Tuesday, November 17, 2020

Impact of Racism Across Generations Discussed at APA Town Hall

The adverse effects of structural and interpersonal racism persist across generations, said panelists last night in the third online town hall meeting hosted by APA’s Presidential Task Force to Address Structural Racism Throughout Psychiatry.

“This is a period of turbulence in our country, and we are all being forced to confront the disparities in the treatment of Black, indigenous, and people of color,” said moderator, task force member, and APA Trustee-at-Large Michele Reid, M.D. She is a clinical assistant professor in the Department of Psychiatry and Behavioral Neurosciences at Wayne State University in Detroit and the chief medical officer of CNS Healthcare. “The COVID-19 pandemic has highlighted long-standing inequities caused by race, ethnicity, and income.”

Chuan-Mei Lee, M.D., an assistant clinical professor in psychiatry at the University of California, San Francisco (UCSF), and a child and adolescent psychiatrist at UCSF Benioff Children’s Hospital, spoke about the long-term, epigenetic effects of adverse childhood events (ACEs) that may occur as the result of structural and interpersonal racism.

“Experiences of discrimination produce the type of chronic stress that increases allostatic load, sets off cortisol production, shortens telomeres, and methlylates DNA,” Lee explained.

Ebony Dix, M.D., an assistant professor in the Department of Psychiatry at Yale University School of Medicine and an inpatient geriatric psychiatrist, discussed how structural racism affects Black adults on a daily basis. She cited differential treatment of patients in the emergency department due to their race, as an example.

“Take an African-American male who is 50 years old and a white female who is 50 years old presenting to the same ED with the same psychotic symptoms,” Dix said. “I’ve seen time and time again that the full … work-up will be given to the white woman, but for the Black man the first things at the top of the differential is substance abuse or schizophrenia.”

Peter Ureste, M.D., an assistant clinical professor in the UCSF Department of Psychiatry and Behavioral Sciences, discussed how structural racism affects Latinx and LGBTQ populations, including transgender people of color.

“Transgender and gender nonconforming individuals face extraordinarily high rates of social and health inequalities, including poverty and discrimination by employers. They are [more likely to be] victims of violence, and they face higher rates of family rejection and homelessness than their cisgender peers. I would say this is even more so for transgender people of color,” Ureste said.

At the end of the discussions, Reid gave an update on the task force’s work. Highlights include the following:

  • A website resource, psychiatry.org/TaskForce, that offers a recommended reading list, educational content, and a glossary of terms approved by the APA Board of Trustees.
  • Three mini-surveys issued to guide the task force’s work and engage APA’s membership.
  • A report by the task force’s Assembly work group that outlined eight actions to improve diversity and inclusion and reduce structural racism in the Assembly, actions that have since been approved by the Board of Trustees.
  • Feedback sessions with APA councils and committees.
  • Presentations made at the Kentucky, Missouri, North Dakota, Ohio, Utah, and Virginia district branches.

The next town hall will take place on February 8, 2021, from 8 to 9:30 p.m. ET.

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