Preventing Violence: Exploring the Progressive, Contextual, and Intersectional Role of Race and Power Among Black Men in a Treatment Setting for Co-Occurring Disorders

Background and Purpose: A paucity of empirical studies has concentrated its attention on better understanding the intersection of race, gender, ascribed pathology, and treatment participation of Black men with co-occurring disorders.  The socially marginalizing classifications of being Black, male, mentally ill and in need of inpatient/residential treatment not only highlights the number of multiple stigmatizing and thus marginalizing social classifications many Black men with co-occurring disorders face; but compels the consideration of the qualitatively different and compounding social effects that likely result from this multiple marginalization.  This paper describes and examines the expression and role of race as a contextual experience for 471 Black men receiving mandated mental health residential treatment for co-occurring psychiatric disorders due to problematic behaviors in the community. It explores the intersecting relationship of three racial identity variables (black centrality, black private regard, and black public regard) to Black men's mental health treatment response (help receptivity, problem recognition, and active recovery) during and after participation in inpatient residential treatment and overall impact on perceived control, problematic behavior and illness self-ascription.

Methods: The proposed paper utilizes the first two waves of data garnered from a longitudinal study conducted over a five year period, involving 471 Black male participants in residential treatment centers for co-occurring disorders throughout various sites in a large urban Midwestern county. Participants were provided and completed comprehensive questionnaires and assessments while in treatment.  The second wave of studies occurred within 30 days post treatment, with a drop in total number of participants to 230.   Descriptive statistics and regression models were used to examine the expression of three racial identity variables (black centrality, black private regard, and black public regard) before and after inpatient residential treatment and the influences of these variables on participants’ sense of perceived control and self-identification with their clinical diagnosis and associated co-occurring disorders.

Results: The majority of participants reported a strong black private regard, but the opposite in black centrality and black public regard. Racial identity played no significant role in reports of overall wellbeing. Only black private regard proved nearly significant related to help receptivity/problem recognition and active recovery. The study results revealed the stability of black public regard overtime, but a significant drop in black centrality and private regard post treatment and overtime. Racial identity showed minimal to no influence on participants’ perceived control or tendency towards illness identity self-ascription.  However, perceived control played a major role in participants’ reported overall wellbeing, decreased tendency towards problematic behavior and treatment conformity.

Conclusions/Implications: Results reveal important intragroup differences in perceived personal control, self-ascription, and racial regard, as well as a significant relationships between personal measures of satisfaction, wellbeing, and overall treatment adaptation overtime. Perceived control superseded racial identity in its influential impact on overall treatment compliance, compliant behavior and wellbeing overtime. The study makes evident the implications, costs and onerous effects of multiple marginalization for Black men in clinical treatment settings and suggest the continued need for empowerment interventions to reduce violent propensity among Black men multiply marginalized in treatment.