All her adult life, novelist Crystal Wilkinson has “take[n] the back roads.” She grew up on Indian Creek, in Casey Co., Kentucky. “I’m from these hills,” she says.

So when she had to drive nearly four hours home to Lexington, Ky., from a reading she gave at Ohio University, in Athens, she took the slow route. It was dusk, on Nov. 5, 2015, or nearly five months after Donald Trump had announced his candidacy. The Republican candidate had already held 22 rallies in 14 states.

Somewhere along the way, she recalls, “I was driving along a winding road, and slowed down … I look in the rear-view mirror and see a pick-up truck, with those flags flapping on both sides. I figured they were locals and I was going too slow so I tried to let them pass, but they didn’t. I kept driving; they kept driving. There were at least three guys. I started to speed up, and they did, too. They didn’t say anything At one point I called my husband. They chased me for about 30 minutes … around severe curves. When I got to a more populated area, I turned to the left. They did a U-turn and went back where they came from.”

The incident has stayed with her ever since. “I probably should have talked more to somebody about this, but I never have,” the Writer-in-Residence at Berea University said. “It takes something out of you.”

But it’s not just her. Wilkinson’s black students have come to her to say they don’t think they can continue their studies, after incidents such as Klan pamphlets appearing on campus. “They tell me, ‘I think I’m going home,’” she says.

These moments are examples of what she thinks black people in America are living through right now. “African-Americans are living under a kind of PTSD,” Wilkinson says. “Any black person in America has dealt with racism — we know how to do that,” she continues. “But there’s something new going on, that’s returned us to the 1950’s and 1960’s.”

That “something new” includes increased anxiety, depression, and fear for physical safety, according to interviews with clinicians and mental health advocates across the country. They say that the political and social times we are living in — including increased public expressions of racism and social media’s ability to multiply images of police and protest violence — are affecting the mental health of African-Americans. These impacts may be more challenging to deal with in areas like rural Appalachia, where population percentages below or around double digits mean there’s less social and professional support networks available.

Also new are a growing number of efforts to build those networks, however. In Los Angeles, Black Women for Wellness, a nonprofit organization, and several other groups launched “Are You OK, Sis?” in February, a series of eight workshops aimed at helping black women deal with the effects of what executive director Janette Robinson Flint called “a hostile government, economic uncertainty, dwindling health care resources and increasing anti black environments.” Recent online efforts to provide information about mental health include “getsomejoy,” a “year-long multimedia campaign to promote mental and emotional wellness among Black & Brown folks,” and “Depressed While Black.” And the American Psychological Association (APA) launched a page on its website about “racial and ethnic socialization … to reduce the effects of racial stress through improved coping and positive identity development,” says Tiffany Townsend, senior director, office of minority affairs.

Therapists are on the front lines of the mental health situation facing African-Americans. They are seeing a range of symptoms. Sarah Vinson, an Atlanta-based psychologist, says that “mothers of black boys” who seek treatment are “anxious about the world they’re raising their children in. They say, ‘I’m worried about my son. What happens if he gets in trouble?’” Vinson plans to launch a magazine in 2018 called “Ourselves Black,” about mental health and African-Americans.

Crystal Joseph, in her second year at a private practice less than two miles from the nation’s capitol, recalls the day after the presidential election. “All my clients were crying. They couldn’t verbalize how they were feeling.” Since then, she’s seen “higher rates of panic attacks” among her clients. In a January survey, the APA reported that 69 percent of African-Americans felt that “the outcome of the election was a very or somewhat significant source of stress” — compared to 42 percent of non-Hispanic whites. The same survey showed that 71 percent of blacks were feeling stress about police violence against minorities. Thirty-five percent of whites felt the same way.

Joy Harden Bradford, who’s had a private practice in Atlanta since 2014, says her “clients are talking about agressive situations at work … being called the “n” word. I don’t think there’s any way to avoid this coming into therapy.”

