Health researchers and policymakers have long lamented the poor health standing of Black Americans.  Biomedical research consistently finds that Blacks have worse physical health than Whites, an expected pattern given their greater exposure to psychosocial stressors, poverty, and racial discrimination. Yet there is surprising lack of consensus regarding race differences in mental health, with most scholars finding similar or better mental health outcomes among Blacks than Whites.  Past research often attributes this “race paradox in mental health” to various factors – most notably, social relationships, religiosity, and stigma.  I review the empirical data regarding these and other causal mechanisms (e.g., stigma, clinician bias, and measurement bias) in order to make the case that the race paradox in mental health may not be valid and therefore, that many Black patients are not receiving needed diagnosis or treatment.  These findings have implications for mental health policy, the measurement of mental health problems, and the provision of culturally appropriate mental health care to Black Americans.