Wednesday, December 23, 2020

Psychiatrists Outline Strategies to Achieve Antiracism in Medicine

From the devastating effects of COVID-19 on the Black community to the killings of Black Americans by police, 2020 is likely to be remembered in part for the stark reminder that racism and racist policies kill people. 

“Physicians’ responsibilities in addressing racism and racial violence toward Black Americans range from examining and taking steps to counter our own implicit and explicit biases to addressing policies and procedures that reproduce inequities within mental health delivery systems,” wrote psychiatrists Barbara Robles-Ramamurthy, M.D., Angela A. Coombs, M.D., Walter Wilson, M.D., and Sarah Y. Vinson, M.D., in a commentary in the Journal of the American Academy of Child & Adolescent Psychiatry.

Drawing from literature and their personal experience, the authors offered the following recommendations for the field of medicine, as it relates to the following roles:

Educators: “[I]t is incumbent upon us to change how we teach about race,” they wrote. This includes considering structural competence (the ways in which social structures affect patients’ health and well-being) as a core competency, as well as providing training about “how structural racism fuels inequities in child mental health.”

Clinicians: Clinicians should educate themselves about the over- and underdiagnosis of psychiatric disorders in Black youth and conduct chart reviews to see if there are inequities in diagnostic patterns within their practices. It is also important for clinicians to “seek to attain a basic understanding of the structural traumas experienced by communities we serve to better appreciate how it affects pediatric mental health and what helps or hinders families’ access to services,” they wrote.

Medical administrators: Medical administrators must take active and intentional steps to recruit, mentor, sponsor, promote, and retain Black physicians, clinicians, and staff at every organizational level; gather and address feedback from Black patients; and support antiracist work by clinicians, staff, and administrators with protected time and/or compensation.

The authors also outlined ways for individuals to address racial inequities through advocacy, including participation in partnerships with child advocacy groups, juvenile attorneys, law schools, advocacy groups, and educational systems to address educational and juvenile legal system inequities. Additionally, they recommended greater inclusion of clinicians on mobile crisis teams and equitable distribution of these teams “so that law enforcement officers are less likely to be involved when Black youth and families need crisis intervention.”

The authors concluded, “As clinicians serving children and families, we are well aware of how critical adult support, safety, and security are for children during times of uncertainty and unrest. Structural racism undermines each of these needs for Black youth. Knowledge of and a commitment to action against it is a prerequisite for serving them. Silence and inaction are complicity with the racist, harmful status quo. As clinicians who have taken an oath to do no harm, we must act.”

For related information, see the book Social (In)Justice and Mental Health from APA Publishing, edited by Ruth S. Shim, M.D., M.P.H., and one of the authors of this commentary, Sarah Y. Vinson, M.D.

(Image: iStock/fizkes)

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