Psychiatric Annals

Guest Editorial Free

Race and Psychiatry: A Necessary Conversation

Christin Drake, MD; Dennis M. Popeo, MD

Health disparities in medicine exist and increase morbidity and mortality in patients who are Black, Latinx, and Indigenous. This is not news. Thirty-five years ago, the United States Secretary of the Department of Health and Human Services highlighted the need to address health disparities.1 This call to action was renewed in two reports in 1990 and 2000, but unfortunately the effect of the resulting programs was negligible.2,3 In reviewing 15 health status indicators discussed in the reports above, Orsi et al.4 described a reduction in the disparities in some indicators such as mortality from stroke or cancer between Black and White patients, but noted an overall widening of other disparities at a similar rate. Psychiatry is not immune to these issues. Generally, all people who suffer from a psychiatric disorder are affected negatively by implicit bias and the stigma society casts upon them. There is a 15- to 20-year mortality gap between people who have mental illness and those who do not.5 Those patients who are at the intersection of being both Black, Latinx, or Indigenous and have mental illness fare much worse. This issue of Psychiatric Annals deals specifically with the effect that systemic and structural racism have on the care of Black, Latinx, and Indigenous patients.

In the first article, “Health Disparities in Black Patients with Severe Mental Illness and the Role of Structural Racism,” by Drs. Uzoamaka Asonye, Nicholas Apping, Leonardo V. Lopez, and Dennis M. Popeo, the authors detail differences in the care of patients who have serious mental illness due to implicit bias and structural racism. In in the next article, “Racial Disparities in Perinatal Mental Health,” by Dr. Bronwyn Huggins, Dr. Clancy Jones, Oluwaseyi Adeyinka, Dr. Adaora Ofomata, Dr. Christin Drake, and Dr. Cathy Kondas, the authors discuss the way in which racism has shaped the health care of peripartum women with mental illness. In the third article, “Systemic Racism and Substance Use Disorders,” by Drs. Pantea Farahmand, Arslaan Arshed, and Mark V. Bradley the authors illustrate the racial disparities in the treatment of substance use disorders. In the final article, “Acting Against Racism in Academic Departments of Psychiatry,” by Drs. Christin Drake and Crystal F. Lewis, the authors describe the effect of racism in academic departments and suggest initial strategies to dismantle the structures that reinforce racism.

Lastly, we cannot talk about racism without mentioning the fatal interactions between Black, Latinx, and Indigenous people and law enforcement. The 8-minute 46-second video of George Floyd's murder was a lens that brought this problem into sharp focus. Unfortunately, the interactions between Black, Latinx, and Indigenous people who have mental health disorders and law enforcement are similarly dangerous. Currently, contact between law enforcement and people with mental health disorders—especially those in an acute crisis—is nearly inevitable.6 One in four police encounters with a person with severe mental illness ends in their death, with the numbers for Black, Latinx, and Indigenous people thought to be higher.7

This has been illustrated recently with the tragic murder of Daniel Prude.8 During a visit with his brother in Rochester, NY, Mr. Prude began to exhibit symptoms of his illness. Police found him on the street, naked, bleeding, and agitated. After the interaction with police, he died and his death was ruled a homicide due to complications of asphyxia in the setting of physical restraint. Mr. Prude joins many other Black, Latinx, and Indigenous people who suffered from mental illness who received brutality rather than care. The names below are all people with mental illness who were killed by police from January 2015 to the present.

Please say their names:9

References

  1. Heckler MUS Department of Health and Human Services. Report of the Secretary's Task Force on Black & minority health. Accessed October 13, 2020. https://collections.nlm.nih.gov/ext/heckler/8602912X1/PDF/8602912X1.pdf
  2. Centers for Disease Control. Healthy people 2000: national health promotion and disease prevention objectives for the year 2000. MMWR Morb Mortal Wkly Rep. 1990;39(39):689–690, 695–697. PMID:2119475
  3. US Department of Health and Human Services. Healthy people 2010: Understanding and improving health. Accessed October 13, 2020. https://www.healthypeople.gov/2010/Document/pdf/uih/2010uih.pdf
  4. Orsi JM, Margellos-Anast H, Whitman S. Black-White health disparities in the United States and Chicago: a 15-year progress analysis. Am J Public Health. 2010;100(2):349–356. doi:10.2105/AJPH.2009.165407 [CrossRef] PMID:20019299
  5. Thornicroft G. Physical health disparities and mental illness: the scandal of premature mortality. Br J Psychiatry.2011;199(6):441–442. doi:10.1192/bjp.bp.111.092718 [CrossRef] PMID:22130744
  6. Livingston JD. Contact between police and people with mental disorders: a review of rates. Psychiatric Serv. 2016;67(8):850–857. doi:10.1176/appi.ps.201500312 [CrossRef]
  7. Fuller DA, Lamb HR, Biasotti M, Snook J. Overlooked in the undercounted: the role of mental ill-ness in fatal law enforcement encounters. Accessed October 6, 2020. https://www.treatmentadvocacycenter.org/storage/documents/overlooked-in-the-undercounted.pdf
  8. Knowles H, Thebault R, Jacobs S. Officials in Rochester, N.Y., tried to withhold information about Daniel Prude's death, documents show Accessed October 6, 2020. https://www.washingtonpost.com/nation/2020/09/15/daniel-prude-death-documents/
  9. Fatal force. Accessed October 6, 2020. https://github.com/washingtonpost/data-police-shootings
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Authors

Christin Drake, MD
Dennis M. Popeo, MD

Christin Drake, MD, is a Clinical Assistant Professor, the Director of Diversity, Equity and Anti-Racism, and the Associate Program Director, Psychiatry Residency Program. Dennis M. Popeo, MD, is an Associate Professor of Psychiatry. Both authors are affiliated with the Department of Psychiatry, NYU Grossman School of Medicine.

Address correspondence to Dennis M. Popeo, MD, Bellevue Hospital Center, 462 First Avenue, Room 12S-23C, New York, NY 10016; email: Dennis.popeo@nyulangone.org.

Disclosure: The authors have no relevant financial relationships to disclose.

10.3928/00485713-20201006-02

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