We Must Speak to Patients and Their Families About Racism

As the nation addresses longstanding and entrenched inequalities, we as psychiatrists need to talk about racism in our clinical work. Whether individual, internalized, or structural, racial discrimination has an adverse effect on mental health. As psychiatrists, we should be comfortable exploring its impact with patients and their families.

For many, it is difficult to talk about race or racism, and some may be prevented from having such conversations by the fear of inadvertently offending the patient. Yet, while each patient is different, engaging in healthy conversations about race and racism can improve the therapeutic alliance, keep patients in treatment longer, increase trust, and help them feel comfortable sharing their innermost lives with us.

Alternatively, not having such conversations can make some patients feel isolated and less likely to engage in treatment. Especially for patients from minority or underserved communities, having their experiences with racism go unacknowledged in the therapeutic setting can lead them to believe their psychiatrist is not willing to listen to them, and they will go on suffering in silence. Worse, if we exhibit our own unchallenged implicit biases while interacting with patients, they may question if we see them as whole people or if the treatment we offer is really in their best interest.

At the request of Dr. Cheryl Wills, chair of APA’s Presidential Task Force to Address Structural Racism Throughout Psychiatry, the Council on Children, Adolescents, and Their Families sought to create an educational resource document that would provide some guidance and suggestions around discussing race and racial discrimination with patients, their parents, and their family members.

The council’s chair, Gabrielle Shapiro, M.D., appointed Tresha Gibbs, M.D., to lead the work group to develop the resource document. The work group was composed of members from different parts of the country, career stages, and ethnic backgrounds. The work group also included Anish Dube, M.D., M.P.H., Asha Martin, M.D., Brandon Newsome, M.D., and Jordan Wong, M.D. APA Staff Liaison Ricardo Juarez was critical in formatting the final product and ensuring its timely release to members.

In creating the document, we held numerous conversations on how we could make it user friendly while also addressing a challenging and broad topic, including the evolving nature of definitions and language around race and racism. The document is based on the premise that it is helpful to ask patients questions rather than make assumptions or rely on stereotypes. We included guidelines on how to provide both culturally and structurally competent clinical care, informal questions that could be used to prompt a discussion about race or racism, and resources to aid in the process of having these conversations.

The document also includes numerous vignettes that illustrate situations related to race that a psychiatrist might encounter with a patient. Some of the vignettes are focused on approaching children and adolescents, while others are aimed at situations that may occur within a general psychiatric practice. We hope these vignettes will spark conversations about how to engage with patients about race or racism and create opportunities for all psychiatrists to consider and challenge their own implicit biases.

The document is not meant to be a monolithic or static product but rather serve as the first edition of a dynamic resource document.

Racism impacts the work of all psychiatrists, no matter where or how they practice. It also plays a significant role in the lives of our patients. We hope this document supports our patients by increasing awareness about the health impacts of racism among mental health professionals and facilitates dialogue about patients’ experiences of race and culture in a thoughtful, open environment. ■