There are myriad reasons why, say experts at Mental Health America. One reason is systemic racism and historical mistreatment, such as in the U.S. Public Health Service Syphilis Study at Tuskegee. This has caused a mistrust and avoidance of the medical system in many Black communities, the result of which is underdiagnosis and undertreatment of mental illnesses and other health conditions. Another reason: stigma. Many Black people in the United States are not open to acknowledging mental health issues, according to a study published in Nursing Research. Many Black Americans fear judgment in their communities for admitting to psychological problems and needing help, per Mental Health America. Lorenzo P. Lewis, the founder of The Confess Project, America’s first mental health barbershop movement, aims to change that. Founded in 2016, The Confess Project helps Black men and boys, who are even less likely to seek help because of gender stereotypes about “toughness,” get the mental health help they need by training people they trust — their barbers — to encourage them to open up about their emotional and psychological challenges. The program has been so successful that the American Psychiatric Association honored The Confess Project with its Pioneer in Advancing Minority Mental Health award in 2019. Here, Lewis answers questions about The Confess Project, why barbershop health interventions are so effective, and how The Confess Project is improving mental health care for Black men and boys around the country. Could you tell us about your mental health journey and how it ties into your work as the founder of The Confess Project? Lorenzo Lewis: I was born to an incarcerated mother who was serving a short sentence in Newark, New Jersey. I was separated from my parents and siblings, and my aunt and uncle from Little Rock, Arkansas, stepped in. Because I was separated early from my parents and siblings, I faced obstacles like separation anxiety, the early stages of depression, aggression, and other behavioral challenges, which all contributed to my own incarceration at age 17. After I got a second chance at life by avoiding a felony conviction, I began working in the behavioral health field and juvenile justice system. I later realized I was a “unicorn,” so to speak, as a Black man working in the mental health field, because there’s a shortage of clinicians of color. According to the American Psychiatric Association and American Psychological Association, only 2 percent of psychiatrists and 4 percent of psychologists in the United States are Black. What led you to start The Confess Project? LL: Growing up in the Black community, I recognized a lot of unique challenges African American men face. My aunt owned a beauty salon, and as a child, I spent a lot of time there. I watched my aunt and all the stylists there serve their community every day by doing their hair, feeding people, and helping people that didn’t have any money. It was a gathering place for their community. There, I met my first mentor — a barber. This led me to think about how powerful it would be to start a mental health movement in a barbershop. I took that idea, along with my work in the mental health field, and founded The Confess Project. Because of the shortage of clinicians of color, I knew all of these things coming together could lead to something vibrant. According to The Confess Project’s website, one of the key reasons you founded it was because many Black men and boys have a similar experience of being told to “man up.” What have been some of the mental health consequences of this in Black communities? LL: When you think about a shortage of clinicians of color, you have to think about several cultural barriers to care that have resulted from this. We also have to consider how the mental health of people in Black communities is affected by racism, interpersonal violence, police brutality, and community violence. Those challenges all create toxic situations in which people feel they can’t be vulnerable or verbalize their emotions simply because they’re living in neighborhoods with high crime rates and public safety concerns. In Black communities, someone who talks about what’s going on with their mental health or how these factors affect their mental health can sometimes be viewed as a weaker person. That can lead us to internalize our mental health challenges. There have been several similar barbershop-related health interventions for Black communities around the country for other health issues, too, such as heart disease, which have been very effective. Why are barbers and barbershops so effective for these interventions? LL: Barbershops have been recognized as one of the longest-running institutions that have truly been a beacon and a pillar for Black communities in the United States. Barbers are essentially seen as heroes. This role dates back to the civil rights era with the Malden Brothers Barber Shop, which was founded in 1952 in Montgomery, Alabama, and the Voting Rights Act of 1965, which prohibited racial discrimination in voting. During the civil rights era, Black people often gathered at barbershops to strategize. In addition, barbershops are one of the few trades in which Black men who have a felony conviction or a criminal record can build their way to owning their own business, build wealth, and own their own time, which in turn creates other economic opportunities to bolster themselves for their families and their communities. It’s a trade that can really change the lives of African American men and their families. What can barbershops do that traditional mental health intervention can’t? LL: They’re in close proximity to 20 to 25 people a week or more, depending on their clientele. This means just one barber could see 100 or more folks a month, which is a significant reach when it comes to a mental health intervention. Counselors and mental health clinics typically don’t reach this number of people in marginalized and disinvested communities. Barbers are a part of the gateway to mental health interventions for Black communities, and I believe we’ve begun to do something magical that’s sustainable over time and helps Black people attain the quality of life they deserve. How does the intervention work? If someone comes in to get a haircut, is the barber a therapist, or do they have training in asking the client getting a haircut about their mental health? LL: We train the barbers in a framework with four core areas:
Active listeningPositive communicationStigma reductionValidation
