welcome to state of minda new section of Slate and Arizona State University dedicated to exploring mental health. follow me on twitter.
“Can you do it? suppress he already? cried the head nurse.
“Why won’t she keep her mouth shut?” cried a male mental health worker.
“I can handle it. Thank you guys for your help,” I replied. Both workers (both white) trampled.
As a black woman, I didn’t have the freedom to yell and swear at work, so I kept my voice low and calm in my appearance. But deep down, I was angry at the lack of empathy and compassion for the child entrusted to our care. I had just arrived. His 10-year-old male patient, who had not yet been diagnosed with an autism spectrum disorder, threatened to hurt himself and threw a glass of water at the staff. When he saw me, he ran to me in tears.
He could have been my cousin—caramel skin tone like mine and thick, curly locks with dark brown hair. Probably because I treated him like a struggling human being. But I also took the time to observe him. I knew he was triggered by loud noises and had trouble transitioning. He tended to get upset when staff changed shifts and came and went noisily. And that was exactly what happened that day. A West Indian nurse and a Latina nurse remained by my side, skillfully de-escalating the patient using psychiatric techniques tailored to the patient’s needs.
In fact, he never needed restraint.
Many of my colleagues branded him as “manipulative and violent.” It’s a common racist term he’s heard his colleagues use to describe black and brown patients. I saw the same psychiatric colleague treat white children who proudly use the N word with patience and understanding. When I ask if they have told patients that hate speech is unacceptable, white staff often say,
We are in the middle of an adolescent mental health crisis. But black youth has been at stake for decades. Black youth suicide rates are rising faster than any other racial/ethnic group in the U.S.A black youth under the age of 13 is twice as likely to commit suicide as a white youth will be However, black youth are less likely to access and maintain mental health care. Attention is often drawn to the cultural stigma and lack of economic resources in the black community. What is rarely talked about is the racism black youth experience within the healthcare system.
A recent Yale University study found that black children were almost twice as likely to be physically restrained in the emergency department compared to white children. Black children, like my patient, are diagnosed and treated for an autism spectrum disorder at an average age of almost five and a half years, about six months later than white children. just a while ago.
Research often cite lack of access to care, wealth inequality, and the low socioeconomic status of the black population to explain this disparity, but these problems are usually associated with white supremacy. is caused by the willful and racist economic oppression of black Americans by ideology. But a big factor in these racial disparities is the blatant disregard and poor treatment of black children by predominantly white mental health providers. We need more black mental health care professionals. And we need them in positions of power and influence.
Psychiatry is a white dominated field and I am constantly reminded that I could never fully belong as a black woman. If they point out (and record in the patient chart) the unprofessional and harsh descriptors they sometimes use, they are protected by their administrators. Retaliation is often vile and cowardly – “tell me” that you opposed a treatment plan that the nursing supervisor never told you, and “not very enthusiastic” when I stood up for the patient. Talking to me in their office, interrupting and ignoring my questions (and sometimes even yelling in my face). I’m forced to find strategic ways to advocate for black patients, always watching my back, but I don’t have to. Many times Black nurses and mental health workers come to me in secret to discuss the mistreatment they received for trying to stand up for their Black patients. They ask me for help because reporting the behavior risks further targeting. Many black mental health providers are forced to endure additional stress and burden that their white colleagues do not face. It’s the burden of speaking up in a system that wasn’t built to protect us. They are the exception, not the rule. We desperately need change.
First, it helps to clarify the different mental health roles in hospitals. Psychiatrists are responsible for administering medications and prescribing treatment, but they actually spend the least amount of time with their patients. There are nurses who carry out the psychiatrist’s orders and provide critical front-line knowledge when restraints or additional medications are required on the ward. Inpatient psychiatric wards have mental health technicians who keep patients safe by neutralizing conflicts, helping children take their medication, and engaging in therapeutic activities with patients. Psychologists play an important role in managing treatment groups, and in addition to treatment, social workers are also important in helping patients plan safe discharges.
The truth is that getting more Black people into all these roles has to start with the money. Even elementary and high school students need to go to college to impress them how much they need psychiatrists and other mental health professionals. Black students are most likely to have high student debt, so it’s important to provide adequate funding for training and certification, whether it’s becoming a psychiatric nurse or a mental health technician. .
When it comes to psychiatrists, only 2% are black. That’s why we also need to invest in programs that are working to increase the pipeline of black medical students, such as the White Coats Black Doctors Foundation and medical schools associated with historically black colleges, such as Xavier University’s new medical school. . Black psychiatric workforce pipeline programs are almost non-existent and often do not fully cover medical school tuition. One such program, funded by the American Psychiatric Association, provides mentorship, funding to attend APA conferences, and preparation for medical college entrance exams. But if we need more black psychiatrists, we need more programs like this.
In addition to hiring, you also need to focus on retention. Black mental health professionals like myself aren’t just witnessing the racism black patients experience. We are also targeted by anti-black racism in the workplace, both by our colleagues and by our patients. My black colleague is commonly referred to as her N-word by white patients and often gets no support from white colleagues. The first time I called him the N-word was by an older, adolescent patient who was stable and nearing discharge. Even though it happened in front of a large group of white staff and supervisors, no one asked me if I was okay. I told him to come back and apologize.It was a black nurse.
We need accountability for racist behavior in the workplace so that Black mental health professionals can feel safe and protected when advocating for their patients and themselves. You need the power to shape and provide key perspectives and expertise. When black mental health professionals are hired but not placed in positions of power and influence, change is minimal and retention is low in areas that need them most Although some hospitals have racist reporting systems, it is still very difficult for white colleagues to report racist behavior towards patients and staff. are often protected by powerful white people, such as Additionally, the individuals responsible for interpreting and responding to reports of racism in the workplace are often not experts in mitigating racism, so reporting systems are minimally effective.
Our mental health workforce needs to reflect the population we serve, and Black people are hugely underrepresented right now. If we really want to improve the mental health of Black adults and children, busy.
State of Mind is a partnership between Slate and Arizona State University that takes a hands-on look at our mental health system and how to improve it.
