From Cultural to Structural Competency—Training Psychiatry Residents to Act on Social Determinants of Health and Institutional Racism

Hansen, Helena; Braslow, Joel T.; Rohrbaugh, Robert M.

doi:10.1001/jamapsychiatry.2017.3894

Cited by 152 publications

(97 citation statements)

References 6 publications

(10 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In view of this mapping, it is notable that several recent reviews have emphasized the unique role of mental health services in addressing social determinants of health as well as individual biomedical conditions [60,26,27]. The portrait of community-based care in VHA presented here illustrates the way mental health systems have been shaped by such social determinants.…”

Section: Discussionmentioning

confidence: 91%

“…The current system of community-based care for people with SMI thus developed in response both biomedical innovations and what has increasingly been referred to as social determinants of mental health [26] (by which is meant, social determinants of mental illness) [27][28][29]. The result has been a non-institutional system composed of two broad components: a standard clinic-based component backed by a limited hospital capacity, that serves the majority of patients, providing medications and behavioral therapies and a second, outwardly facing, community focused component providing more resource intensive services to patients most impacted by "social determinants" in need of specialized intensive care.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Social Determinants of Mental Health Care Systems: Intensive Community Based Care in The Veterans Health Administration

Bhalla

Stefanovics²,

Rosenheck

2020

Preprint

View full text Add to dashboard Cite

BackgroundSince deinstitutionalization in the 1950s-1970s, public mental health care has changed its focus from asylums to general hospitals, outpatient clinics and specialized community-based programs addressing both clinical and social determinants of mental health. Analysis of the place of communitybased programs within a comprehensive health system such as the Veterans Health Administration (VHA) may illuminate the role of social forces in shaping contemporary public mental health systems. MethodsNational VHA administrative data were used to compare veterans who exclusively received outpatient clinic care to those receiving four types of specialized community-based services, addressing: 1) functional disabilities from severe mental illness (SMI), 2) justice system involvement, 3) homelessness, and 4) vocational rehabilitation. Bivariate comparisons and multinomial logistic regression analyses compared groups on demographics, diagnoses, service use, and psychiatric prescription fills. ResultsAn hierarchical classification of 1,386,487 Veterans who received specialty mental health services from VHA in Fiscal Year 2012, showed 1,134,977 (81.8%) were seen exclusively in outpatient clinics; 27,931 (2.0%) received intensive SMI-related services; 42,985 (3.1%) criminal justice services; 160,273 (11.6%) specialized homelessness services; and 20,921 (1.5%) vocational services.Compared to those seen only in clinics, veterans in the four community treatment groups were more likely to be black, diagnosed with HIV and hepatitis, had more numerous substance use diagnoses and made more extensive use of mental health outpatient and inpatient care. ConclusionsAlmost one-fifth of VHA mental health patients receive specialized community-based services addressing, most prominently, major social determinants of health and multimorbid substance use disorders. BackgroundCare for people with psychiatric disorders has undergone extraordinary changes in the past 70 years from a focus on asylum care to a "de facto" system of diverse, largely non-instiutional services [1][2][3].

show abstract

Section: Discussionmentioning

confidence: 91%

mentioning

confidence: 99%

Social Determinants of Mental Health Care Systems: Intensive Community Based Care in The Veterans Health Administration

Bhalla

Stefanovics²,

Rosenheck

2020

Preprint

View full text Add to dashboard Cite

show abstract

“…However, connecting downstream health problems (e.g., chronic diseases) to upstream issues and characteristics of communities is challenging for medical models, pedagogy, and tools [1,2] (Fig 1). Consequently physicians are rarely prepared to consider the social and systemic issues of a place because health models and medical training and practices either omit or fail to integrate place-health concepts that could explicate the structural, historical, and institutional features of places where patients reside [1][2][3][4][5][6][7][8].…”

