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APA Targets Structural Racism, Offers Solutions

The negative consequences of structural racism on mental health, and opportunities for change, are the focus of a special theme issue of the American Journal of Psychiatry (AJP), released to coincide with the American Psychiatric Association (APA) Annual Meeting.

The hope is this special issue will “motivate clinicians, educators, and researchers to take actions that will make a difference,” AJP editor-in-chief Ned H. Kalin, MD, writes in an editor’s note

“We cannot overestimate the impact of structural racism from the standpoint of its consequences related to mental health issues and mental health care,” Kalin said during an APA press briefing.

“This is one of our highest priorities, if not our highest priority,” he noted. The journal is the “voice of American and international psychiatry” and is a “great vehicle” for moving the field forward, he added.

Articles in the theme issue highlight “new directions to understand and eliminate mental health disparities [through a] multidimensional lens,” writes guest editor for the special issue Crystal L. Barksdale, PhD, health scientist administrator and program director with the National Institute on Minority Health and Health Disparities.

A New Agenda for Change

In one article, Margarita Alegría, PhD, chief of the Disparities Research Unit at Massachusetts General Hospital, and colleagues write that the Biden Administration’s new budget offers the opportunity to redesign mental health research and service delivery in marginalized communities.

Given the rising mental health crisis in the US, the FY22 budget includes $1.6 billion for the community mental health services block grant program, which is more than double the money allocated in FY21.

Alegría and colleagues describe several interventions that have “sound evidence” of improving mental health or related outcomes among people of color in the US within 5 years — by addressing social determinants of health.

They include universal school meal programs, community-based interventions delivered by paraprofessionals in after-school recreational programs, individual placement and support for employment, mental health literacy programs, senior centers offering health promotion activities, and a chronic disease self-management program.

Alegría noted that reducing structural racism and mental health disparities requires multilevel structural solutions and action by multiple stakeholders. In essence, “it takes a village,” she said.

A National Conversation

Another article highlighted at the press briefing focuses on structural racism as it relates to youth suicide prevention.

Previous studies have shown the risk for suicide is higher earlier in life for youth of color. Suicide rates peak in adolescence and young adulthood for youth of color; for White populations, the peak happens in middle age and later life, lead author Kiara Alvarez, PhD, research scientist with Mass General’s Disparities Research Unit, noted.

However, there are well-documented mental health service disparities where youth of color experiencing suicidal thoughts and behaviors have lower rates of access to needed services. They also have delays in access compared with their White peers, Alvarez said.

The authors propose a framework to address structural racism and mental health disparities as it relates to youth suicide prevention, with a focus on systems that are “preventive, rather than reactive; restorative, rather than punitive; and community-driven, rather than externally imposed.”

“Ultimately, only structural solutions can dismantle structural racism,” they write.

The special issue of AJP aligns with the theme of this year’s APA meeting, which is the social determinants of mental health.

“Mental health has clearly become part of the national conversation. This has given us the opportunity to discuss how factors outside of the office and hospitals can impact the lives of many with mental illness and substance use disorder,” APA President Vivian Pender, MD, said during a preconference press briefing. 

“These factors may include where you live, the air you breathe, how you’re educated, exposure to violence, and the impact of racism. These social determinants have become especially relevant to good mental health,” Pender said.

The research was supported by grants from the National Institute of Mental Health, the National Institute on Minority Health and Health Disparities, the National Institute of Drug Abuse, the National Institute of Alcohol Abuse and Alcoholism, and the National Institute of Child Health and Human Development. Kalin, Barksdale, Alegría, Alvarez, and Pender have disclosed no relevant financial relationships.

Am J Psychiatry. Published online May 23, 2022. Full issue

American Psychiatric Association (APA) 2022 Annual Meeting, May 21-25, 2022.

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