A new article, published in Lancet Psychiatry, calls for an anti-racist approach to mental health care and outlines how to practice as an anti-racist clinician. The author points to the need for increased awareness, culturally appropriate assessments, humanistic approaches to medication, and treatment approaches that directly address racism.
The author, Jude Mary Cénat, an assistant professor in the Clinical Psychology Program of the School of Psychology at the University of Ottawa, writes:
“The reality is that racial discrimination, racial profiling, microaggressions, and racism exist within physical and mental health-care institutions and services in western countries. These widespread and chronic factors are associated with a lack of mental health professionals’ training on racial issues and disparities.”
Racism experienced by individuals of color at personal and systemic levels, including police brutality and murder of Black citizens, has long been demonstrated as inflicting psychological and emotional harm, producing traumatic stress reactions, understood as racial trauma, and other negative health outcomes, such as low self-esteem, substance abuse, diabetes, heart disease, chronic stress, among many other negative impacts to psychological and physiological health.
Much like in all systems in the United States, racism has a long-standing presence in the mental health field. For example, racial bias has been shown to contribute to the overdiagnosis of schizophrenia in Black persons. Additionally, Black individuals are also forcibly admitted to mental health institutions 2-3 to 2-5 times more often than White individuals.
Individuals, such as the radical psychiatrist Frantz Fanon, have been calling for anti-racist approaches to psychiatry and psychotherapy since their inception. More contemporary writers have called for systemic interventions, such as understanding racism through a cultural-psychology lens and exploring White privilege and the psychology of White Americans, to better address racism and its impacts via psychology.
In the current article, Cénat defines anti-racist mental health care as recognizing “. . . issues related to racial discrimination and racism and addresses their potential consequences and the racialized experiences of Black individuals.”
He outlines a number of guidelines on how to effectively conduct anti-racist health care, beginning with awareness of racial issues, such as racial discrimination, microaggressions, racial profiling, among other issues, and how these issues impact the mental health of people of color.
Awareness also includes a willingness to recognize differences, not to adopt a racist stance of color-blindness, but to gain an understanding of how the dynamics of racial differences are present in treatment. This includes understanding racial and ethnic disparities in mental health treatment, including in the prescription of psychiatric medications, and becoming culturally competent in prescribing. Further, awareness of racial issues requires mental health practitioners to become educated about how the social, cultural, and racial context impacts overall health.
Additionally, Cénat advocates for culturally appropriate assessments that are “adapted to the real needs of Black individuals.” He cautions against assuming cultural homogeneity when working with Black people and urges clinicians to learn more about Black clients’ ethnic-cultural backgrounds.
He provides a number of other suggestions to allow for assessments that are more culturally competent, such as addressing the intergenerational impacts of racism, assessing factors related to racism (microaggressions, racial profiling), and addressing other issues that are associated with race, such as mass incarceration, police violence, and low socioeconomic status, among other issues. He also encourages clinicians to assess for strengths and resources at the individual and collective levels, including resilience, faith, and community involvement.
Moreover, Cénat promotes a humanistic approach to medication and prescribing, urging providers only to prescribe if there are no possible alternatives. He calls attention to the over-prescription of psychiatric drugs to Black individuals in mental health treatment. He suggests that providers also take the time to adequately explain the purpose of the medication being prescribed and why it is being prescribed and potential side-effects so that individuals are fully informed and aware of potential risks and benefits.
Lastly, Cénat calls for “a treatment approach that addresses the real needs and issues related to racism experienced by Black individuals.” He emphasizes the need for an individualized approach to treatment, one that utilizes culturally appropriate interventions and addresses racial issues and their effect on mental health.
He suggests that it is okay for White clinicians to admit that they do not completely understand their clients’ experiences related to racism while acknowledging that they are firm in their commitment to providing anti-racist treatment. He also provides direction for psychotherapies that have been specifically demonstrated to be effective with Black individuals, such as culturally adapted cognitive-behavioral therapy.
Cénat highlights how following these guidelines can improve interactions between health care systems, treating professionals, and Black clients and easing fears and mistrust of treating clinicians and mental health treatment.
“Finally, these guidelines can help establish equity in care by reducing disparities, building confidence in care systems, humanizing care, and restoring hope to people from Black communities. Psychiatrists, psychologists, social workers, and nurses working in mental health must recognize that it will never be enough to be nonracist; they must commit themselves to be anti-racist towards care that facilitates social justice, rather than endorsing a racist and dehumanized system.”
Cénat, J. M. (2020). How to provide anti-racist mental healthcare. Lancet Psychiatry. https://doi.org/10.1016/ S2215-0366(20)30309-6 (Link)