“It’s not like we can take off our black skin and operate in this world without it”: A social worker on how racism affects mental health

“It’s not like we can take off our black skin and operate in this world without it”: A social worker on how racism affects mental health

Donna Alexander is a social worker who offers specialized services for Black youths dealing with addiction, mental illness, suicidal thinking and criminalization. Toronto Life spoke to her about the cumulative psychological effects of racism, the need for culturally specific counselling for Black people, and why she believes police should not be first responders to mental health crises.

As told to Pacinthe Mattar

“I worked in middle management at a hospital for years, but I always wanted to do social work in the community. And fate had a way: when I was laid off from my hospital job, they agreed to pay for me to go back to get my degree in social work as part of my departure package.

“My first placement was in 2001 at a community centre in Regent Park. I was working mostly with racialized and Black people, and there was so much addiction, so much poverty. The need was so great among our people. One morning, as I was driving into work, I saw a woman in her late 30s on the side of the street. I recognized her as one of our clients: a sex worker who was addicted to drugs. I could see that she was crying, that there was anguish on her face. I pulled over next to her, rolled my window down and asked her what was going on. She told me that she had just found out that her daughter, who was only 14, was also being recruited to do sex work. And I saw the despair it was causing her. This woman had accepted her own life choices, but the idea of her daughter being lured into that world had broken her. There was a crisis of mental illness and addiction in Regent Park at the time, but nobody talked about it. If you were a drug dealer, nobody wanted to have anything to do with you. If you were a woman and you were hooked on crack, or if you were an alcoholic, you were shunned. It was a lonely, isolating thing.By the time I left that placement, I’d made up my mind that I was going to specialize in addiction and mental health.

“Since 2005, I’ve had the privilege of working mostly with Black youth, ages 13 to 24, who are dealing with mental illness and addiction issues. That’s the primary focus, but they’re also dealing with a sense of devaluation, low self-esteem, the feeling that their lives are not worth as much as everybody else’s. I have Black youth out there saying, ‘I don’t even want to be black.’ And it’s because they don’t see themselves reflected anywhere: in politics, in their school administrations, in leadership roles in the professional world. They internalize that, and they feel there’s no psychological safe space for them. They deal with carding, when police roll up on them and ask, ‘Where are you going? What’s in your pockets? Where do you live? Do you have any charges?’ And you’re just a kid going about your day. This issue disproportionately affects Black youth, and for some of these kids, the sight of a police car or the sound of a siren is enough to trigger a major panic attack and leave them shaking.

“And yet over the course of my career, due to the lack of proper crisis response services, I’ve often found I’ve had no choice but to call the police when dealing with someone in crisis. Every time I call them, I can’t breathe because I don’t know what will happen—in April, D’Andre Campbell, a 26-year-old Black man with schizophrenia, was fatally shot by Peel police; the following month, 29-year old Regis Korchinski-Paquet died during an interaction with police after her family called for help during a mental health crisis.

“I remember one call I got years ago from shelter staff on Yonge Street near College, asking me to get there immediately. When I arrived, there was so much commotion and the police had blocked off the area with their cars. And there in the middle Yonge Street was a barefoot man, using a crutch to break the glass of nearby businesses. He had schizophrenia and had been doing well on his medication, but he’d stopped taking them. This happens often with schizophrenic patients: the medication works so well that they think they can go without it, and then they deteriorate.

“The man was clearly in distress, and still the first officer on the scene pointed his gun at the man, shouting at him to get down on the ground. The man kept backing up, backing up, backing up, bewildered. He had no idea what was going on. I was trying to get as close as possible to explain to the man what was going on. Suddenly, a petite female officer walked up to the man and said, ‘Sir, we’re here to take you to the hospital.’ The man said, ‘For what?” And she told him calmly, ‘The staff at the shelter told us you’re not doing well. We’re going to take you to the hospital for some help.’ And you could tell he understood. He just said, ‘Okay. Just tell my grandmother.’ That officer had figured out a way to de-escalate the situation. She didn’t raise her voice. She just explained everything clearly and calmly.

“We cannot underestimate the psychological and physiological effects of these incidents on Black Torontonians. That’s why the system needs reform—police should not be first responders in mental health crises. We need crisis workers with the right skills. Social workers, for example, are trained in de-escalation skills, and we take a mandatory refresher course every year because it’s so central to our work.

