Racism and mental health and the role of mental health professionals

Schouler‐Ocak, Meryam; Bhugra, Dinesh; Kastrup, Marianne; Dom, Geert; Heinz, Andreas; Küey, Levent; Gorwood, Philip

doi:10.1192/j.eurpsy.2021.2216

Cited by 31 publications

(18 citation statements)

References 57 publications

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“…Future studies need to address how the effects of diverse severely aversive and traumatizing experiences of patients with psychosis may best be treated. This includes psychosocial interactions focusing on the community in a case of systematic social exclusion, as well as psychotherapeutic interventions aiming at specific traumatizing experiences (113,114). Given the strong effect of indicators of social and racist exclusion (6, 10) on psychosis risk, interventions at a societal level could include fighting stigma and racism, and providing social support to reduce poverty and marginalization, and to increase solidarity and community inclusion (35,115,116).…”

Section: Discussionmentioning

confidence: 99%

Traumatic Events, Social Adversity and Discrimination as Risk Factors for Psychosis - An Umbrella Review

et al. 2021

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Exposure to childhood trauma is a well-known risk factor for severe mental disorders including schizophrenia and other non-affective psychoses. Beyond childhood trauma, there is increasing evidence that bullying, social exclusion, and discrimination during adolescence and adulthood may increase the risk of developing a psychotic disorder, and that such forms of traumatization may also underlie the elevated psychosis risk among migrants or persons with a visible minority status. In this umbrella review, we systematically assess meta-analyses regarding trauma and social adversity. A systematic literature review yielded 11 meta-analyses that met inclusion criteria and could be summarized quantitatively with a random effect model. Furthermore, six meta-analyses were evaluated qualitatively. Heterogeneity and publication bias were apparent in several meta-analyses. We observed that most significant social risk factors for psychosis were vulnerability for racist discrimination [OR = 3.90 (3.25–4.70)], migration [OR = 2.22 (1.75–2.80)], and childhood adversities [OR = 2.81 (2.03–3.83)]. Furthermore, social factors increasing the risk for psychosis were variation/impairment of parental communication, aversive adult life events, bullying, and factors associated with social isolation and discrimination. In spite of these environmental risk factors, there is a lack of evidence regarding treatment of trauma and psychosis, although some psychotherapeutic and art therapy approaches appear to be promising. Beyond individual interventions, stigmatization, racism, and other forms of discrimination need to be targeted to increase solidarity and communal support.

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Section: Discussionmentioning

confidence: 99%

Traumatic Events, Social Adversity and Discrimination as Risk Factors for Psychosis - An Umbrella Review

et al. 2021

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“…Strategies and policies aiming to mitigate the mental health care burden (especially for vulnerable groups with migrant status, socioeconomic disadvantage, and risk of social exclusion and isolation) require to focus on reducing poverty and income inequality and promoting opportunities of social participation, work with fair income, and access to mental health care with intercultural competences, in addition to fighting discrimination and providing mental health care for the general population [ 119 , 124 , 125 ]. Practical guidance on how to engage in strategies to reduce discrimination and racism in clinical practice have been advocated by health care organizations such as the Royal College of Psychiatrists [ 126 ], the German Association for Psychiatry, Psychotherapy and Psychosomatics [ 127 ], the European Psychiatric Association [ 103 ], and the American Academy of Pediatrics [ 128 ].…”

Section: Social Isolation and Discrimination In Humansmentioning

confidence: 99%

“…Interventions designed to reduce social isolation stress involve two distinct concepts: subjective social isolation (including loneliness and perceived social support) and/or objective social isolation (having little social contact with other people measured by social network size or the frequency of social contacts with others) [ 168 ]. Furthermore, social exclusion, discrimination, and isolation are to be addressed at an institutional level [ 103 , 126 – 128 ].…”

Section: Social Isolation and Discrimination Interventionsmentioning

confidence: 99%

“…Discrimination is defined as making distinctions between people based on prejudice and biologically unjustified assumptions of categorical differences attributed to perceived "race" or "ethnicity" [99,[101][102][103]. Racism discriminates according to scientifically disproven and discredited concepts of "racial classifications" and is not limited to individual beliefs, values, and interactions, but also manifests on a systemic level such as structural racism, which refers to racial discrimination in housing, education, employment, income, health care, justice, and media, among other societal domains [99,101,102].…”

