Lorenzo Lewis describes himself as, “a child who had no hopes and felt lost by ten.” Born of an incarcerated mother, disconnected from his parents, and later incarcerated himself, Lewis recognizes he had something other children facing adversity do not: A support system. The young Lewis had extended family including an aunt who ran a beauty shop and local community members — including his barber. He recounts formative years working for state Medicaid as an eligibility worker and considers that “a game-changing opportunity… that was with, of and through the member community”. As keynote speaker at the NAMD Fall 2022 Conference, Lewis connected his personal story and early career in Medicaid to founding the Confess Project, a community mental health model designed for Black men and boys who are otherwise disconnected from health services.
According to the National Alliance on Mental Illness, over 60% of Black people believe that a mental health condition is a sign of personal weakness. The Confess Project uses the barbershop to overcome stigma and change the mental health narrative for young men of color. It brings the conversation to the community, through trusted voices who often are already informally serving in the role of councilor. As Lewis describes, there is a secret society that exists in a barbershop – the shop is brotherhood and cutting hair is a conversation. Confess is changing the way Black men talk about mental health, one barbershop and one haircut at a time by providing the barbers with a toolbox of peer counseling resources and direct connections to mental health service providers.
The Confess Project has trained has more than 1,900 Black barbers in 48 cities as mental health advocates. The model is similar to community-based suicide prevention models like safeTALK and Mental Health First Aid. The Confess training culminates in certification for the barbers and contains four skill-building components:
- Active listening
- Positive communication
Through training and on-going education, the barbers build advocacy skills to better connect their clients to needed mental health services. The Confess Project creates relationships with providers, hospitals, and health agencies so that barbers can plug into the continuum of behavioral health services. The program is on a growth trajectory. Through academic partnerships and work with the federal Substance Abuse and Mental Health Services Administration, the curriculum is evolving to be evidence-based and more effective. To address COVID-driven barriers, the curriculum expanded with a virtual component. An affiliate model will fuel expansion, including services to women in salons.
Connecting to Medicaid
In the United States, people of color are more likely to be insured by Medicaid and CHIP than White people. As the single largest payer for behavioral health services, Medicaid is an important access point for behavioral health treatment and can play a meaningful role in closing racial disparities. Once the stigma of seeking mental health treatment options is overcome, community-based peer support models help break down barriers to Medicaid, which typically include access and trust. The Confess Project helps meet the member where they are, with authenticity, and move them through a continuum toward getting the care they need.
Today, the Confess Project estimates that it’s barber peer mentors reach about 2.2 million people a year breaking down barriers and connecting them to care.