Challenges in Psychiatry Patient Disparities and Caregiver Representation

This year’s American Psychiatric Association (APA) Annual Meeting in New Orleans featured a headline theme of “Social Determinants of Mental Health,” reflecting both recent advances toward considering the clinical and social aspects of psychiatry, as well as the need for continued advancement in making mental health equitable and tailored to the whole individual patient.

But the theme should also consider how US psychiatry should continue to advance as an industry itself, with consideration to social disparities.

In an interview with HCPLive during APA 2022, Rachel Talley, MD, director of the Fellowship in Community Psychiatry at University of Pennsylvania, discussed the significance of addressing mental health disparities in 2022—a time which she called “exciting” for the opportunities that it presents.

“These issues are longstanding, and yet in the past 2-3 years have gotten this new lease as systemic and structural racism has gotten more of a focus,” Talley said. “To my end, the key issues are thinking about the social determinants of mental health—or in other words, these upstream factors that trickle down and influence a person’s outcome in terms of symptoms and ability to engage in treatment productively.”

Everything from housing and income instability, lacking nutritional food access and limited education resources and opportunities adversely impact people of color—and may play a critical role in mental health outcomes, Talley said; Black and Hispanic communities lack adequate screening, facilitation of care, appropriate diagnoses, and a sense of connection with their responding clinicians.

That latter point is of particular interest to Talley, who as a clinician educator is involved with recruitment and retention strategies that target future clinicians of color to better diversify the psychiatry workforce so it may better representation its patient population.

“Across the board, as in a lot of fields…we see disparity in terms of race and ethnicity,” Talley said. “Folks particularly from the African American or Latinx background are underrepresented in these fields.”

While there are signs of slight increases among these populations in academic psychiatry in recent years, Talley noted associate and full professor positions are still predominately filled by White men.

“And this is so important in mental health, as far as talking about serving diverse populations, because there’s absolutely data that suggest for people of marginalized identity, race and cultural concordance can be a very powerful and important factor in terms of initial access to care or retention to care,” she said.

Beyond recruitment, though, is the need to assure residents and fellows of color are retained within the field. Talley noted many report being subjected to a “constant barrage of micro-aggressions,” or possessing a sense that they are expected to serve as an “ambassador” for their race or ethnicity in the field.

While these transgressions are often unintentional, they do highlight a clear disparity in the culture the modern psychiatry workforce, and the culture that advocates like Talley believes they must embrace to better care for and represent their patients.

“I think there’s a lot to do around really hearing the voices of our trainees of color and understanding what their experiences are like, and being thoughtful about how we build training environments to be hospitable to folks who have been traditionally shut out of that training, such that they’re excited to stay in the field,” Talley said.