Learning How to Actively Listen: In Conversation With Stephen McLeod-Bryant, MD

Stephen McLeod-Bryant, MD

CLINICAL CONVERSATIONS

As part of Psychiatric Times’ 40th anniversary celebration, we are interviewing a wide range of psychiatric professionals to better understand how the field has developed over the last 4 decades. Today, we are proud to feature Stephen McLeod-Bryant, MD, president of the Black Psychiatrists of America and recipient of the American Psychiatric Association (APA)’s Solomon Carter Fuller Award. With over 30 years of experience in providing care to patients with serious mental illnesses, Dr McLeod-Bryant is an internationally acknowledged expert in the field of behavioral health.

Psychiatric Times: As we wrap up Black History Month, can you share how the (somewhat warranted) mistrust of the medical system has impacted mental health care?

Stephen McLeod-Bryant, MD: From the perspective of Black Americans, there are a number of things that raise concern about established medicine. That includes everything from the lack of practitioners who look like us, talk like us, and have some of the same sort of cultural experiences that would help to frame the communication, to the questions and assumptions made about how we are doing medically. This extends to the history of actual experimentation on Black Americans at their expense to advance so-called “medical science.”

PT: 2020 was a wakeup call regarding inherent bias in the medical system. Even the APA somewhat apologized for its past. Did that help? Have we moved the needle at all in terms of inherent bias?

McLeod-Bryant: I think that major organizations, who represent large numbers of practitioners, acknowledging and recognizing the impact that their biases have had on the outcomes for people of color is an important step. That recognition raises the spotlight on health disparities and inequities, and helps move the needle forward, so to speak. However, there is much more that needs to be done concretely in order to improve the health outcomes for communities of color.

PT: As a leader, what strategies do you recommend to continue breaking down those barriers, both professionally for Black psychiatrists as well as for patients?

McLeod-Bryant: There are efforts being done on the federal level to remove so-called DEI initiatives, including data that has been collected over the years on health outcomes based on race, ethnicity, and gender. That data collection needs to be continued, to be followed to see what progress or lack thereof we are making on removing disparities and inequities. It is important.

We know that there are currently disparities, and in some cases, we are making some progress. In other cases, we are not. If we are not tracking that data, we will not know what progress or lack thereof we are making. I think it is equally important that we continue to have research and education about social determinants which are the basis for these disparities. Just identifying someone as being Black or Brown does not indicate the source of their health disparity. The social determinants that are associated with race—that is the important piece for health practitioners to focus on in terms of improving the health outcomes for all.

PT: We are very excited that the Black Psychiatrists of America recently became a Strategic Alliance Partner with Psychiatric Times. Can you tell our audience more about the organization, such as your mission, vision, and current goals?

McLeod-Bryant: The Black Psychiatrists of America is an organization that is relatively new. It was created in 1969 during the Civil Rights Movement, when a number of psychiatrists within the APA, as well as outside of the association, recognized that the APA was not doing enough to address the disparities and psychiatric outcomes for Black communities. We were doing little to increase the numbers of Black psychiatrists in America, and so based on the needs of the Black community, Black Psychiatrists of America was formed. Some of the founders included Chester M. Pierce, MD, and the recently departed Alvin F. Poussaint, MD.

Through the years, we have placed demands on the APA, as well as trying to work with other organizations to support and nurture the growth of Black psychiatrists, including increasing their numbers, so that we can be more of a force in our communities. We also provide another source of collective wisdom and ideas on psychiatric services for all people, as well as promoting research and education in areas that the larger organizations tend to either ignore or neglect.

PT: The FDA recently said the clozapine REMS program is no longer needed, with Peter Weiden, MD, noting it should help improve access to the medication, as absolute neutrophil count levels in Black patients were often misinterpreted. Can you speak more about what this might mean for patients of color with schizophrenia?

McLeod-Bryant: In the past decade, there has been a lot of work in this area. There is a phenomenon known as benign ethnic neutropenia, which is a lower absolute neutrophil count that is more prevalent in individuals of African descent. It has also been shown in other populations as well, but it particularly is germane to Black patients with schizophrenia, such that there may be hesitance to provide clozapine to these individuals because of their low neutrophil counts, when in fact, they have just normally lower neutrophil counts. Adjustments in clinical decision making needed to be made to properly assess any adverse effects that the clozapine may be making. In its later years, the REMS program tried to address this discrepancy, but still had a difficult time convincing many practitioners to provide this medication to Black patients. We are hopeful that with the removal of some of these barriers, there will be greater use of this very efficacious medication for Black patients with schizophrenia.

PT: As we look back on 40 years of Psychiatric Times, what is the most impactful thing you've seen in the past 40 years in psychiatry?

McLeod-Bryant: I would say the most impactful thing in psychiatry in the last 40 years has been the growth of psychotropic medications and other biological interventions. That would include the growth and breadth of options which are available. Also important are various brain stimulation techniques, such as the advances made in ECT, as well as transcranial magnetic stimulation. There is also the research that is going on in other forms of stimulation, such as through light, sound, and music therapy. More recently, growing research in the use of psychedelics and complementary medicine add to the advances in biological alternatives of helping people to feel better, I think, has been the most impactful thing in the last 40 years.

PT: If you could make one meaningful change in psychiatry right now, what do you think it would be?

McLeod-Bryant: The Black Psychiatrists of America are in the process of creating a think tank initiative to try to pull ideas from some of the great minds from around the country to think about, at this critical time and American history, what is it that we can do to make the most effective change for Black psychiatrists and Black communities. We struggle to think of 1 thing we need to change that would make a positive impact, and so we have created this think tank to help guide us.

I will say that I think one of the biggest things that psychiatry could do at this time to help improve things is to help teach people how to actively listen to one another. One of the problems that we have now is the one-sided dialogue, the debates that we have on social media and TV, even in our own homes—we have lost the ability to just sit still and listen to what people are saying and truly understand where they are coming from before forming our own opinions, responses, retorts, or rebuttals. We oftentimes make those rebuttals without truly understanding where the person is coming from, which is frustrating to both parties in the long run. We are not communicating, we are not connecting. So if we in psychiatry could help others to learn how to actively listen and understand one another, that would be a nice positive.

PT: Any final thoughts?

McLeod-Bryant: I appreciate this opportunity that Psychiatric Times is providing to help us share our goals and interests with a larger audience. We look forward to working with other likeminded psychiatrists and other health professionals to improve the mental health care of not only Black Americans, but all Americans.

PT: Thank you!

Dr McLeod-Bryant is the president of Black Psychiatrists of America and recipient of the American Psychiatric Association’s Solomon Carter Fuller Award.