Ensuring Mental Health Access for All Featuring Darcy Gruttadaro and Stephanie Robertson

In this episode, guest host Darcy Gruttadaro is joined by NAMI’s new Mental Health Equity Director, Stephanie Robertson. During their discussion, listeners will learn about the Community Health Equity Alliance (CHEA) and the Crisis Can't Wait campaign, Black History Month, mental health equity, and actions NAMI is taking to expand access to care for mental health conditions. 

You can find additional episodes of this NAMI podcast and others at nami.org/podcast.

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Currently, only 4% of psychologists and 2% of psychiatrists in the US are Black. Despite Black communities making up almost 14% of the US population, these numbers highlight the significant disparity, leaving many without access to culturally relevant care. Intergenerational trauma, stigma, structural racism, the legacy of slavery, segregation, and other forms of institutional discrimination has created inequities in diagnosis and treatment, as well as general mistrust in the healthcare system. Bringing more diversity into the mental health field allows individuals to find providers and understand experiences who continue to amplify the impact of this work and affect lasting change. Welcome to Hope Starts With Us, a podcast by NAMI, the National Alliance on Mental Illness. I'm your guest host Darcy Gruttadaro, NAMI’s Chief Innovation Officer. NAMI started this podcast because we believe that hope starts with us. Hope starts with us talking about mental health. Hope starts with us making information accessible. Hope starts with us providing resources and practical advice. Hope starts with us sharing our stories. Hope starts with us breaking the stigma. If you or a loved one is struggling with a mental health condition and have been looking for hope, we made this podcast for you. Hope starts with all of us. Hope is a collective. We hope that each episode, with each conversation brings you into that collective so you know you are not alone. I'm Darcy Gruttadaro, NAMI's Chief Innovation Officer. At NAMI, I collaborate with a team that covers youth and young adults, workplace mental health, and cross-cultural innovation and engagement. These are critical areas for NAMI in our work as we embark on a new strategic plan from 2025 to 2030 and really focus on our outreach, building our tent, and reaching more broader communities around the country. I'm excited about a conversation today with NAMI’s new Director of Mental Health Equity Innovation, Stephanie Robertson. So I'll ask Stephanie to introduce herself and tell us a little bit about her background, and then we'll launch into questions. Stephanie? First of all, thank you so much, Darcy, for having me today to speak on this important topic, especially in recognition of Black History Month. This is my first podcast, and it's great to be able to share this experience with my new amazing boss while discussing an issue that deeply matters. My name is Stephanie Robertson and I am the new Director of Mental Health Equity Innovation with NAMI. I grew up in Aiken, South Carolina, attended Duke undergrad and Georgetown Law, and worked in higher education for about 15 years before I joined NAMI this past December. So in this last role, I led diversity, equity and inclusion efforts at Duke University's School of Business, working with students, staff, and faculty to foster inclusion, belonging, and allyship. I also incorporated mental health advocacy into our DEI efforts, creating spaces for open dialog and mental health advocacy training opportunities to support those within the legal community who may have had mental challenges. I am really looking forward to speaking to you today about the importance of equity in mental health care, and why this work matters to me personally and professionally. I'm also looking forward to sharing how NAMI, in partnership with Incredible organizations and community leaders is working to better support minoritized communities and today, especially for today, focusing on those within the Black African ancestry community. Thank you, Stephanie. We are so happy to have you here at such a pivotal time. And as we embark, as I said, on our new strategic plan to really build the movement to include those who have not had the same opportunities in communities around the country. So today's theme for our episode is honoring Black History Month and NAMI's commitment to ensuring mental health access for all. So just a bit about why NAMI has expanded our work on mental health equity. Black History Month is the right time to talk about the inequities that exist in the mental health space. What we know from research and data that is well-established is that only 1 in 3 Black adults with mental illness receives treatment in the United States. That leaves a lot of our community members behind. Black adults are also less likely to receive guideline consistent care. And one of NAMI's pillars in our new strategic plan is making sure that people get the best possible care. Black adults in the U.S. are also less frequently included in research, and are more likely to use emergency rooms or primary care, rather than seeing a mental health specialist. Also, an alarming rise in suicides among Black boys, rising 144% from 2007 to 2020, while overall youth suicide rates trended down. We must stay committed to expanding access to mental health in Black African ancestry communities. And I'm so excited to be having this conversation with Stephanie to both honor Black History Month and to really highlight the need for change and some of the strategies we're embarking on to see that change happen. So let's launch into our conversation as we think about addressing mental health equity. What are the challenges that Black African ancestry communities