APA Task Force Charged With Examining Structural Racism Throughout Psychiatry
Abstract
APA President Jeffrey Geller, M.D., M.P.H., and Task Force Chair Cheryl Wills, M.D., answer questions about the task force, including its composition and goals.
Emory health care staff take a knee for eight minutes and 46 seconds in memory of George Floyd in a June demonstration they called White Coats for Black Lives. The demand to address racism and racial inequality throughout the country prompted APA President Jeffrey Geller, M.D., M.P.H., to undertake an overdue, major initiative addressing structural racism at APA and in psychiatry.
APA President Jeffrey Geller, M.D., M.P.H., announced the formation of the Presidential Task Force to Address Structural Racism Throughout Psychiatry during a virtual town hall on June 15. The town hall, titled “Member Town Hall – APA Addresses Structural Racism, Part One,” was held in response to spreading protests against systemic racism and demands from psychiatrists that APA examine structural racism within the Association and the profession.
The task force held its first meeting on June 27 and conducted its first survey, which addressed the mental health care of Black patients. The results are posted here. The task force is planning a second virtual town hall for August 24.
APA CEO and Medical Director Saul Levin, M.D., M.P.A., said that for APA, this is a time for reflection, knowledge, accountability, and action. “I am committed to ensuring that this task force, coupled with important actions by our organization, our leadership, our entire membership, and our administration under my supervision, helps us dismantle systemic racism in our communities.”
Chairing the task force is Cheryl Wills, M.D., APA Area 4 trustee. Other members include Renée Binder, M.D., former APA president; Frank Clark, M.D., an APA delegate to the AMA’s Section Council on Psychiatry; Charles Dike, M.D., M.P.H., a member of the Ethics Committee; Mary Jo Fitz-Gerald, M.D., M.B.A, speaker-elect of the APA Assembly; Danielle Hairston, M.D., president of the APA Caucus of Black Psychiatrists; Hunter McQuistion, M.D., a community psychiatrist; Michele Reid, M.D., APA trustee-at-large; Steven Starks, M.D., chair-elect of the Assembly Committee of Minority and Underrepresented Groups and the Assembly representative of the Caucus of Black Psychiatrists; Richard Summers, M.D., APA treasurer; and Sanya Virani, M.D., M.P.H., APA’s resident-fellow member trustee.
Below Geller and Wills answer questions they have received about the task force.
Dr. Geller responds:
Q. What is your objective in creating the Task Force to Address Structural Racism Throughout Psychiatry?
A. As I have mentioned in my prior articles, racism is not new to psychiatry. Throughout our history, we have marginalized and discriminated against minority psychiatrists and minority patients. This has significantly impacted Black Americans, who, because of their unwilling arrival in this country and history of maltreatment, discrimination, and segregation (which existed legally in my lifetime) have been marginalized in terms of education, health care, employment, and housing.
One result of this history is a culture in which Black psychiatrists are underrepresented in academia, psychiatry, and leadership positions, and Black patients suffer more from chronic medical illness and untreated mental illness because of lack of access to care. Even those who receive treatment are often misdiagnosed because psychiatrists are not trained to account for Black patients’ trauma or their lived experiences.
The charge of the task force is broad—it covers identifying structural racism, educating people about it, and proposing solutions in several areas in which structural racism has resulted in negative outcomes for minorities including within APA and with regard to access to care, treatment, hospital and clinic administration, health insurance, and psychiatric academia.
It is a massive endeavor, and we understand the need to clean our own house first. But as we look inward at APA, we also intend to educate our members about structural racism to begin to change a culture that has had such a serious health impact on Black Americans for 400 years. (In 1619 the first slaves, about 20 of them, arrived in what would become the United States, landing in what would become the state of Virginia.)
Q. How did you choose the members you appointed to the task force? What characteristics were you looking for?
A. I carefully considered the task force membership. I listened to and heard several of my Black colleagues who believe that to overcome racism, white people first need to really understand it. Therefore, I wanted to ensure that the task force was composed of Black and white members and had representation from the Board of Trustees, the Assembly, and the Caucus of Black Psychiatrists. Since this is an ethical issue as well as a national issue, I included a member of the Ethics Committee. Also, because criminal justice is a significant part of the dialogue on racism in the country now, I also included members who are experts in this area. Every member of the task force has an expertise or interest that will help address the issues that the task force is charged with exploring. Please review their bios at psychiatry.org/taskforce.
