Psychiatrist Addresses the Unique Challenges Facing Patients and Psychiatrists of African Descent

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During the American Psychiatric Association’s 2018 Annual Meeting, held in New York, New York, Patricia Newton, MD, MA, MPH, delivered the 2018 Solomon Carter Fuller Lecture, in which she discussed the challenges that face patients and psychiatrists of African descent.

Newton, who is the chief executive officer and medical director of the Black Psychiatrists of America and the medical director of Newton & Associates, explained that, in preparation for her lecture, she surveyed 150 African American psychiatrists from a variety of organizations and 350 African Americans in the Baltimore community about what they feel are the greatest challenges facing people with mental disorders and the greatest challenges in delivering care.

In the survey of the general population, notably, men were more reluctant than women to be interviewed, and many participants were concerned about whether they could be identified personally based on their responses, though 85% of women and 20% of men who participated asked to be informed of the results of the survey and even volunteered their contact information to hear Newton’s findings.

The community respondents identified the following as key problems facing those with mental health issues:

• Not enough culturally competent doctors (75% of male respondents, 100% of female respondents)
• Not enough physician concern for the wellbeing of patients (85% of male respondents, 90% of women respondents)
• Physician training to dispense medication rather than to counsel (85% of male respondents, 95% of women respondents)

Newton explained that electronic health records (EHRs) may contribute to the problem of patients viewing psychiatrists as prescribers only, as EHRs may impede patient—physician communication.

With respect to the cultural competency of providers, Newton pointed to misdiagnosis and dismissal of cultural factors that can lead to inappropriate treatment of patients as a major problem.

“I had a patient who was put incorrectly on haloperidol because the gentlemen’s wife had died. It’s classic for many indigenous patients to talk about visitations from a deceased relative,” Newton explained, but because the patient’s prior physician didn’t understand the patient’s culture, he gave a diagnosis of psychosis. “Even with the best intentions, many of our colleagues don’t have the cultural competency” to deal with these kind of situations.

In a language analysis of the survey concerning the problems facing patients with mental health issues:

• “Racism” appeared in 100% of responses
• “Discrimination" appeared in 98%
• “Frustrated” appeared in 60%
• “Inhumane” appeared in 35%
• “Hopeless/helpless” appeared in 20%

In her survey of psychiatrists of African descent (response rate, 52%), fully 50% were also concerned about whether they could be identified by name if they responded to the survey questions.

When asked about challenges facing patients, the clinicians reported the following:

• Poor access to care (30% of early-career respondents, 25% mid-career, 40% senior career)
• Inadequate patient wrap-around services (20% early-career, 30% mid-career, 50% senior-career)
• Incarceration of mentally ill patients (25% early-career, 35% mid-career, 40% senior-career)

The trend toward greater concern about all 3 of these issues among senior-career psychiatrists suggests, says Newton, that “As you progress, you tend to be more concerned about things outside just medicine.”

In terms of challenges facing the psychiatry profession, the respondents identified the following key challenges:

• Lack of culturally competent providers (15% early-career, 40% mid-career, 45% senior-career)
• Hostile work environments (50% early-career, 30% mid-career, 20% senior-career)
• Inadequate number of black faculty members in academia (35% early-career, 40% mid-career, 25% senior-career)

Interestingly, in contrast with the general population, no psychiatrists in their early- or mid-career stages used the word “racism” in their responses. This finding, suggests Newton, may reveal a disconnect between the patient and provider populations.

“We have to rewire our neural networks to accept the reality of what is going on in our profession…We have to talk about system change.”

In looking at the trends facing psychiatrists of African descent, Newton explained that the challenges that she and her colleagues confront today are similar to those that faced Solomon Carter Fuller—the first African American psychiatrist and the researcher for whom the lecture is named—in his own career. These challenges include pay and status discrimination, microagressions in medical education and residency training, academic tenure and promotion issues, and distrust from patients who are aware of prior ethical violations in medical research at large.

Newton called on her fellow clinicians to “Understand that, as we analyze our patients and ourselves is that we’re all suffering from the combined effects of trauma. Oftentimes, we are victims of microaggersssion…then we’re trying to help someone work out their mental disorders.”

She also encouraged colleagues to remember that they don’t work in silos; “Psychiatrists of African descent and psychiatrists in general need to understand…we work in a world where there’s hunger, where there’s water problems…all of these have an impact on the nature and the way we deliver care.”