have faced and are facing when it comes to accessing mental health care? Well, I believe the Black African ancestry community faces a significant barriers to accessing equitable mental health care, and that these barriers really are rooted in a number of things, including intergenerational trauma, stigma, structural racism, the legacy of slavery, segregation and other forms of institutional discrimination has created inequities in diagnosis and treatment, as well as general mistrust in the health care system. And there are examples throughout history, like the Tuskegee Experiments and forced sterilizations that further deepen this mistrust. Also, there have been studies on how Black patients often receive lower quality care, including having symptoms dismissed completely or being misdiagnosed altogether. And this is all in addition to the normal everyday life stressors that we all go through, like work and taking care of family and loved ones, taking care of your own physical health. The Black African ancestry communities often have less access to quality mental health care because of things like disparity in insurance coverage, provider bias, and mental health care deserts, which essentially means that people are living in areas where there aren't enough mental health services. Another huge issue is a shortage of Black health care providers and practitioners that may be able to better connect to patients, and those who are able to truly demonstrate cultural humility, which is essentially about learning and valuing the perspectives of those being served. Additionally, stigma remains a major barrier in the Black African ancestry community, making it more difficult to openly discuss, understand, and address mental health challenges and just overall mental well-being. For some, prioritizing one's mental health may seem like a luxury rather than a necessity, and seeking help can sometimes be perceived as an overreaction or even a sign of weakness. These beliefs can make it much harder for individuals to understand their own experiences and the underlying causes, while also creating barriers to accessing support, which then reinforces these cycles of silence and suffering. And often, those experiencing mental health crisis are just disproportionately met with legal ramifications and don't end up getting the proper care they need. Which then just again reinforces fear and mistrust. And this is just a really high level overview of possible reasons for these barriers. And going deeper will require more time. And probably another podcast episode. Yes. No. That is an excellent summary of the key areas that really make inequities exist and really highlight the importance of this work, and particularly around stigma as a major barrier. Since NAMI has a long history, and recognizing that stigma is one of the biggest barriers to people accessing care when they need it. And one thing we know for sure is that the earlier or sooner people access mental health care, the better the opportunity for long-term positive outcomes. So we have to continue to work at breaking down those barriers. And that's something NAMI has excelled at over the years through our education programs, our support groups, and now really broadening our tent to offer much more in the areas of programming and initiatives that really focus on the Black African ancestry community. So I guess that brings me to the next big issue, which I think is critically important, which is what are ways we can better support mental health awareness. Knowing awareness matters a whole lot around people knowing when and where to get care and advocacy when it comes to Black African ancestry, communities, so ways we can better support this process. First, as you just talked about, we need to tackle stigma. And one way to do this really is by normalizing conversations around mental health conditions. And as you've just talked about, NAMI has some amazing initiatives that do exactly that. One example is sharing hope, which is a three-part community conversation that is rooted in stories and evidence-based practices. The conversations are prompted by videos and guided by facilitators who help participants understand, support strategies, and community resources. Facilitators are fellow community members who seek to find wellness as well. A program like this helps individuals feel seen, heard, and supported, allowing them to share their experiences without fear of judgment. We also need to increase the number of mental health providers from diverse backgrounds. Only 4% of psychologists and 2% of psychiatrists in the US are Black. Despite Black communities making up almost 14% of the US population, these numbers highlight the significant disparity leaving many without access to culturally relevant care. To address this, we must tackle the systemic barriers that exist within higher education as well, and access to training. I mean, to accomplish any of this, though, is essential to strengthen existing partnerships and create new opportunities for collaboration. This includes working with the Divine Nine, a collective of historically Black sororities and fraternities. We already have established strong partnerships with Sigma Gamma Rho and Delta Sigma Theta, and are committed to expanding relationships within this network. Additionally, we plan on working with such organizations like the Young Doctors Project, which is a program focused on encouraging women of color to pursue careers in medicine and providing them with mentorship, education, and hands-on experience in the health care field. We continue to collaborate with industry organizations such as the Black Psychiatrists of America and the Association of Black Health System Pharmacists to Advance Health Equity. Additionally, partnering with nonprofits like the Confess Project and the Loveland Foundation, both