Q. Why did you include members of the Board of Trustees?
A. As I mentioned, part of the task force’s charge is to evaluate structural racism within APA. I included Board and Assembly members who are familiar with APA’s organizational and governance structure and can be leaders in making changes to ensure that APA as an organization is inclusive of minority members in its operations and leadership.
Q. What is the charge of the task force?
A. Focusing on organized psychiatry, psychiatrists, psychiatric trainees, psychiatric patients, and others who work to serve psychiatric patients, the task force is initially charged with the following:
Providing education and resources on APA’s and psychiatry’s history regarding structural racism.
Explaining the current impact of structural racism on the mental health of our patients and colleagues.
Developing achievable and actionable recommendations for change to eliminate structural racism in APA and psychiatry.
Providing reports with specific recommendations for achievable actions to the APA Board of Trustees at each of its meetings through May 2021.
Monitoring the implementation of tasks 1 to 4.
Structural racism has significantly influenced institutional racism and bias in our organizations. We are starting with structural racism as it affects Black individuals, but this is a long-term task. I will seek to continue the task force as a committee or some other component of APA to ensure that the work continues and expands to encompass other minority groups. This cannot be a “one and done” proposition.
Q. Why did you not include members of other minorities on the task force?
A. At this moment in history, in the midst of national protests about unnecessary killings and violence against Black individuals and considering psychiatry’s long history of racism against Black psychiatrists and patients, it is appropriate to begin with the interests of Black people first.
Q. How does the task force intend to address concerns expressed by other underrepresented racial/ethnic groups?
A. While some of the issues cross minority populations, each minority population has unique issues. With respect to the APA structure, I believe that any changes that are made will impact all minority populations, and therefore, the task force is seeking input from APA’s minority and underrepresented caucuses (M/UR) along the way. With respect to M/UR populations’ treatment outside of APA, each group may have different concerns. We are counting on our caucuses and members to bring these concerns to the task force and to work with the task force to identify problems and propose solutions. In addition, I have convened a Board work group to propose a definition of “minority APA member,” a definition that exists now only in the Assembly, but not in APA as a whole. This action will benefit all minority groups.
Q. Will the scope of the task force’s work extend to addressing racism experienced by patients?
A. There are areas in which APA can help to address racism experienced by patients. For example, APA can be instrumental in educating psychiatrists about how race, trauma, and lived experiences can influence diagnosis and treatment; we can consider racial issues in practice guidelines and in DSM; we can help our members understand how implicit bias may impact their own and others’ treatment of diverse patient populations; and we can ensure that materials produced by APA for the purposes of improving patient care are themselves devoid of all racial insensitivities, bias, and misleading information.
APA also continues to advocate for mental health parity, increased payment for psychiatrists from insurance plans to encourage more members to participate in insurance plans, expanding the Affordable Care Act, and improving access to care.
Q. What work products (“deliverables”) do you expect the task force to develop that will work toward the eradication of racism in psychiatry?
A. I have asked the task force to deliver achievable recommendations to the Board before the next Annual Meeting. The task force has already delivered several work products including the June town hall and has scheduled a second town hall on August 24 to help members learn more about structural and institutional racism and its impact on psychiatrists and patients. The task force has also conducted a mini-survey on how structural racism impacts patients to educate members, whose results are posted here and created a website with materials aimed at educating our members and the public about racism; free CME courses for members about how unconscious bias, racism, and microaggressions impact patient care; and definitions of racism, structural racism, institutional racism, equity, and unconscious bias to ensure that we have a common lexicology when discussing the issues. Members should check psychiatry.org/TaskForce for continual updates.
Q. Can members contribute comments that might inform the deliberations of the task force?
A. Absolutely. The task force welcomes comments, ideas, and suggestions. We encourage everyone to participate in the mini-surveys and to send comments to [email protected]
Dr. Wills responds:
Q. What are your goals for the task force?
A. Our immediate goals are to start educating our members on understanding structural racism and how it impacts APA, psychiatric practice, our colleagues, patients, and the public perception of psychiatry and to get our members engaged in the discussion. We are doing this through town halls, recommended readings on the website, mini-surveys, and free CME. If people do not recognize a problem, it cannot be addressed.