Section: Place-health Conceptsmentioning

confidence: 99%

“…For Fullilove, the systems approach required an understanding of how cities, neighborhoods, and regions are designed, socialized, and managed. The presence of these downstream health problems like drug abuse and tuberculosis suggested to Fullilove that causation and solutions to health problems go beyond individual bodies defined as patients to bodies defined as social beings impacted by a place with systemic institutional, social, and structural features [1,4]. In fact, a foundational premise of place -health research is described as embodiment where the external physical and social worlds are taken in and expressed in human biology [10][11][12][13][14][15][16].…”

Section: Place-health Conceptsmentioning

confidence: 99%

“…In comparison to cultural competency, which situates customs and individual level symptoms on the bodies of marginalized groups, structural competency extends the diagnosis of individual health and culture populations and how the features of a place including its' institutions, systems, policies, and markets shape the lives and health of those groups [1,45,46]. Structural competency involves the recognition of structural and systemic issues as risk factors that contravene the production of health and individual clinical interventions [1,4,44,45].…”

Section: Place-health Conceptsmentioning

confidence: 99%

See 1 more Smart Citation

Shifting the gaze of the physician from the body to the body in a place: A qualitative analysis of a community-based photovoice approach to teaching place-health concepts to medical students

Andress

Purtill

2020

PLoS ONE

View full text Add to dashboard Cite

Medical practitioners, trained to isolate health within and upon the body of the individual, are now challenged to negotiate research and population health theories that link health status to geographic location as evidence suggests a connection between place and health. This paper builds an integrated place-health model and structural competency analytical framework with nine domains and four levels of proficiency that is utilized to assess a communitybased photovoice project's ability to shift the practice of medicine by medical students from the surface of the body to the body within a place. Analysis of the medical student's photovoice data demonstrated that the students achieved structural competency level 1 proficiency and came to understand how health might be connected to place represented by six of the nine domains of the structural competency framework. Results suggest that medical student's engagement with place-health systemic, institutional and structural forces deepens when they co-create narratives of their lived experiences in a place with patients as community members during a community-based photovoice project. Given the importance of place-health theories to explain population health outcomes, a place-health model and structural competency analytical framework utilized during a community-based photovoice project could help medical students merge the image of patients as singular bodies into bodies set within a context. OPEN ACCESSCitation: Andress L, Purtill MP (2020) Shifting the gaze of the physician from the body to the body in a place: A qualitative analysis of a communitybased photovoice approach to teaching placehealth concepts to medical students. PLoS ONE 15 (2): e0228640. https://doi.org/10.

show abstract

How Pharmaceuticals Mask Health and Social Inequity

Castillo

Braslow

2021

AMA Journal of Ethics

View full text Add to dashboard Cite

Medications, like all interventions, shape the ways in which physicians see disease, provide care, define successful outcomes, and organize health care systems. Pharmaceuticals make symptoms and biological drug targets more visible while rendering individuals and their social suffering invisible, thereby focusing our profession on the intracellular effects of an unequal society. This article uses psychopharmacology as a probe to trace a more general problem within contemporary medicine: the pervasive influence of biomedical narratives and therapeutic rationales extending from clinical practice, to medical education, to health care finance.To claim one AMA PRA Category 1 Credit TM for the CME activity associated with this article, you must do the following: (1) read this article in its entirety, (2) answer at least 80 percent of the quiz questions correctly, and (3) complete an evaluation. The quiz, evaluation, and form for claiming AMA PRA Category 1 Credit TM are available through the AMA Ed Hub TM .

show abstract

From Cultural to Structural Competency—Training Psychiatry Residents to Act on Social Determinants of Health and Institutional Racism

Cited by 152 publications

References 6 publications

Social Determinants of Mental Health Care Systems: Intensive Community Based Care in The Veterans Health Administration

Social Determinants of Mental Health Care Systems: Intensive Community Based Care in The Veterans Health Administration

Shifting the gaze of the physician from the body to the body in a place: A qualitative analysis of a community-based photovoice approach to teaching place-health concepts to medical students

How Pharmaceuticals Mask Health and Social Inequity

Contact Info

Product

Resources

About