of which are dedicated to raising awareness and providing critical support to communities of color through the Community Health Equity Alliance, or CHIA which I'll talk about a little bit more later on. We will continue to support NAMI state organizations and affiliates dedicated to work around mental health equity for Black African ancestry community. And so through these strategic partnerships, we really are aiming to destigmatize mental health conditions and expand access to culturally responsive material for mental health resources to amplify impact. That's a lot. And so exciting. And I have to say, the community conversations is so critically important. That really does go to normalizing, as you said. I mean, really storytelling and sharing experiences and supporting those who have similar experiences is largely what NAMI was founded on. A group of mothers coming together, experiencing really trauma associated with their children having schizophrenia. So this idea of coming together with community conversations and really connecting and community, it is that collective. It is that collaborative that NAMI is really about. And the idea that our workforce is so lacking in providers who represent the communities they're working with, in terms of delivering mental health care, is such a critical area of need to really diversify the workforce. And the partnerships are very impressive. I think we say force multiplier. That is really how we work collaboratively in a united fashion to really help effect change at the community level. So such impressive and important partnerships and really excited to hear more about the Community Health Equity Alliance. So as you think about equity and mental health equity, and as we honor Black History Month, what are some of the biggest gaps or opportunities when it comes to equity and ensuring that all which is really important to NAMI, that word, all that, that all of us have that opportunity, who need care, have access to it, and that you will be really addressing in your new role at NAMI. So as the new Director of Mental Health Equity Innovation, I will be co-leading the Community Health Equity Alliance, or CHIA initiative, working with NAMI state organizations and affiliates to expand mental health awareness and improve access to care and Black African ancestry communities and beyond. This initiative, which focuses on SMIs or serious mental illness, unites thought leaders and organizations across advocacy, faith, civic, and health care sectors at the national, regional, state and local levels. NAMI is addressing these gaps in mental health equity by broadening each year's reach and impact and focusing on scalable, community informed solutions to ensure better diagnosis, treatment and access to mental health care. So by leveraging these collaborative partnerships and this model itself, we aim to provide resources and build strategic partnerships that strengthen support for those directly serving minoritized communities. Our key priorities include amplifying and distributing culturally relevant resources, bringing together experts to explore pathways for mental health equity and policy solutions for individuals with serious mental illness. Our main goal is to improve access to and delivery of mental health care for all by working with community leaders and stakeholders, developing more effective and sustainable solutions. So as part of this effort, we do continue to amplify our Crisis Can't Wait campaign, educating people on 988, which is the nationwide hotline connecting individuals to the National Suicide an Crisis Lifeline. It also provides access to trained crisis counselors, offering immediate support, de-escalation, and connection to additional resources for those in distress. And through this campaign, we also continue to work on developing flexible care, journey maps, or blueprints that can be adapted to different communities. This roadmap will help guide individuals with mental health conditions, from initial conversations to screening and diagnosis, through crisis mitigation, and ultimately to care coordination and ongoing support ensuring a more structured and accessible path to health care. Wow, that is a comprehensive array of ways in which we can really make sure that people, especially those with the most serious mental health conditions, have access to care. What we know from the national data that's come out of the research institutions like the NIMH, National Institute of Mental Health, is that on average, it's 11 years from the onset of symptoms to intervention. And when you have a serious mental illness, that is very concerning, because people's lives can really get very much off track and has led to, as we know, homelessness, incarceration, people losing their homes, their jobs, their connection to family. It is a devastating reality. And so our ability through the Crisis Can't Wait campaign to really make sure people know early signs of mental health conditions, especially those that are more serious. NAMI has been such a leader on 988 with our Reimagine Crisis initiative, and it's terrific to see the focus on 988 and now really focusing on building out the services and supports that we need to ensure that people have access to the level of care they need, that people don't just have emergency rooms as an option, that they have outpatient care. They have day programs that really meet their needs. They have job training programs and more so they can get and keep their lives on track, so critically important. And then also knowing the care journey. We know a lot of people drop out of care after a first or second touch. So we want to make sure that people stay connected to care, especially people in Black African ancestry communities who are experiencing some of the biggest challenges. So, so appreciate the work you have planned