Section: Discrimination and Racismmentioning

confidence: 99%

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The effects of social isolation stress and discrimination on mental health

et al. 2022

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Social isolation and discrimination are growing public health concerns associated with poor physical and mental health. They are risk factors for increased morbidity and mortality and reduced quality of life. Despite their detrimental effects on health, there is a lack of knowledge regarding translation across the domains of experimental research, clinical studies, and real-life applications. Here, we review and synthesize evidence from basic research in animals and humans to clinical translation and interventions. Animal models indicate that social separation stress, particularly in early life, activates the hypothalamic-pituitary-adrenal axis and interacts with monoaminergic, glutamatergic, and GABAergic neurotransmitter systems, inducing long-lasting reductions in serotonin turnover and alterations in dopamine receptor sensitivity. These findings are of particular importance for human social isolation stress, as effects of social isolation stress on the same neurotransmitter systems have been implicated in addictive, psychotic, and affective disorders. Children may be particularly vulnerable due to lasting effects of social isolation and discrimination stress on the developing brain. The effects of social isolation and loneliness are pronounced in the context of social exclusion due to discrimination and racism, during widespread infectious disease related containment strategies such as quarantine, and in older persons due to sociodemographic changes. This highlights the importance of new strategies for social inclusion and outreach, including gender, culture, and socially sensitive telemedicine and digital interventions for mental health care.

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“…On the heels of the COVID-19 pandemic, which revealed the enduring violence of structural racism, along with simultaneous unabated killings of Black individuals and other persons of color, the year 2020 saw a large, global movement protesting structural racism in the USA [ 16 , 17 ]. As a result, several institutions, organizations, and professional associations (e.g., American Medical Associations, American Psychiatric Association, National Association of Social Workers) are reckoning with the role of structural racism in persistent health disparities and their complicity in the perpetuation of structural racial inequities [ 13 , 18 , 19 , 75 ]. For example, following the civil unrest precipitated by the police killings of Black individuals, especially the death of George Floyd, as well as the disproportionate impact of COVID-19 on persons of color, the APA president Geller resolved to address structural racism in the professions’ diversity efforts.…”

Section: Social Backgroundmentioning

confidence: 99%

Structural Racism, Workforce Diversity, and Mental Health Disparities: A Critical Review

Kyere

Fukui

2022

J. Racial and Ethnic Health Disparities

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Objective Racial workforce diversity has been suggested as a critical pathway to address persistent racial mental health disparities. However, structural racism has been noted to diminish such workforce diversity efforts. The purpose of this critical review is to identify the mechanisms through which structural racism operates in organizations, including mental health organizations, to undermine workforce diversity efforts and reinforce inequities. Methods Using the theories of racialized organizations, the current review critically draws on literature underscoring the racial character of organizations as mezzo-level racialized structures that may systematically activate and uphold white privilege in the mental health workplace. Results Findings suggest that in the context of institutionalized white dominance, workers of color within mental health organizations may experience race-based cultural exclusion, identity threat, and racialized workplace emotional expression, and be burdened by racialized tasks. The workers of color may also become the means for organizations to attract communities of color due to their diverse characteristics, yet workers’ effects to address disparities in mental health are minimized due to potential racialized organizational forces, including the whiteness of organizational leadership and color-blindness. Conclusions and Implications for Practice Structural racism may create resistance to the efforts and effects of a racially diverse workforce within mental health organizations. This review calls for a race-conscious framework that drastically shifts the traditional organizational structure to an inverted hierarchy (i.e., client-centered management) to maximize diversity efforts in the mental health organizational workforce to address racial disparities in mental health.

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Racism and mental health and the role of mental health professionals

Cited by 31 publications

References 57 publications

Traumatic Events, Social Adversity and Discrimination as Risk Factors for Psychosis - An Umbrella Review

Traumatic Events, Social Adversity and Discrimination as Risk Factors for Psychosis - An Umbrella Review

The effects of social isolation stress and discrimination on mental health

Structural Racism, Workforce Diversity, and Mental Health Disparities: A Critical Review

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