On the Legacy and Future of Mental Health in Black Communities

As Director of the Center for Youth Advocacy and Well-Being, Altha Stewart, MD, highlights the historical challenges Black individuals have faced in psychiatry, dating back to the 19th century when segregationist policies shaped mental health institutions. Today, these inequities persist through misdiagnosis, inadequate treatment, and limited access to care.

For Black clinicians, these systemic challenges are compounded by stigma and underrepresentation in leadership roles. Stewart recalls that, despite progress, she remains the only Black psychiatrist ever elected president of the American Psychiatric Association. The intersection of stigma and structural racism continues to hinder access to high quality care for Black patients, as seen in policies like restrictive prescribing requirements that disproportionately limit treatment options for certain populations.

Representation is key to improving mental health outcomes. More Black professionals entering psychiatry can build trust within communities and advocate for culturally competent care. Stewart finds hope in the next generation of psychiatrists, who bring a strong commitment to social justice and public health. Organizations are also developing tools to assess systemic barriers in mental health care, pushing for change from within.

To combat the ongoing impact of systemic racism and historical trauma, Stewart calls for reform across medical education, clinical services, research, and community engagement. Without trust between communities and mental health professionals, even the most effective treatments will fail to reach those in need.

During Black History Month, Stewart honors pioneers like Solomon Carter Fuller, the first Black psychiatrist in the U.S., whose contributions to Alzheimer’s research were overshadowed due to racial discrimination. His legacy, she emphasizes, serves as both a reminder of past injustices and a call to action for future generations in psychiatry.

Dr Stewart is a Senior Associate Dean for Community Health Engagement and Founding Director, Center for Youth Advocacy and Well-Being at the University of Tennessee Health Science Center, Memphis. She has led large public mental health systems in Pennsylvania, New York, and Michigan over her 40+ year career. Dr. Stewart is currently President of the American Association for Community Psychiatry, and past president of the American Psychiatric Association, Black Psychiatrists of America, Association of Women Psychiatrists, and American Psychiatric Foundation.