out for the Community Health Equity Alliance and more. So I want to return to what we touched on earlier, which is what role do personal stories and lived experience play in shaping our conversations about mental health challenges and really in developing strategies as we work to achieve equity. I'm interested in how your personal journey influenced your approach to inclusive mental health initiatives. Well, personal stories and lived experiences are just such powerful tools for breaking stigma and opening conversations about mental health, which really is a critical first step toward equity. Hearing real stories creates empathy, understanding, and validation, making it easier for people to speak up and seek support and really feel less alone. Also, centering the voices of those with lived experiences just really ensures that solutions are community driven and meet the needs of those most affected, rather than being dictated by outside institutions of sharing. Personal narratives also helps drive policy change and better resource allocation, leading to more equitable mental health care. With improved access, representation, and culturally competent providers. So because of all this, I do want to take a moment to share my own experiences. So my own personal journey has been far from linear, requiring multiple doctors and various diagnoses and misdiagnoses. Storytelling representations really do matter, and I often wish someone had been open about their journey with me, because if I'd seen others discussing these challenges, I feel I would have approached my mental health very differently. So in 2023, I was diagnosed with ADHD, generalized anxiety disorder, and major depressive disorder, but my struggles really began long before then. In 2006, during my second year of law school--I know we both went to law school, so in general, is a very stressful experience. But for me personally, it really was an intense period with the nonstop networking and interviews and challenging classes, which all led to a pretty severe downward spiral. I couldn't get out of bed. I failed a class for the first time in my life, struggled with relationships, all while my drinking became worse. I decided to seek out professional help, though I still resisted the idea that I needed more than rest and time to recover. I was prescribed my first antidepressants and began therapy, although quite reluctantly. However, with medication, supportive friends, and an incredible professor, I was able to pull myself out of that dark place. Unfortunately, after law school, my mental health declined again and my drinking escalated. As a first year associate at a corporate law firm, I realized I didn't enjoy the job and wasn't great at it, which was the issue because I didn't feel a passion with it. Living in New York City, I felt overwhelmed by a career that didn't fulfill me. Very harsh winters, constant overstimulation. So after 11 months, I was let go. It was embarrassing and hard for me, and those that knew me didn't quite understand what was going on. I kept looking into it and doing more research on my own, but it was very difficult. And so in 2009 I was diagnosed with ADHD, but dismissed it. You know, at that time I had never seen a Black woman talk about having ADHD. And so I didn't think it was possible. I also didn't understand what it meant and continue to struggle in silence. And so by 2012, after just job instability, pacing addiction, and continuing to self-medicate with alcohol, I was diagnosed with bipolar, too. The diagnosis surprised me a little bit, but I accepted it because I was at a point where I just needed a path forward, and this seemed like it could be that. Looking back, I just didn't fully fit, but at the time, it was something I could hold on to and start making changes. So fast forward to 2019. I joined Duke University, leading diversity, equity, and inclusion efforts and for the first time, I was open about my mental health journey. It was liberating. Removing this mask I built up over the years allowed me to be my authentic self, and gave me the courage to ask for help when I needed it. During the COVID-19 lockdown in 2020, I saw firsthand how much our students were struggling, their mental health suffered, and I knew more needed to be done. So in response, I led initiatives to destigmatize mental health conversations and provided education and training for students, staff, and faculty. These efforts helped them better understand mental health conditions and equip them with tools to support themselves and others. So as I learned more about mental health conditions during this time, I began to question my own diagnosis. And by late 2021, after being exhausted and balancing the pressures of creating a business for managing my own mental health challenges and navigating life as a Black woman, I turned to anger and sadness, which affected my working relationships and knew that that could not last. I talked to my therapists and supervisors, took a four-week leave under FMLA or the Family Medical Leave Act to focus on getting better. And when I returned, although I was no longer angry or sad at something, still just felt off. For about a year I struggled in this type of mental fog. Confidence had faded, ability to communicate was just suffering. As Assistant Dean, I was expected to provide guidance on complex issues around identity and inclusion, but my own mind would often go blank, leaving me unable to recall basic words. It was just pretty scary. Multitasking was almost impossible, and I realized that I needed to figure this out. I became close to a professor at that time who had been diagnosed with ADHD recently, and seeing really a lot of similarities in our experiences, I decided to test myself. And so I underwent some assessment for ADHD including interviews and cognitive exercises and officially