Structural Racism and Psychiatric Practice: A Call for Sustained Change

Rachel Talley, M.D.

Friday, February 10, 2023

Structural racism has received renewed focus, fueled by the convergence of major political and social events. Psychiatry as a field has been forced to confront a legacy of systemic inequities. Dr. Talley will use examples from her clinical and supervisory work to highlight the urgent need to integrate techniques addressing racial identity and racism into psychiatric practice and teaching. This urgency is underlined by extensive evidence of psychiatry's long-standing systemic inequities. She will argue that our field suffers not from a lack of available techniques but rather a lack of sustained commitment to understand and integrate those techniques into our work; indeed, there are multiple published examples of strategies to address racism and racial identity in psychiatric clinical practice. She will provide recommendations geared toward more firmly institutionalizing a focus on racism and racial identity in psychiatry and suggest applications of existing techniques to our initial clinical examples.

Recording:

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Resources:

Continued Education:

The title of this presentation comes from a paper written by Dr. Talley and a group of her peers. The following references lead with this paper and other suggested references.

References:

  • Talley RM, Edwards ML, Berlant J, Wagner ES, Adler DA, Erlich MD, Goldman B, Dixon LB, First MB, Oslin DW, Siris SG. Structural Racism and Psychiatric Practice: A Call for Sustained Change. J Nerv Ment Dis. 2022 Jan 1;210(1):2-5. doi: 10.1097/NMD.0000000000001442. PMID: 34731092.
  • Harrell SP. A multidimensional conceptualization of racism-related stress: Implications for the well-being of people of color. American Journal of Orthopsychiatry. 2000;70(1):42-57
  • Holm, A. L., Gorosh, M. R., Brady, M., White-Perkins, D. (2017). Recognizing Privilege and Bias: An Interactive Exercise to Expand Health Care Providers’ Personal Awareness. Academic Medicine. 92(3): 360-4
  • Medlock, M., Shtasel, D., Trinh, N.-H.T., Williams, D.R. (Eds.) Racism and Psychiatry: Contemporary Issues and Interventions. Springer, 2018.
  • Metzl J. The Protest Psychosis: How Schizophrenia Became a Black Disease. Boston, MA: Beacon Press, 2009
  • Williams M.T., Rosen D.C., Kanter J.W. (Eds.) Eliminating Race-Based Mental Health Disparities: Promoting Equity and Culturally Responsive Care Across Settings. Oakland, CA: New Harbinger Publications, 2019.
  • Fernando S. Institutional Racism in Psychiatry and Clinical Psychology: Race Matters in Mental Health. Springer International Publishing, 2017.
  • Holm AL, Rowe Gorosh M, Brady M, White-Perkins D. Recognizing Privilege and Bias: An Interactive Exercise to Expand Health Care Providers' Personal Awareness. Acad Med. 2017 Mar;92(3):360-364. doi: 10.1097/ACM.0000000000001290. PMID: 27355785.
  • Shankar, M., Albert, T., Yee, N., Overland, M. (2019). Approaches for Residents to Address Problematic Patient Behavior: Before, During, and After the Clinical Encounter. Journal of Graduate Medical Education. DOI: http://dx.doi.org/10.4300/JGME-D-19-00075.1
  • Harrell SP. A multidimensional conceptualization of racism-related stress: Implications for the well-being of people of color. American Journal of Orthopsychiatry. 2000;70(1):42-57

Educating Ourselves - resources from Dr. Rachel Talley:

  • Medlock M., Shtasel D., Trinh N.-H.T., Williams D.R. (Eds.) Racism and Psychiatry: Contemporary Issues and Interventions. Springer, 2018
  • Metzl J. The Protest Psychosis: How Schizophrenia Became a Black Disease. Boston, MA: Beacon Press; 2009.
  • Williams M.T., Rosen D.C., Kanter J.W. (Eds.) Eliminating RaceBased Mental Health Disparities: Promoting Equity and Culturally Responsive Care Across Settings. Oakland, CA: New Harbinger Publications, 2019.
  • Fernando S. Institutional Racism in Psychiatry and Clinical Psychology: Race Matters in Mental Health. Springer International Publishing, 2017

Resources suggested by the audience:

  • Elise Stoner recommends My Grandmother's Hands: Racialized Trauma and the Pathway to Mending Our Hearts and Bodies by Resmaa Menakem. Learn more on his website resmaa.com
  • Nancy Massey suggests Bertice Berry, PhD, author of several books including Redemption Song and her latest, Blackworld.

 

Rachel Talley, M.D. is Assistant Professor of Clinical Psychiatry in the Department of Psychiatry at the University of Pennsylvania. She directs the University of Pennsylvania’s Fellowship in Community Psychiatry, a post-residency training program that teaches administrative and leadership skills to grow the next generation of public sector psychiatric leadership. She has several years of frontline clinical experience in community-based settings, and is currently staff attending at Horizon House, Inc where she sees patients in outpatient, integrated care, intensive case management, and homeless services settings; and is also involved administratively in quality improvement activities. Dr. Talley received her B.A. from Harvard University and her M.D. from Stanford University School of Medicine. She completed both her residency training in adult psychiatry and a post-residency fellowship in public psychiatry at Columbia University/New York State Psychiatric Institute. She has several peer-reviewed publications examining issues relevant to the care of individuals with serious mental illness. She currently serves on the Board of the American Association for Community Psychiatry as Early Career Psychiatrist representative.