Although it’s a framework, I like to call it a conversation. We teach barbers about cues that someone may be struggling — withdrawal, agitation, differences in their grooming habits, and other factors that may change over time due to mental health. They become a spotter of these signs and a communicator with their clients. Having their barber engage with them in this way often leads a client to want to receive a therapeutic intervention and also deepens their relationship with their barber. They often feel comfortable opening up to their barber because they see them so frequently during the month. Sometimes, single mothers bring their children to barbershops, and the barbers can have these conversations with their children. We’ve had stories of young men with single mothers who met a barber who served as a role model to them and helped change their lives. What kinds of support do the barbers receive? LL: Beyond their initial training, we work with barbers throughout the year. Twice a month, barbers are invited to our monthly support group. We also host classes on topics that are very helpful to them, including mental health education, professional advancement strategies, and how to achieve the ideal cultural experience in their barbershop for their clients. We’re also teaching the barbers about 988, the new suicide and mental health crisis hotline that launched on July 16. Our research shows that our barbers are finding these resources just as helpful for themselves as they are for their clients. I think it’s a two-way impact. How is The Confess Project funded? Who pays to have these services available in a barbershop or to train barbers to be mental health advocates? LL: We have several partnerships from which we receive funding. We’ve partnered with Gillette, which has allowed us to enhance the grooming platform we offer our barbers and to scale The Confess Project to many cities throughout the country. We’ve also partnered with several foundations such as the Arkansas Black Hall of Fame Foundation, as well as the government. For instance, in Atlanta, we have a partnership with the Georgia Department of Behavioral Health and Developmental Disabilities that allows us to continue to deliver these services and host focus groups with our barbers to improve the research and evidence-based criteria around our work. We’re always excited to take on new partnerships. How do you choose and train barbers to become mental health advocates for this program? LL: We administer an assessment, which helps us understand the barbers’ interests, their client and time capacity, and how they operate in their barbershop. We try to partner with barbershops that have already invested in their communities in ways like hosting backpack drives, for example. Many of our barbers are already community-oriented because they encounter so many different kinds of people in their shops, including teachers, principals, and members of law enforcement. According to your website, The Confess Project partnered with Harvard University to study the role of Black barbers as agents of change when it comes to mental health and getting care in Black communities. Could you talk about what that study showed? LL: The study showed that barbers can be mental health and suicide prevention gatekeepers, and in return could also be gatekeepers for solving community and interpersonal violence. It also showed barbers could be very congruent in helping solve domestic violence challenges. That research has really compelled our work and demonstrates that barbers are a significant part of the social fabric of our communities. What are some of the most significant mental health challenges Black communities in the United States are facing right now? LL: Anxiety, depression, substance use, violence, and crime are all significant mental health challenges for Black communities right now. These factors all contribute to what I call a “slow suicide” — engaging in risky behaviors that lead to detrimental challenges and outcomes down the line. Suicide is also a significant problem in Black communities. In 2019, suicide was the second leading cause of death for Black men between the ages of 18 and 24, according to the U.S. Department of Health and Human Services Office of Minority Health. In addition, suicide is the second leading cause of death for Black children ages 10 to 19, according to a report released in December 2019 by the Congressional Black Caucus Emergency Task Force on Black Youth Suicide and Mental Health. What role does religion play in mental health issues that affect the community? LL: Over the years, many people who go to church have been told to pray about their mental health concerns, but they’re usually never told to go to therapy to get the help they need or that there are mental health alternatives outside of just going to church. And as we have children and raise them, sometimes we pass this same advice along to our children, too. At The Confess Project, we aim to show people that there is an alternative to prayer when it comes to your mental health, that there are mental health resources out there for you, and that you can turn to someone like your barber who has the credibility to help you get counseling through referrals or guide you to other reliable mental health resources. Studies have shown that there are racial and ethnic disparities in the diagnosis and treatment of mental health conditions, that Black people are less likely to be diagnosed and treated for mental health issues than white people, and that even misdiagnosis is more common for Black people than white people. What role is The Confess Project playing right now in helping improve these rates for Black people? LL: The United States’ history of systemic racism and mistreatment of Black people, such as the U.S. Public Health Service (USPHS) Syphilis Study at Tuskegee, in which Black men who had syphilis were denied treatment, have caused a lack of trust in the U.S. healthcare system among Black people. This mistrust is a key reason many Black people don’t seek healthcare in the United States. In our research, we found that barbers feel more comfortable coming to therapy if the therapist is affiliated with The Confess Project. Since we at The Confess Project have built trust within Black communities, we believe we will become the resource providing professional services that will bolster the well-being and quality of life of Black people and Black communities. In Atlanta, we’re currently building a mental health clinic to pair with our barbershop interventions, and we plan to hire competent therapists who will see both barbers and barbershop clients in Atlanta. We’re hoping we can grow and scale this model throughout the country. If someone owns a barbershop or would like to see The Confess Project’s programming available at the barbershop they go to, how can they make that happen? LL: Barbers can visit TheConfessProject.com to submit a form to join our barber coalition, and someone from our team will contact them about our next available training. We’re always hosting trainings virtually, and we host training events throughout the country, too, in partnership with various healthcare systems, providers, foundations, and corporations. Right now, we’re training barbers in Atlanta, Minneapolis, and Mississippi. We’re continuing to scale up this work, as well as vet potential new partners that could allow us to reach more communities not only in Atlanta, but across the country. What is your message for Black people around the country struggling with their mental health right now? LL: Remember that there are alternatives outside of prayer for improving your mental health. There are therapeutic programs and resources you can tap into to better your well-being, health, and quality of life. I also hope our communities continue to seek new mental health care alternatives and partner with other ecosystems of Black leaders who are engaged in this work. This interview has been edited for length and clarity. 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