was diagnosed with ADHD combined type However, ADHD is far more complex than just a diagnosis. And every day I continue to uncover its impact on my life and those around me. So I believe my previous misdiagnoses stemmed from doctors not fully listening or understanding my symptoms, particularly within the context of being a Black woman. My life felt like a series of extremes, attending top schools and landing amazing jobs, yet also struggling academically and facing unemployment a number of times. Sometimes I was impulsive and craved excitement, while others I longed for structure and quiet. I hyperfixated on a number of things, from learning Germans and making jewelry, to collecting sea glass and many other seemingly random things. On top of that, my loved ones didn't quite know how to support me, having been raised to believe that the ways you get through this is pushing through with grit, faith, and arrest, and this is why it's crucial for families and communities to be properly educated on mental health conditions, and to understand that sometimes resilience alone isn't enough. Support through therapy, medication and mindfulness is often just as essential to healing our well-being. Thank you very much for sharing that journey. That was heartfelt, and it is a journey that I'm guessing, as we say at NAMI, you are not alone on that. Finding the right diagnosis, finding the right treatment plan that worked effectively for you is so critically important, but can really take time. And I really appreciate the story of equity built into that, that you didn't feel like providers were fully listening to you. That is such a critical piece, is creating that therapeutic alliance, being part of the treatment planning process. All of that is so critically important. And I really think that the more we hear stories like the one you just shared, the more people are willing to be open and share openly about their experience. That's what really moves the mark in understanding what mental illness is, understanding how we stick with our care journey, how we find the support we need in the community, and the role that family plays, and friends, and faith, and more can play in that journey as well. So the more we share stories, the more we make it okay to talk openly. And one thing we know about research on stigma is that when people have a person-to-person contact with someone that's had the kind of experience that you have, it really opens their mind to understanding better that whether or not you live with a mental health condition, you can have a full life, you can achieve great things, and you've proven that you as a, person who attended very prestigious universities and law school, is really important for people to hear and understand. And because it reminds them that mental health conditions don't have to hold us back when we get the right care, when we get access to care, when we break down those barriers, that's when the real difference happens. So, so appreciate your commitment to these issues based on your own personal experience and that you're working with us to help break down those barriers and to create that equity that's so greatly needed. So I also wanted to touch on the fact that you've led initiatives like Daring Dialogues and Restorative Circles, and just interested in how those and similar initiatives really help foster deeper conversations about mental health and really connect people in the process. So Daring Dialogues was a series of facilitated conversations that I helped create at Duke that were designed to address topics that impacted the business school community. These discussions provided a structured and supportive space for participants to really learn from others’ experiences, ask questions, and share their own perspectives. The main goal was to really foster trust, respect, and meaningful relationships that extend beyond the sessions and into daily life at the school. Topics often included race, economic status, religion, gender and gender identity, and many more. And each session featured what we called Courageous Community Members, who were individuals nominated by their peers to share their own personal experiences related to that topic. A moderator works with the Courageous Community Members and then led the discussion before participants broke into small group conversations with everybody to further explore the themes. The first Daring Dialogue we ever did was focus on mental health conditions and making it. To my knowledge, the first time such an open conversation about mental health conditions took place at the Fuqua Business School. Each year, the topics vary, but a few remained constant, and one of them was the discussion on mental health conditions, which took place every year without exception. And so for those seeking a deeper, more intimate discussion, we also held something called Restorative Circles. Restorative Circles are rooted in restorative practices, and these circles help build community, strengthen relationships, and address conflicts. They provided, again, a structured and safe space for participants to share experiences and listen to each other with a focus on respect, accountability, and really most importantly, empathy. So whether used proactively to foster connection or reactively to address challenges, these circles offered really meaningful ways for people to tell their stories and learn from each other, gaining new perspectives from those around them. And so when I joined NAMI in December, I was introduced to the many initiatives that some of them that we've already talked about here, that provided some more opportunities for connection and learning. That means commitment to elevating lived experiences is truly inspiring to me. Programs like NAMI Family and Friends, NAMI Peer-to-Peer empower individuals, whether they have firsthand