Addressing Racism and Racial Trauma in Behavioral Healthcare: A Review With the Experts

Recent social movements such as Black Lives Matter and protests over the murder of George Floyd have brought anti-racism and diversity, equity, and inclusion to the forefront of American consciousness. For behavioral health providers, addressing racism and racial trauma in behavioral healthcare is crucial. Providers have a moral obligation to understand how incidents of racism can impact clients of color and have the competency to address this impact.

At our 2021 Impact Nation conference, we sat down with three experts in the field of behavioral healthcare and its intersection with racism and racial trauma. Jamila Holcomb, Ph.D., LMFT, Ifeanyi Olele, OD, MBA, MS, and Benjamin Reese, Psy.D., discussed the foundations of what is considered racial trauma, how racism impacts individuals and families, and what behavioral healthcare clinicians can do to mitigate its effects.

Throughout this robust discussion, several participants asked insightful questions that merit greater awareness. The following content is a collective answer from our panelists.

Addressing the impact of racial trauma in behavioral healthcare

Question: What is the best way for friends or family to help address or minimize this trauma?

For children, research would indicate that racial and ethnic socialization is an effective tool to help them cope with racial trauma. This includes the direct or indirect messages children receive about the meaning of race in a way that bolsters a positive view of their own racial identity. Friends and family of children who have experienced racial trauma can view this resource on racial and ethnic socialization, which has a lot of great resources and information about this process.

For adults, we can simply listen to our family and friends and allow them the space to process their experiences. We can continue to do our own work so that we can work on dismantling the systemic racism that is impacting our lives.

Origins of racism

Question: Where do you believe the majority of the system of racism begins in society? In families? Education?

We need to look at the history of white supremacy and how races were socially constructed to further perpetuate this ideology. Central to the foundation of racism in America was the notion that Africans were not human. Unlike institutions of slavery in other countries, which was often the result of war, Africans were viewed as inherently inferior beings. Throughout the 18^th and 19^th centuries, pseudo-science promulgated notions of Africans having smaller brains, thicker skin, fewer nerve endings, etc.

Africans were generally enslaved their entire life. They were property to be purchased, insured, and then transferred to relatives after the death of the master. The foundation of every American sector of life was built around this system. Formally ending slavery in 1865 did not change the systems and structures built into this nation, and it certainly didn’t change the mindset of most White Americans at the time.

Abundant research on implicit bias clearly indicates how deeply ingrained notions of “Black inferiority” are within our culture. Racial inequities in every sector of American life continue to impact the feeble attempts to create racial equity.

In regard to childhood and education, research suggests that many young children with racially diverse friends often harbor unconscious or implicit notions of racial inequity. Schools in Black communities remain underfunded, with implicit bias impacting the assessment and evaluation of Black students in these schools.

There is also a history of racism in education in America. For example, in the 1800s, it was a crime to teach a Black person to read or write. Additionally, many of the major U.S. universities (some incorporated in the 1600s and 1700s) were created as segregated institutions.

These are brief comments that don’t even begin to describe and document the history of racism in America. The book My Grandmother’s Hands by Resmaa Menakem does a great job of connecting this history to our current experiences that might be helpful.

Racial bias in diagnosing

Question: When it comes to diagnosing, we see that Black/African Americans have higher rates of being diagnosed with schizophrenia, where instead the diagnoses should be PTSD or MDD. How can we change the way clinicians are diagnosing Black/African Americans?

One of the reasons we see this misdiagnosing happening is due to the biases of the clinician. We need clinicians to become aware of their explicit and implicit biases so they know when to challenge themselves and others in the field when we attempt to place a diagnosis on symptoms.

Clinicians should make sure they commit themselves to meeting the criteria for diagnosis in the DSM-5. They should also make sure to re-evaluate their initial diagnosis as they have regular follow-ups with their clients.

We can also have a system of checks and balances in place, where peers review our diagnoses or have peer consultation regarding diagnoses. Peer reviews of the initial diagnosis can help reduce the change of a client being misdiagnosed and offers the opportunity for someone to help challenge our possible biases.

Incorporating anti-racism into your organization

Question: When you work for a company that is trying very hard to make a culture shift, what is the best way to move this action forward?

If everyone is on board with the culture shift to incorporate anti-racism work into your organization, first take a review of the policies that shape your organization. See where you can be more inclusive, create a mission statement, and outline goals that work toward creating a more diverse and safe space for everyone. It might be helpful to hire a DEI consultant who can help outline next steps in this process.

Jamila Holcomb, Ph.D., LMFT, is a licensed marriage and family therapist in Tallahassee, Florida, specializing in individual, family, and trauma counseling. She also provides consultation and trainings centered around anti-racism, diversity, equity, and inclusion best practices within the education and mental health fields.  

Ifeanyi Olele, DO, MBA, MS, is a board-certified psychiatrist and received his medical degree from Philadelphia College of Osteopathic Medicine. He is the founder and CEO of Genesis Psychiatric Solutions, a mental health outpatient clinic with offices in Virginia and Washington D.C.

Benjamin Reese, Psy.D., is a clinical psychologist and president of BenReese, LLC, a North Carolina-based global diversity, equity, and inclusion consulting firm. He is also an adjunct professor in the Departments of Psychiatry and Behavioral Sciences, Community Medicine & Family Health, and Psychology and Neuroscience at Duke University.

Editor’s Note: This blog post was recognized as a Silver winner in the Media/Publications category of the Spring 2022 Digital Health Awards.