The scourge of racism has been identified as a pandemic in our country and communities. It’s often pointed out that it is not enough to not be racist, but that we must be anti-racist. But what does anti-racism mean when we apply it to the public mental health system? The public mental health system serves predominantly marginalized communities of Black, Indigenous and Persons of Color, or BIPOC individuals. How might racism, implicit bias and discrimination be embedded in the policies, practices and paradigms of care of the MH system? Do current public Mental Health services adequately acknowledge and address the festering wounds inflicted by racism? Or do MH providers (unconsciously or not) perpetuate racism by ignoring, obscuring and in some sense blaming the victims of racial trauma and associated toxic stressors?
Several studies raise troubling disparities about minorities’ experiences with mental health care in the U.S. A Lancet study reports that each killing of an unarmed black man increases the number of days of poor mental health among individuals from Black communities. Black people were 2.3 to 2.5 times more likely to be compulsorily admitted (5150) to psychiatric facilities than their White counterparts. According to a Rutgers University study (2019) Black men are 4 times more likely to be diagnosed with schizophrenia. BIPOC youth are more likely to be directed to the juvenile justice system than to specialty care institutions when compared to White youth.
It’s important to consider that the dominant, driving paradigm of the mental health system is that mental illnesses can best be understood as genetically predisposed brain diseases that afflict individuals. The broader, trauma informed lens expands the view to recognize that much anxiety, depression, and acute psychological distress can be attributable to recurring exposures to threatening encounters with law enforcement, discriminatory housing policies and school to jail educational environments. The brain disease/medical model directs many practitioners’ attention towards medication compliance, obtaining disability benefits and illness management. A more trauma informed approach would assess for the normal responses to the toxic experiences of historical trauma, systemic oppressions and institutional racism. Well known Trauma expert, Bessel van der Kolk MD, observes that wellness correlates to zip codes much more than genetic codes.
In a recent LA Times editorial, Kareem Abdul Jabbar wrote that; “Racism in America is like dust in the air.” A pervasive dust that many people of color are choking on in their daily lives. Does the public mental health system mostly focus on alleviating the symptoms of choking, the effects of oxygen deprivation and lung disease? Or can we begin to better acknowledge and address the dust itself, the permeating conditions and social determinants of (mental) health?
One example of a practice that could begin to shine a light at the presence of this debilitating dust is including questions about racial trauma in standard assessments. By asking simple, straightforward questions such as; how has racism affected you, your family (grandparents), friends and people in your community? An open ended invitation for people of color to consider how racism may have impacted them can be a powerful starting point, ensuring that the dust is acknowledged. Self-understanding is the goal. Creating and holding this kind of space can be crucial to the healing process. It can also empower people of color and their allies to advocate for themselves and seek social justice.
How else can anti-racism be promulgated in the public Mental Health sector? Is promoting social justice in our job descriptions? This Lancet commentary; How to Provide Anti-Racist Mental Health Care provides more helpful suggestions.
What do you think?