Conference Series Highlights Experiences of Black Youth

When some staff members on an inpatient psychiatric unit learned that a patient, Cristina, was being readmitted, some rolled their eyes and others groaned. “Any chance we can block the admission?” one asked wryly.

A child and adolescent psychiatrist who was new to managing the hospital and had never met Cristina (not her real name) overheard the conversation. Later, when she tried to connect with Cristina in an initial interview, the 13-year-old showed just as much resentment for the hospital staff as the staff had shown for her. “None of you care about me,” she said before abruptly leaving the room. “I don't trust any of you.”

As she got to know Cristina, the psychiatrist witnessed incidents in which staff yelled at Cristina, even when she wasn't doing anything disruptive. They would say: “She's oppositional.” “She doesn't listen to authority.” “She is a nightmare.” “She's a Tasmanian devil, that one, especially with that wild hair.”

Yet when a White child was destroying property and threatening to punch people, the same staff members who had been complaining about Cristina treated the White child differently, approaching him with gentle humor and empathy. They would say: “He's really struggling.” “He's been through a lot.”

Cristina's story, and the racism that the child and adolescent psychiatrist, who was also Black, witnessed, was described in a narrative during the first session of Yale School of Medicine's Clinical Case Conference Series on Black Youth Mental Health in January. Amanda Calhoun, M.D., M.P.H., chief resident and child psychiatry fellow at the Yale Child Study Center, developed and directs the series.

Recently, Calhoun published an article in Time about the Black youth mental health crisis in which she called for accountability among mental health clinicians who engage in racist behaviors toward their patients. “Leaders of mental health institutions, like hospitals and clinics, must take an active role in ensuring that, when Black children do seek help, their mental health is not further harmed by racism in medical care,” she wrote.

In response to that article, Black psychiatrists and other mental health professionals from across the country reached out to her to share their own experiences. “One of the reasons we are seeing worsening health outcomes among Black children is because medical professionals are providing them subpar care,” Calhoun told Psychiatric News. “I began thinking about how I could create a space for people to talk about these issues, because there really isn't a standardized space in which we can talk about the cases or patients whose mental health deterioration is rooted in the behaviors of their medical team.”

From those conversations, Calhoun developed the monthly clinical case conference series, which began in January and ends in June and can be attended in-person or virtually. Calhoun starts each session by sharing an anonymous narrative she wrote based on numerous interviews she had with psychiatrists from around the country who shared both their personal experiences and what they've witnessed.

The cases are written with a storytelling flair. In the story about Cristina, Callhoun added details that subtly indicated each character's race. The nurses and other staff members who were unhappy that Cristina was returning to the unit had blue eyes or blond hair. Cristina had light brown hands and voluminous, curly hair.

Using a narrative approach helps Calhoun to show her audience the multifaceted effects that racist behaviors in clinical settings can have on children, she said. For example, she can show how these Black children and adolescents are experiencing “adultification,” in which Black youth are often expected to act older than they are and as though they do not need the compassion and patience that White youth receive.

“It's one thing to read about a statistic and another thing to hear how it impacts a specific person or child,” she said.

The narrative approach also allows her to explore how Black psychiatrists often feel targeted because they protect these Black youth. “I want the participants to feel like they're in the room with that child and the person caring for that child so they can really understand the emotional impact that anti-Black racism has,” she said.

The conference series is interdisciplinary and designed to educate both mental health professionals as well as anyone who interacts with Black youth. After Calhoun shares the narrative at the beginning of each session, a three-person panel discusses the case before a question-and-answer session with the audience. The experts on the panel come from a variety of disciplines. Carolyn Roberts, Ph.D., M.A., was on the first panel. Roberts is an assistant professor of the history of science and medicine in Yale's Department of African American Studies.

“As a historian, I don't believe it's possible to intelligently solve problems if we have no idea how long they have been going on,” Roberts told Psychiatric News.

Misperceptions that negatively impact Black youth have been around for hundreds of years, such as believing that Black children are more mature, less innocent, and more dangerous than White children. Tracing those beliefs through history gives much-needed context to our present, Roberts said.

“We can't just blame practitioners who are merely living in our country's medical and scientific inheritance,” she continued. “What we can do and must do is use historical perspectives as part of a multidisciplinary strategy aimed at harm reduction and anti-bias.” ■