Studies from the general medical literature demonstrate considerable promise in addressing lifestyle risk factors. Existing programs will require tailoring to address the needs of those with serious mental illness and may be harder to implement given the challenges faced by this population. However, successful lifestyle interventions for those with serious mental illness can make a significant impact on the health and well-being of this vulnerable population and may inform future strategies for other underserved groups.
Purpose
The United States has an implicit agreement known as the racial contract that exists between white and non-white communities. Recently, the racial contract has produced much tension, expressed in racial violence and police brutality. This study explores how this racial violence and police brutality have affected the practice and education of Black trainees and physicians who are members of the racial community being targeted.
Method
This qualitative cross-sectional study interviewed 7 Black trainees and 12 physicians from 2 Southern medical schools in 2020. Interview data were collected using aspects of constructivist grounded theory, and then analyzed using the concept of racial trauma; a form of race-based stress minoritized individuals experience as a result of inferior treatment in society. Data were then organized by the causes participants cited for feeling unsafe, conditions they cited as producing these feelings, and the consequences these feelings had on their education and practice.
Results
The results show that even though participants were not direct victims of racial violence, because their social identity is linked to the Black community, they experienced these events vicariously. The increase in racial violence triggered unresolved personal and collective memories of intergenerational racial trauma, feelings of retraumatization after more than 400 years of mistreatment, and an awakening to the fact that the white community was unaware of their current and historical trauma. These events were felt in both their personal and professional lives.
Conclusions
As more minoritized physicians enter medicine and medical education, the profession needs a deeper understanding of their unique experiences and sociohistorical contexts, and the effect that these contexts have on their education and practice. While all community members are responsible for this, leaders play an important role in creating psychologically safe places where issues of systemic racism can be addressed.
This article highlights the profound and far-reaching impact of the Coronavirus disease 2019 health crisis on persons with serious mental health conditions. To understand and mitigate against the negative effects of the crisis on this population, we offer a resilience intervention framework that attends to three key resilience processes, namely control, coherence, and connectedness (3Cs). We then detail interventions and associated evidence-informed intervention strategies at the individual, interpersonal, and systemic levels that behavioral health professionals can employ to bolster each of the 3Cs for persons with serious mental health conditions. These intervention strategies, which must be implemented in a flexible manner, are designed to enhance the biopsychosocial functioning of persons with serious mental health conditions during the COVID-19 pandemic and beyond and strengthen their interpersonal and systemic environments. We conclude with recommendations for future directions.
Impact StatementResilience is a powerful predictor of positive mental health in the context of stress, such as a pandemic. This article offers an array of individual, interpersonal, and systemic interventions to bolster the resilience of persons with serious mental health conditions and support their ongoing recovery. These interventions can help these individuals have more control over their lives, a greater sense of meaning in accord with their values, and feel more connected to others and their community.
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