Older black Americans are increasingly seen in mental health settings, although prevalence rates of many psychiatric disorders in this group are unknown because black Americans are underrepresented in epidemiologic studies. Improved treatment of this population requires an understanding of the biopsychosocial context of their lives, including historic events that have affected them and the influence of African values emphasizing community and family. Risk factors for mental disorders among older black Americans include multiple medical problems and resulting polypharmacy as well as stressors such as living in high-crime areas. The author suggests using a reminiscence approach in inital interviews to learn the elder's personal histosy and to identify his or her coping capacities and important relationships and resources. Group psychotherapy can be effective with other elderly persons. Pharmacologic interventions should be used cautiously.