experience with mental health conditions or support loved ones who do, and help facilitate conversations that really do foster, again, this understanding of empathy that is needed in order to create stronger support systems. Then there are programs geared toward specific populations, like Sharing Hope, which focuses on those within the Black African ancestry community, and which I discussed earlier, and Compartiendo Esperanza which focuses on mental wellness within the Hispanic Latino communities. So also understanding that many people lean on their faith and spirituality, NAMI has also developed FaithNet, which is an initiative that builds bridges between faith communities and mental health resources. It equips faith leaders and spiritual communities with the knowledge and tools to support mental wellness, while reducing stigma and encouraging open compassion and dialogue around mental health. And so all of this is really to say, it's been amazing to see how NAMI is committed to reaching diverse communities by meeting people where they are, using the power of storytelling and representation to foster this connection and understanding, and which is how I, through my previous work, was really able to reach those who needed to be heard and supported. So I'm super excited to continue on with this and work with these different programs at NAMI. Thank you. And I don't want to minimize for a moment the story that you shared, because storytelling is at the heart of what NAMI does, and the level of detail you shared is something I think many will connect with and feel a great sense of, kindred spirit with because so many go through a similar experience. And also, I'm so glad you mentioned faith, because the NAMI board and the NAMI field are growing much more interested in connecting with the faith and spiritual communities, knowing many people turn to them first when it comes to support and when it comes to changes that are happening in their lives. It's a trusted relationship. It's a long standing relationship, and it's one that can really help them connect with the support they need. And we're excited that more faith communities are coming to NAMI and letting us know we need support from you. And understanding mental health and understanding how to connect people with mental health care and support. So it's such an important conduit to the care community and more so really exciting work, so critically important. And as my final question, this has been such a great conversation and I hate to see it end, but just really want to ask you, how can we all move toward real impact when it comes to mental health equity? Just to quickly summarize a lot of what we just talked about, affecting real change in mental health equity comes down to several things, mainly breaking stigma, increasing access, and creating community driven solutions. Going back to sharing our stories, it helps normalize mental health conversations and encourages people to seek support. And while working with community leaders and those with lived experiences ensures mental health resources and education actually meet the needs of the people they serve. So bringing more diversity into the mental field allows individuals to find providers who can understand experiences and strengthening these amazing partnerships that NAMI already has will continue to amplify the impact of this work and effect lasting change. So real progress. It's going to take all of us health providers, educators, faith leaders, policymakers, family members, community members, and those with experiences. All of us need to come together to do this work. And when we break stigma, expand access, and empower communities, we take real steps toward improving equity for everyone. Wow, that was fantastic. And what a great way to honor Black History Month and to really think about forging our path forward when it comes to achieving mental health equity for NAMI and for communities across the country. So before we conclude, I want to ask you the question that we ask every podcast guest. The world can be a difficult place, and sometimes it can be hard to hold on to hope. That's why each episode we dedicate the last couple minutes of our podcast to a special segment called Hold On to Hope. So Stephanie, can you tell us what helps you hold on to hope? Well, knowing that organizations like NAMI exist, that gives me hope and being able to be part of a mission driven organization like NAMI that is truly committed to helping people regardless of their background or experiences is really inspiring. But what gives me the greatest hope is being able to share my story now and seeing its impact, and watching others find the courage to be honest about who they are. To seek support without fear, and to really know that they are not alone. Thank you. And I just want to say that what gives me hope is that NAMI has the opportunity to bring in incredible people like you who are smart, who are wise, who have a story to share that can really help break down the barriers that prevent people from getting help and so happy that you're here to really move our equity work forward. So that gives me hope. Thank you so much. I'm really excited to do this work with you. Thank you. And thank you for honoring Black History Month with me this morning or today rather. This has been Hope Starts With Us, a podcast by NAMI, the National Alliance on Mental Illness. If you are looking for mental health resources, you are not alone. To connect with the NAMI Helpline and find local resources, visit NAMI.org/help. Text “helpline” to 62640 or dial 800-940-NAMI (6264) or if you are experiencing an immediate suicide, substance use, or mental health crisis, please call or text 988 to speak with a trained support specialist or visit 988lifeline.org. I'm Darcy Gruttadaro, your guest host. Thanks for listening and be well.