mine when I was that age. As long as I was at home, Katrina couldn’t bother me. It’s not the same now. You can be in your house and Katrina is still harassing you and getting her friends to gang up on you. Cyberbullying takes things to a whole different level. Kids now are exposed to troubling experiences much earlier, but nobody’s talking to them about how to cope with that stuff. Instead, we have a generation of jungle-machete parents, which I’m sometimes guilty of being.
RH: Jungle-machete parents?
Breland-Noble: Yeah, some call them lawnmower parents. We’re parents in the jungle making sure no palm leaf should ever slap our kids in the face. We chop all those leaves out of the way. We clear the path for them, but that means they often don’t develop coping skills. How do you build resilience like that?
I treat these kids, and I see it all the time. Even when they get to college, they’re regularly texting their parents things like, “My roommate won’t clean up. I don’t know what to do.” I’m like, “Open your mouth and have a conversation.” We have to practice in therapy how to do that, because they don’t know.
RH: You build culturally relevant programs on all levels: local, national, and everything in between. What does that look like?
Breland-Noble: The first step is learning the landscape and figuring out who the culturally resonant powerbrokers in a community are, whether it’s an individual, an organization, or a small group of leaders. Sometimes it’s grandmothers. Originally, I did a lot of my work in the South, where there was always the grandmother everybody knew in the neighborhood.
RH: You’re saying equip her with the right tools because everyone goes to her anyway?
Breland-Noble: Yeah. In a way, she’s everybody’s grandma. Of course, this isn’t the case in all communities. When you get up north to New York, for example, long-standing community-based organizations often serve that function, like the settlement house where I worked with Chinese, Dominican, and Puerto Rican immigrant kids. It was the hub for all recently immigrated families. In other places, it’s often a faith community.
So after you learn what kind of existing support there is, the next step is sharing your vision with people and finding out if it resonates with them. My vision always has to do with mental health, and I’m especially interested in learning how depression and anxiety impact diverse kids, so we can help them.
The third step is to figure out what you can do collaboratively to build programming that resonates with the people in that community. We’ve had pretty good success using that model.
RH: This sounds similar to Howard Stevenson’s work.
Breland-Noble: Yep. He goes to barbershops and runs a program called PLAY to mentor African American boys. It’s based around sports, which resonates with a lot of those boys. I love Howard’s work because it works with them. They love him.
RH: You’re the director of The AAKOMA Project. What is that?
Breland-Noble: It started in 1999, when David Satcher released his mental health report for the San Francisco APA meeting. It focused on culture, race, and ethnicity, and everybody who was anybody worked on it. But it occurred to me at the meeting that while it’s wonderful to have all those people looking at the issue, they can’t help anyone if no one shows up to get care. So I wanted to focus my research on the most effective ways to reach underserved people, so we can treat and support them.
Because I’m really into mindfulness as a clinical tool, The AAKOMA Project originally was African American Knowledge Optimized for Mindfully-healthy Adolescents. It started out as my research lab in the psychiatry departments at Duke and Georgetown, but now it’s a nonprofit. And although it started as African American knowledge, at this point I’ve worked with so many different communities that we’re focused on making sure everybody feels there’s room for them.
RH: You’ve said that we need to use our uniqueness to connect across racial and cultural lines. What’s that about?
Breland-Noble: Sometimes when I say this, I feel like I can sound a little like a Baptist preacher, but the point is that each of us is gifted with unique abilities, talents, and special qualities. So if you can recognize that what unites us all is the fact that we’re all unique, then you lose any inclination to judge, discriminate, and look down on others. I tell young people: “There’s no standard. You are the standard just for you.”
Even the grown people I say that to will often come to me in tears. They’ll tell me, “I never thought about it like that. I always felt like the thumb on my family hand, and now I realize that we’re all a bunch of thumbs.” I’m like, “Yes, we’ll all thumbs and that’s okay.”
I wish somebody had told me that when I was growing up in Virginia Beach. I wish they’d said it’s okay to be black and like skateboarding and surfing. I wish somebody had been able to say, “Alfiee, you know what, baby, it’s okay. And as a matter of fact, let’s celebrate the fact that you’re black and you like surfing. You’re not the strongest swimmer, but you can get up on the board.” We’re all connected to the same hand, but we all have qualities that belong just to us.
