Eradicating structural racism takes actions both big and small. Read more to learn about one doctor’s experience and what you can do in your own practice.
Photo courtesy of Dr Blackman
Him: Have you been to a protest?
Him: Why not?
Me: Well, I have my hands full taking care of folks. Do you wish you could go to a protest?
He was young black male, and I am a community psychiatrist. He was clearly watching the news. I was too. We ended our encounter that day in awkward silence with timid eye contact and then we walked away in different directions.
He did not say if or how he had experienced structural or other racism. I wish I had asked. Next time I will ask. I noticed something unsettling in how he interacted with me that day: he sought me out and gave me an opportunity, but I missed his invitation to ask and align.
I know that settings and systems are fraught with structural racism. I realize I bring biases to my relationships, both explicit and implicit. Statistics note all kinds of disparities, inequities, injustices, and overrepresentations. On the one hand, minority individuals are less likely to receive mental health services. When patients from minority groups do receive psychiatric care and services, my experience is that compared to individuals from the majority population, they are more often: confined and kept involuntarily for longer periods; receive psychotropics at higher numbers and doses; discounted, disbelieved or narrowly understood; and given serious mental illness diagnoses.
Ending structural racism takes all kinds of action. For example, I once received a person of color to my caseload after months of treatment from another team, who had characterized interview responses about educational and work history as examples of delusional thinking and gravely disabled impairment. The patient shared lived experiences of higher education achievements and professional pursuits that were relayed and documented as evidence of psychosis and disorganization. It took me only seconds to establish via public records much of what the person conveyed was true. I cried when I saw the proof on the screen, angry that such a gaffe occurred and then was not corrected in the record.
The person asked to be called by honorific title. Staff struggled to do so, having difficulty reconciling the whole person. I intervened by insisting that a patient should always be addressed and acknowledged according to stated preference.
In recent months, guidance on how to eradicate structural racism in the form of tip sheets, calls for new hires, town hall meetings, white papers, and organizational manifestos have flooded the digital space. Times, tools, and inspiration go hand in hand. I wonder how many quiet actions of unsung change have ensued from these outpourings.
I love the story of Georgia Gilmore, who started a secret kitchen and the Club From Nowhere to feed and fund those affected by Montgomery’s 381-day bus boycott for civil rights in 1955. Serendipitously, I had only learned just under a year ago about her and her actions. I came across her work as I was researching how communities, community members, and causes intersect to springboard programs of the American Association for Community Psychiatry (AACP), the national group of community psychiatrists and others committed to promoting health, recovery, and resilience in people, families, and communities.
Gilmore’s resolve to do what she could with what she had resonates with me. Access and opportunity for all, no matter the circumstance, are values I believe in and carry out in my everyday practice to combat structural racism.
I make vases from plastic bottles, plucked out of trash cans, for daffodils I pick on hikes in the woods to demonstrate reimagination in recovery. I consolidate the number and times medications are administered as much as I can, rarely using standing psychotropic prns, to emphasize the portability of plans in meeting patients’ personal and clinical goals. I critically evaluate diagnoses for psychiatric overshadowing to keep options open. I teach students rotating on my service that justice and cultural change for patients depend on our integrity, grit, and curiosity as treaters at every juncture and with every signature.
While I missed an opportunity to ask the young man in this story about structural racism, I have asked other people. I first asked staff how we as a treatment community might address current events. No one responded. I switched to a visual prompt, finding and displaying public domain clip art of a fist bump, which generated some attention and interest. Someone offered to draw the picture as a mural. The mural started a conversation. Patients became engaged and added to the mural; they then chose slogans to represent our collective treatment community response. We held a rally of sorts gathered around a corridor wall in front of our sign.
Although the poster is gone now, its impact persists. “What happens to one of us, happens to all of us,” can be heard echoed time and time again on site, the treatment and working home where over 50 people converge daily. This purposeful act of presence took citizenship awareness to the next level, and still guides our decision making and interactions today.
I wonder how many other people and stories of action, big or small, are missing from discourse and dissemination. Who else out there has changed constituents and communities for the better by joining together to achieve antiracism and promote social justice? Do you know #CommunityPsychiatryChampions that you would like to recognize, thank, and highlight? Tweet a photo or video @PsychTimes to share or email us at PTEditor@mmhgroup.com.
Dr Blackman is a per diem psychiatrist for Connecticut’s Department of Mental Health and Addiction Services. She serves as clinical preceptor for physician assistant students from Yale and University of Saint Joseph. She sits on the Board of the American Association for Community Psychiatry.