“It is of the utmost importance to provide culturally competent forensic psychiatric services that are better suited to the needs of the African American community.”
BLACK HISTORY MONTH
In honor of Black History Month, we asked clinicians to share their thoughts on Black history and the contributions of Black Americans to the psychiatric field and beyond. Here’s how they answered.
Black History Month is a time for African American (AA) psychiatrists to recognize the contributions, accomplishments, and struggles of Black/AA physicians in the field of psychiatry. It is also a time to reflect on their long commitment to improving the mental health of Black/AA communities.
The contributions of Black/AA physicians to the field of psychiatry have been immense since the early 20th century. Pioneering psychiatrists such as Chester M. Pierce, MD; Ezra Griffith, MD; William B. Lawson, MD, PhD; Frances Cress Welsing, MD; and June Jackson Christmas, MD, have played pivotal roles in their respective fields, dedicated to addressing health disparities, promoting human rights, advocating for youth education, and combating racism.
These individuals have worked to combat discrimination and disparities in the mental health care system that still exist today. Dr Pierce, for example, was the founding president of Black Psychiatrists of America, a senior advisor for the creation of Sesame Street, and an accomplished researcher and academician.
Dr Griffith has been instrumental in developing effective treatments for mental illness and advocating for better mental health care access for African Americans, while Dr Lawson has had a long-standing interest in addressing racial and ethnic disparities in care and has supported innovative treatments for the underserved, the mentally ill, and substance abusers.
Dr Welsing presented her theories on the roots of racism in her 1970 book The Cress Theory of Color Confrontation. And Dr Christmas is a former New York City commissioner of mental health and mental retardation services, member of President Jimmy Carter's transition team, recipient of the Human Services Award, and founder of the Harlem Rehabilitation Center, a community psychiatric program in Harlem.
I (RKB) began my clinical career at the Harris County Psychiatric Hospital in Houston, caring for many of the most vulnerable and fragile patient populations. This experience taught me invaluable career lessons about bias, stigma, and how poor judgement has led to disparities in the mental health of the Black/AA community. I have also seen firsthand how AAs are routinely undervalued, misdiagnosed, and even criminalized for mental health issues in our society. If we are to ensure that all Black/AAs receive the quality mental health care they deserve, we must take action to address these disparities.
Throughout my career, I have spent a great deal of time fighting the stigma of mental health care within the Black/AA community by advocating for the treatments and intervention strategies that can help AAs. Unfortunately, stigma is still pervasive and is one of the main reasons many AAs are unable to access the care they need.
Furthermore, there are often intentional or unintentional actions that create health disparities for AAs when it comes to mental health care, such as lack of access to providers, lack of insurance coverage, lack of culturally competent clinical providers, lack of community education about mental health care, medication non-compliance, families not valuing mental health care, and more.1 We must continue to advocate for better mental health care access to improve lives.
I learned early on during my forensic psychiatry fellowship at Yale University that AAs are disproportionately affected in the criminal justice system. AAs often face over-incarceration and over-criminalization, they often receive longer sentences, and they are granted parole at a lesser rate than their counterparts.2,3 We have a need for forensic psychiatrists to recognize this issue and strive to ensure that all individuals receive equal treatment under the law.
It is of the utmost importance to provide culturally competent forensic psychiatric services that are better suited to the needs of the AA community. This can be done by providing more investment in training opportunities for psychiatrists to reduce these disparities that exist in the criminal justice system. By doing so, forensic psychiatrists can help ensure that the criminal justice system is fair and equitable, and that all individuals receive the same level of discernment regardless of race or socioeconomic status.
We must recognize the contributions of Black/AA psychiatrists by, for example, acknowledging the accomplishments of Black/AA physicians, advocating for better access to care, providing more mentorship of AA medical students and residents with an interest in varying areas of psychiatry, and investing in research that focuses on disparities in AA communities.
Additionally, it is important to recognize the struggles of Black/AA physicians to raise awareness of the discrimination and disparities that still exist in the mental health system.
Furthermore, it is essential for non-Black/AA clinicians to take responsibility and an active role in combating racism and bias. Non-Black professionals should also strive to recognize their own biases and take steps to ensure that they are not perpetuating racism. We should all should take the time to educate ourselves on the history of AAs and support the advancement of Black/AA psychiatrists in our profession.
Dr Bailey is chairman of psychiatry at LSU Health Sciences Center-New Orleans. Dr Mack is a post-doctoral fellow at St. Luke’s University Health Network (PA).
1. Addressing disparities in access and utilization of MH and SU services among Blacks and African Americans. National Council for Mental Wellbeing. February 18, 2022. Accessed February 15, 2023. https://www.thenationalcouncil.org/resources/addressing-disparities-in-access-and-utilization-of-mh-and-su-services-among-blacks-and-african-americans/
2. Bailey RK. A Doctor's Prescription for Health Care Reform: The National Medical Association Tackles Disparities, Stigma, and the Status Quo. WestBowPress; 2013.
3. Bailey RK. At Gunpoint: Firearms Violence From a Psychiatrist’s Perspective. Outskirts Press; 2018.