Breaking the Silence: Unleashing the Power of Emotions in the Fight Against Anti-Black Racism in Mental Health Services

Attendees from the February 28, 2024 presentation. Photo by: Anthony Decarlo.

At the Yale Child Study Center Black Youth Mental Health Case Conference (BYMHCC) on February 28, 2024, I copresented with Amanda Calhoun, MD, MPH, who organized the conference, to tell the anonymized story of “Derrick,” a 12-year-old Black boy. Through this story, we illustrate the ways that racism plays out against Black kids and their parents in inpatient and outpatient psychiatric settings.

Derrick was endearing; he was from an upper-middle-class Black family. He was fortunate to have a passionate and competent psychiatrist who happened to be Black. But when his psychiatrist was on vacation, Derrick had a mental health crisis. He cut himself deeply with a knife on his leg, was taken to a psychiatric hospital, and put on a high dose of an antipsychotic. Every time his mother, “Maya,” asked a question or tried to learn more about the drug or his treatment, she was brushed off. She believed the sedative he was given was far too strong, and when she tried to discuss her concern with the inpatient psychiatrist, an offhand suggestion that she take her issue to his outpatient psychiatrist just was not enough.

After discharge from the hospital, Maya asked the outpatient doctor, “Is this the standard of care?” When she learned that it was not, she added, “Do you think it is because we are Black?” Her psychiatrist, sadly, had to confirm her suspicion.

The second part of the story described how the outpatient psychiatrist was away again to care for an ill family member. Maya called the clinic for advice during a conflict with Derrick in which he locked himself in the bathroom. Maya and the covering psychiatrist disagreed about whether to call the police. When the mother chose not to call the police, the covering psychiatrist called Child Protective Services on the mother, accusing her of medical neglect. Maya was able to successfully deescalate Derrick. The covering provider lacked the information required to come to a good-faith assessment of medical neglect. After this, the family terminated care with this practice.

Often, it is difficult to show bad outcomes due to anti-Black racism due to fear of retaliation, so these stories go unheard. The teaching points are lost, and psychiatrists, as a field, continue to perpetuate racism without thoughtful discourse.¹ This reality drove Dr Calhoun to create the BYMHCC.

Copresenters and expert discussants at the February 28, 2024, presentation. From left to right: Onyi Okeke, MD; Joelle Calhoun, PharmD; Amanda Calhoun, MD (Director of the case series); Akeem Marsh, MD; and AZA Allsop, MD, PhD. Photo by: Anthony DeCarlo.

The conference presents heavily anonymized cases from Black mental health providers from various institutions all over the country. These cases were compiled and anonymized by Dr Calhoun. One case is presented per month from January 2024 to June 2024. The conference is a hybrid event. A key element in the conference is teaching practitioners to use and respond to emotions, which is necessary in addressing anti-Black racism.

In the medical field, we often present anonymized patient cases to teach about the facts of medical treatment that have gone awry. Yet, recounting medical facts does not address medical racism, adequately convey the horror, nor inspire medical providers to take better care of their Black patients. Emotions can serve as a potent tool for medical providers to effectively discuss and thus address racism in medicine.

Emotional storytelling can be incredibly impactful in highlighting racism in the psychiatric care of Black patients. Through storytelling, Dr Calhoun aims to reenact the emotion conveyed by the provider who experienced the case and the racist behavior of the medical team. Afterward, expert discussants who are also present are asked questions about their initial thoughts, views, and guidance on how to address and prevent the racist care in the case being considered. The expert discussants are a multidisciplinary panel of psychiatrists, social workers, and pharmacists from all over the county who share their insights. They advise on the flaws in decision-making. They explain how to address presented issues with an anti-racist approach and deepen the listeners' understanding of the many-layered issues of racism in psychiatric settings.

Emotionally charged narratives can inspire individual accountability by practitioners within the health care system.² By showcasing the impact of anti-Black racism on individual families, such narratives evoke empathy, educate, and empower patients, providers, and community members to advocate for change on a personal level and mobilize encouragement for action toward a more equitable and compassionate healthcare system one person at a time.

To be sure, letting feelings show in medicine is often disregarded as weaknesses or incompetence, and expressions of emotion on the part of the practitioner are discouraged or invalidated, even in psychiatry.³

Through this case conference series, telling the all-too-common but unheard stories of our Black patients invites practitioners to connect with Black patients as people. That connection can lead us to work to address anti-Black racism. Whether they are health care professionals, social workers, or community members, the aim is to humanize patients and illuminate racism within clinical settings. Emotionally driven storytelling serves as a conduit to understanding the continued individual acts of racism in psychiatric settings against Black children and families. This approach emboldens listeners to advocate for change. For instance, for providers to call out issues of racism when they see it, for providers to make an extra effort to remove racist practices from their care. By amplifying the voices of these Black families, we seek to deconstruct the anti-Black injustices embedded in how psychiatric care is practiced in the United States.

Dr Okeke is a child psychiatry fellow at the Yale Child Study Center at Yale University in New Haven, Connecticut, and a Public Voices Fellow with the OpEd Project. 

References

1. Warner J. Psychiatry confronts its racist past, and tries to make amends. The New York Times. April 30, 2021. Accessed April 5, 2024. https://www.nytimes.com/2021/04/30/health/psychiatry-racism-black-americans.html

2. Peteet JR, Witvliet CVO, Glas G, Frush BW. Accountability as a virtue in medicine: from theory to practice. Philos Ethics Humanit Med. 2023;18(1):1.

3. Kerasidou A, Horn R. Making space for empathy: supporting doctors in the emotional labour of clinical care. BMC Med Ethics. 2016;17:8.