“In my work, I make sure to offer Black youth support that recognizes the nuances of our community—support that’s safe and culturally specific. For example, I had a client who was gay and suicidal. And the psychiatrist assigned to him said she didn’t understand why he would want to take his life for being gay. I had to explain to her that in some pockets of my community, if a person is gay, they’re rejected—the message can often be that they might as well be dead; suicide rates in the Black queer community are disproportionately high. When I explained all of this to the psychiatrist, she reframed her approach. Something clicked, because she understood the context he was coming from, and the stakes for him.

“This cultural knowledge is the most important aspect of my work. It dictates every aspect of service, if people choose to stay, if they follow directions. If people are accessing service and they don’t feel that the other person can understand and relate to them, they disengage. I’ve had clients who are sex workers who sense that their mental health workers and social workers cannot understand their work and their life. Clients feel judged, and it often prompts them to leave. It’s yet another barrier in a place where they are supposed to feel safe.

“What matters is how we talk to our clients. I’ve seen social workers dealing with clients who may have criminal records. They often start the conversation with, ‘So what did you do?’ That automatically will get clients’ guards up, and they won’t engage. Instead, I’ll start those conversations with, ‘What were you charged with?’ or even ‘What did they say you did?’ It’s less confrontational. It opens doors to a conversation. If you cannot relate to your clients, you’re often called ‘a textbook therapist.’ You never want to be a textbook.

“Racial trauma, or the cumulative effect of racism on mental health, is incredibly difficult to recover from because the trauma is still ongoing. Our children and our adults are now realizing that the colour of our skin can be enough to elicit violence. We don’t have to do anything wrong. We could be doing everything right. And yet we know with complete clarity that this is something that we are going to have to face for the rest of our lives, because it’s not like we can take off this clothing of black skin and operate in the world without it. So we develop a sense of hyper-vigilance. We have to always be on guard because wherever we are, whatever board room, whatever space we occupy, something can happen again to remind you. Right now I’m getting a lot of calls from Black staff working in mental health and social work—people who are providing support to their clients, but dealing with similar struggles. In between calls or clients, they’re bursting into tears, they’re not sleeping at night. These triggers affect not just our clients, but us too, even as we’re doing the work.

“I try to give clients tools to build resilience and resistance. When we talk, I say, ‘Yes, all of these things can happen to you, but you have the ability to bounce back from this. You cannot let this define you and dictate the rest of your life.’ I ask them, ‘How are you going to resist? How are you going to resist racism and discrimination? How are you going to resist low expectations, especially for the children within the school system?’ And I tell them that recovery from addiction and from mental illness is itself an act of resistance.

“Resistance looks different for everyone. I once had a client who was an inpatient at a mental health organization. He was there because of a substance-induced psychosis that made him very ill, but it had been three years since he’d experienced any episodes, and he was feeling frustrated. I realized that if he stayed there too long, his own mental health would deteriorate. And so I told him, ‘I don’t know when they’re going to let you out. But you’re functioning at a high level. You’re not on meds. Your psychosis is gone. How are you going to resist?’ He was a musician, and I encouraged him to learn to play the piano, instead of just sitting and thinking about his life. By the time he was discharged, he had learned to play the piano.

“For clients, this kind of thing is both therapeutic and confidence-building. By learning this skill, he’d realized he could accomplish things, that he was capable of doing more. Nobody taught him to play. He was musically gifted, and he figured it out himself. I tell my clients that when you resist, however you know how, you’re proving that you believe in yourself. That you can do and be something. That’s what his piano adventure did. Eventually, when he was released, he came to visit me in my office, and this time he had a guitar. And I asked him where he got it and he told me, smiling, ‘I bought it used somewhere on Queen Street. This is my resistance too.’

“I tell the youth I work with that we cannot afford to be consumed by hate. We cannot allow ourselves to be destroyed by rage. We cannot allow ourselves to be hopeless, to lose our vision, to be numb. We can not afford apathy. I say, ‘Don’t tell me you cannot resist. Don’t tell me you cannot recover. Don’t tell me that you cannot move through this trauma.’ As the Ryerson social work professor Akua Benjamin has said, resistance is in our DNA. If Black people didn’t have the ability to resist, we would not be here. The fact that we are here and we are running things and serving our community is because resistance was passed down, from generation to generation. This work, this resistance, is a relay. You’re charged to to run your leg. Then you have to hand the baton off to the other generation, to other people, and they also have to be prepared to take the baton. For the next generation to be prepared to do this work, they have to be unapologetic, to be bold, to speak the truth and to have integrity.

“There are times where I have had to sit down and say to myself over and over again, ‘The race is not for the strong nor the battle for the swift. It is for those that can endure it to the end.’ I get emotional when I think about it, because I cannot name how many times I’ve had to say it out loud to myself. Because I know the work is not done.”