Cindy Graham, in her seventh year of private practice in Anne Arundel, Md., says some of her black clients feel they have had to “unfriend and unfollow” people on social media in the last year or so, because “they’re really seeing their personalities … [and] so not to constantly have this trigger.” They also report being exposed to more racial slurs, whether at work or in their children’s schools.

Some therapists and mental health experts highlight social media’s role in intensifying anxiety and other feelings for African-Americans. Amber Hewitt, chair-elect of the APA membership board and adjunct faculty member at American University, says that images from events like the August rally in Charlottesville “bring old wounds, or historical trauma such as Jim Crow and slavery,” into the present. Angel Dunbar, post-doctoral associate in African-American studies at the Univ. of Maryland, College Park, says “witnessing events like racial slurs and police shootings online have mental health outcomes, including depression and low self-esteem” — especially among children.

Another thing Graham and others report: “a significant increase in people of color seeking services.” Besides the stressors in the current environment, one factor in this increase is a decrease in the stigma against seeking help, they say. Popular culture has helped in this regard, including TV shows such as “Queen Sugar,” which commentators say has helped “normalize” seeking mental health help, and singers like Jay Z, who rapped about the importance of therapy on his most recent album, and has spoken about the subject since. “We have a celebrity-focused culture,” says Vinson, in Atlanta. “If we see a person like Jay Z — who seems to have everything — talking about needing therapy, it helps to shatter stigmas. That was huge.”

Churches, long a pillar of the black community, are also helping to make seeking help for mental health issues more mainstream. Vinson served on a panel earlier this year called “Silence the Shame” with Raphael G. Warnock, senior pastor of the Atlanta’s historic Ebenezer Baptist Church, and others. “I’ve been seeing more black religious leaders say, ‘It’s good to pray, but you also need to see someone,’” she says. Crystal Joseph’s church has also delivered the same message. “Sometimes, African-Americans see it as either/or — a metal health provider, or the church,” says Hewitt. “[But] it can be both.”

Some therapists are feeling the need to get out into their communities more. Graham says she’s been meeting with other black therapists to “share stories on the effects of racism — in light of the social atmosphere, and be a part of helping people.” Joseph is scheduled to speak at a Silver Springs high school in November about “racial identity and anxiety.” Vinson says psychologists “have a platform” and can help highlight the connections between racism and mental health. “We have to support our patients, but we’re part of society, too,” she says.

A complicating factor in seeking help is that many African-Americans would rather see a black therapist, feeling that it’s difficult to convey the impacts of racism in daily life to a white therapist. “I’ve been to a white therapist, and there’s so many things she didn’t understand,” says Wilkinson, who has written about mental illness and spoke in March at Berea about “Black Women and Mental Health in Appalachia.” However, depending on where you live, finding a black therapist may not be easy, or even possible. In an effort to address this, Harden Bradford has developed, in the last year, an online database of black therapists, with 205 to date, from 31 states.

Kara Ashley-Gilmore has been the only black therapist in Hendersonville, North Carolina for the last three years, a town of less than 14,000 that’s about 12 percent black. “There’s not a whole of diversity here,” she says. In recent months, the few African-American clients she has have revealed “a sense of distrust about who amongst [their] peers are [their] advocates — who’s nice to your face, and then telling their children something else? It’s a sense of unease … [and] that you have to be careful.”

In the absence of professional help, Wilkinson notes the importance of social networks. She has been meeting with a group of black women in Lexington, Ky., in recent months, called “NTOO,” or “not the only one in the room.” “It’s a way to keep sane,” she says.

Nonetheless, her attitude about her surroundings has changed, she adds. Wilkinson notes that, having grown up in Appalachia, “I always thought I was country enough to find some common ground with anybody. I would just start talking — and it’s not just my accent. [But] I don’t live like that anymore. It feels like a risk. In Appalachia, the racist has been emboldened.”

Timothy Pratt is a reporter based in the Atlanta area; he writes about a range of subjects including immigration, race, soccer, and education, for the Guardian, the New York Times, the Atlantic and many others

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