Addressing how individual and social determinants affect mental health equity and inclusion with Dr. Regina James

Psychcast

Regina James, MD, tells her personal story and discusses how to understand health equity with guest host Carol A. Bernstein, MD.

Dr. James is deputy medical director and chief of the division of diversity and health equity at the American Psychiatric Association. She also serves on the advisory board of The PACT group (Pan African Clinical Trials) and receives no income from the group.

Dr. Bernstein, a past president of the APA, is vice chair for faculty development and well-being at Montefiore Medical Center/Albert Einstein College of Medicine, New York. She has no disclosures.

Take-home points

• The Robert Wood Johnson Foundation defines health equity as: “Everyone has a fair and just opportunity to be as healthy as possible. This requires removing obstacles to health such as poverty, discrimination, and their consequences, including powerlessness and lack of access to good jobs with fair pay, quality education and housing, safe environments, and health care.” Equity embraces the idea of inclusiveness and evaluates a whole health care system instead of focusing only on individual marginalized communities. For example, it is essential to understand the social determinants that lead to groups being medically underserved and then to understand the impact of the medically underserved on the entire system.
• Dr. James led a 20-year career in research and leadership within the National Institutes of Health, including the National Institute of Mental Health, the National Institute on Minority Health and Health Disparities, and the Eunice Shriver National Institute of Child Health and Human Development. She later transitioned to 2M, a research consulting agency, and then to the APA.
• Within the APA, Dr. James has developed a 5-point strategic plan with the vision that all APA members will be culturally competent and sensitive, and able to provide mental health care for any individual regardless of age, race, gender, or sexual orientation.
• The strategic plan focuses on raising awareness about mental health equity and destigmatization and leveraging the expertise of the APA membership in their communities. A cornerstone of the plan is an educational agenda, including materials on health equity in psychiatry and outreach to APA members and their community partners. In addition, Dr. James and her office partner with APA leadership to lobby the government for mental health equity and inclusion.
• Dr. James describes structural racism as current policies within an organization that lead to racial inequalities. Separate from the Office of Diversity and Health Equity, the APA established a Presidential Task Force to Address Structural Racism Throughout Psychiatry to identify the scope and targets of structural racism within organized psychiatry, including the APA. It also seeks to identify how structural racism affects practicing psychiatrists and their patients.

References

Braveman P et al. What is health equity? Robert Wood Johnson Foundation. 2017 May 1.

American Psychiatric Association. Diversity and health equity.

American Psychiatric Association. Mental health disparities: Diverse populations.

APA Presidential Task Force to Address Structural Racism Throughout Psychiatry. https://www.psychiatry.org/psychiatrists/structural-racism-task-force

Rosenkranz KM et al. J Surg Education. 2020. doi: 10.1016/j.surg.2020.11.013.

Simonsen KA and Shim RS. Psychiatr Clin North Am. 2019 Sep;42(3):463-71.

Alves-Bradford J-M et al. Psychiatr Clin North Am. 2020 Sep;43(3):415-28.

Aggarwal NK et al. Patient Educ Couns. 2016 Feb;99(2):198-209.

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Show notes by Jacqueline Posada, MD, associate producer of the Psychcast; assistant clinical professor in the department of psychiatry and behavioral sciences at George Washington University in Washington; and staff physician at George Washington Medical Faculty Associates, also in Washington. Dr. Posada has no conflicts of interest.

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