RH: I wish I would’ve heard something like that growing up, too. That could help everybody.
Breland-Noble: That’s what I mean when I say that the uniqueness of our differences can unite us. I really do believe that.
RH: What makes utilization of mental health resources a challenge?
Breland-Noble: Well, in one of our focus groups, we were talking with adults who were either mentors or parents of black children. One of the moms had five children; she was an independent parent. Other people would call her a single parent, but she told me that’s a loaded term. Our question to the group was “Why don’t black people go to treatment, and why don’t they take their kids?”
She said, “I’m already black. I’m already a woman. Each one of these identities already makes me feel marginalized. I don’t need to be seen as crazy, too.” The rest of the group erupted in applause.
When you layer more and more marginalized identities onto one person, you push that person further and further out. Essentially, she was saying that she can’t help how people already perceive her as a black woman—and a large, imposing woman at that, sort of like Tyler Perry’s Madea. She said, “Now, you’re going to layer crazy on top of that? Come on. I don’t need another stigma.”
RH: “Too blessed to be stressed.” That’s another thing you’ve said you hear a lot.
Breland-Noble: Yes, it’s a common saying in some black Protestant communities. It means if you’re having emotional issues, you’re not close enough to God. I tell people to stop saying that. In communities of color, black and Latinx in particular, stress is a euphemism for everything that’s not positive. It’s not just “people are getting on my nerves” or “my boss is a jerk.” Stress is depression, anxiety, even PTSD. Obviously, that saying sends a negative message about taking care of your mental health.
RH: I’ve seen you say to groups, “You’re valuable because you’re here.”
Breland-Noble: Oh yes. I need the young people in these groups to understand that they don’t need to be, do, have, or say anything to be of value. Recently, NBC Nightly News was filming a segment with me working with a group of kids. The cameraman was a white guy, a really nice guy, who was chatting with us after the filming was done and stating his politics as a Trump supporter. He said, “I’m a redneck, and I’m proud of it.” We were in a black church, in a room full of 30 black kids. The kids were talking about stuff that stressed them, like how they feel they don’t measure up to the people on reality TV.
Because he’d worked on one of those series for years, he said to the kids, “Hold up. Do you know how much money those women spend per month on hair, makeup, and wardrobe?” They guessed $3,000, $4,000. He said, “$30,000 a month.” The kids’ jaws dropped.
He pulled me to the side later and said, “I needed them to hear that because I didn’t want those kids walking around thinking that what happens on those shows is anywhere close to reality.”
I could’ve hugged him. That was so powerful. I want kids to know they don’t have to look like Beyoncé. They don’t have to sing like Jennifer Hudson. They don’t have to dance like Jennifer Lopez, or rap like Pharrell or Puffy or Drake. Not everyone can be Zion Williamson.
RH: It’s important to accept who you are at this place and time.
Breland-Noble: Zion Williamson isn’t a good person just because he’s near seven feet tall and agile. No, he’s good because he exists. The place I start with these kids is having them understand, “I’m valuable because I’m breathing.” That takes the pressure off, right? You don’t have to do anything special.
Hearing that message is even powerful for adults. A lot of them burst into tears when that pressure comes off. “I can just sit in my chair, in my room, in my house, and I’m perfect just like this?” That’s what that means.
RH: What a message. It’s a total shame-buster.
Breland-Noble: That’s a great way to frame it.
RH: What would you like our readers to know about working with underserved populations?
Breland-Noble: Speak their language authentically. It’s not about trying to talk like them. It’s about speaking with them from a place of authenticity.
I just want to remind providers of something deceptively simple: if we approach our clients from a place of feeling like we’re okay ourselves, we can be more present, more effective, and more natural in helping the people who come to us for support.
Ryan Howes, PhD, ABPP, is a psychologist, writer, musician, and clinical professor at Fuller Graduate School of Psychology in Pasadena, California. Contact: firstname.lastname@example.org.