Feb 3, 2021
Ruth S. Shim, MD, MPH, joins Carol A. Bernstein, MD, to discuss
how to understand systemic racism within psychiatric institutions
and the implications for patient care.
Dr. Shim is the Luke & Grace Kim Professor in Cultural
Psychiatry in the department of psychiatry and behavioral sciences
at the University of California, Davis. She has no disclosures.
Dr. Bernstein, a past president of the American Psychiatric
Association, 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
- Dr. Shim discusses her
editorial published by statnews about why she left the APA, and
describes her frustration about what she sees as the APA’s failure
to prioritize mental health inequity and structural racism within
the organization.
- Dr. Shim describes systemic racism and oppression as
generational traumas that must be recognized and processed if our
professional organizations and country are to move forward with
equity. Psychiatry plays a role in healing societal trauma, so
psychiatrists need to understand and address the damage of
structural racism in our own system.
Summary
- After psychiatry training, Dr. Shim became faculty at Morehouse
School of Medicine, one of the few historically Black medical
schools. During her clinical work in Atlanta, Dr. Shim noted the
difference in health outcomes of inpatients at Emory University
Hospital, which treated majority White patients, compared with
those of Grady Memorial Hospital, which treated majority Black
patients. This observation propelled her research into health
disparities, which continues to inform her academic work.
- Dr. Shim’s decision to leave the APA occurred during the
presidential term of
Altha J. Stewart, MD, who, even as the first African American
president of the organization, was thwarted in her attempt to push
the APA to focus attention and resources on addressing mental
health disparities, inequity, and systemic racism within the
organization and psychiatry, according to Dr. Shim.
- Dr. Shim observes that systemic racism occurs when the
structures of an organization, not individuals, perpetuate the
inequity. An example within the APA is the disconnect and power
disparity between the group’s executive leadership structure and
its elected officials. This disconnect and power disparity stymie
progressive voices and interventions, Dr. Shim said.
- Addressing systemic racism within an organization is
challenging because it may not be considered a problem by all
members, and usually the leadership of an organization caters to
its majority. As an example, Dr. Shim discussed the APA’s
systematic attempt to reduce resources and cancel the Mental Health
Services Conference (formerly Institute for Psychiatric Services,
or IPS meeting), which focuses on health care delivery to the most
vulnerable populations. As observed by Dr. Bernstein, the IPS
meeting might have incurred financial losses, but investment in
such a meeting demonstrated the APA’s concern for mental health
equity. (The Mental Health Services Conference was not held in 2020
but is scheduled to be held virtually Oct. 7-8, 2021).
References
Shim RS and Vinson SY, eds.
Social (In)Justice and Mental Health. Washington, D.C.:
American Psychiatric Association Publishing, 2021.
Shim RS. Structural racism is why I’m leaving organized
psychiatry.
Statnews.com. 2020 Jul 1.
Marmot M et al.
Lancet. 2008 Nov 8;372(9650):1661-9.
Okun T. White supremacy culture.
Dismantlingracism.org.
APA apologizes for its support of racism in psychiatry.
psychiatry.org. 2021 Jan 18.
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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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