We also are beginning to investigate institutional racism within APA. We aim to identify problems, educate leadership, and propose reasonable solutions. Over the longer term, I see the task force working to identify, educate the public about, and propose actionable solutions to institutional and structural racism in patient care, medical education, and employment decisions regarding Black psychiatrists and members of other minority groups.
Changing hearts, minds, and historical practices is a long-term objective.
Q. How have you structured the task force to achieve these goals?
A. We have a very active task force. For each problem, we are breaking down the task force into work groups with task force leaders and asking them to include other member experts on the issues (or problems or topics) under review. Each work group is supported by APA staff, who have been enthusiastic collaborators on our research and discussions. For example, we recently formed work groups to evaluate the nomination and voting processes for the APA Assembly and Board and the appointment process for components and to recommend ways the processes might be adjusted to be more inclusive of minority members and cognizant of matters that are important to them. This necessarily includes a review of the current processes to ensure that the outcomes will be devoid of the implicit bias of the participants.
Q. Will there be opportunities for the task force to obtain input from other APA member experts on racism?
A. Absolutely. The charge of the task force is huge and will “take a village” to fulfill. Prior to the first meeting of the task force, I had discussions with senior leaders in psychiatry, many of whom are members of M/UR groups, and I have used their valuable feedback to inform how the task force conducts its business. I expect task force work groups to consult with member experts.
I have also met with all of the presidents of the M/UR caucuses to ask that they begin engaging in projects within their caucuses to address issues of institutional racism within APA and within psychiatry that are specific to their minority group and to bring those issues to the task force so we can all work together on resolutions.
Q. Members have already been asked to respond to surveys on structural racism. What are these about, and will there be more?
A. These are brief surveys that enable the task force to get the pulse of the membership on topics and help to frame the issues that are most important to our members and their patients. We received about 450 responses to our first survey but would like to have more member engagement on them. The results of the first survey, which addressed the impact of structural racism on our patients, is posted here.
The second survey asked members about structural racism in APA and closed earlier this month. We expect to have a few more short surveys on other topics as we move along. The information is being used to inform the task force of the most pressing issues for our members and helps us to prioritize our work.
Q. How do you plan to study racism at APA and change the current culture?
A. There are two parts to this answer. The first is the APA governance structure, which I’ve discussed above. Also, we will identify educational resources for APA members and leadership that will enhance our understanding of institutional racism and how bias has or can influence decision-making. We encourage all APA district branches to do the same. Each group in organized psychiatry has a duty to look inward—to identify and accept that there are flaws and to make conscious and sustainable efforts to improve.
The second is the APA staff. We have a terrific staff and need to ensure that the work environment is diverse, inclusive, and equitable. The Board and the administration will work with a consulting firm to review the APA internal processes, make necessary changes, and educate the entire staff on the issues.
Q. How do you respond to members of other M/UR groups who believe that the task force should be addressing structural racism as it impacts them?
A. Structural racism affects everyone, consciously or otherwise. While Dr. Geller’s initial goal is to get APA on a better trajectory with Black members, the task force is cognizant of how matters that affect Black psychiatrists affect other groups and how the actionable changes the task force ultimately proposes to the Board will benefit minority psychiatrists in terms of making opportunities accessible in organized psychiatry, improving relationships with their colleagues, increasing health equity for psychiatric patients, and fulfilling the third goal of APA’s Strategic Initiatives: increasing diversity and inclusion in organized psychiatry and psychiatric practice.
I have encouraged leaders of the M/UR caucus groups to expand on the mission of the task force by designing their own projects, in parallel with the task force, that will illuminate how structural racism affects their patients, practices, and organized psychiatry. These groups have the capacity to proffer recommendations that are conducive to improving psychiatry for patients, psychiatrists, and others. Their projects may lead to a Diversity and Health Equity Track being considered by the APA Annual Meeting Program Committee.
I look forward to learning from the endeavors of the M/UR groups—and all APA members. ■
