Formally recognized in June 2008, Bebe Moore Campbell National Minority Mental Health Awareness Month—also known now as Black, Indigenous and People of Color (BIPOC) Mental Health Month—was created to bring awareness to the unique struggles underrepresented groups face in regard to mental illness in the U.S.
According to the National Alliance on Mental Illness, the goals of Bebe Moore Campbell National Minority Mental Health Awareness Month are to improve access to mental health treatment and services and to enhance public awareness of mental illness and mental illness among minorities.
In honor of BIPOC Mental Health Month, Spencer Simon, a physician assistant who provides overnight psychiatric care to patients presenting to the Duke University Hospital Emergency Department, recently sat for an interview to talk about his work in behavioral health.
A Brief History of Racism in Health Care
As part of American culture and society, health care in the U.S. is not immune to structural inequity and systemic racism. Historically, aspects of traditional medical education, diagnostic reasoning and treatment decisions in relation to people of color have been based on early American pseudoscientific beliefs that Africans possess inferior cognitive abilities and the notion that enslavement protected against mental illness through providing “benefits” of structured daily activities, meals and housing.
Over the centuries, American medical education has sometimes unwittingly continued to promulgate the notion of “race” as being biologically determined, demonstrated through surveys and practice patterns of individual physicians and the system as a whole (Hoffman et al., 2016; Wildeman and Wang, 2017). Psychiatry in particular has been subject to cultural norms and expectations; diagnoses and treatment recommendations have evolved over time, and not always in response to empiric evidence.
Around the time of the Civil War, enslaved Black individuals labeled as “property” who displayed signs of depression, fatigue, distress or burnout were given diagnoses of “negritude,” “drapetomania” and “dystaesthesia aethiopica”—all of which were treated by whipping (Lowe, 2006; Willoughby, 2018). After emancipation, medical professionals continued to recommend against mental health treatment for individuals of African descent, sending “lunatic” and “defective” individuals of African descent to almshouses and jails, where they were not offered any medical intervention and were, instead, kept on false pretenses and subject to forced labor. Indigenous Americans were similarly institutionalized and deprogrammed in facilities such as forced boarding schools and psychiatric institutions, where they were forced to suppress their traditional beliefs and abandon their cultural practices (Spaulding, 1986).
Structural Inequities Persist
To this day, students of color, whose behavioral disruptions are more likely to come to the attention of school principals, are disproportionately sanctioned and punished (Bacher-Hicks et al., 2021). BIPOC students are accordingly less likely to complete school and more likely to end up in detention facilities, where mental illness is overrepresented—and is under-recognized, under-diagnosed and under-treated (NAMI.org).
Institutional realities combine with stigma and well-earned mistrust by Black individuals to yield lower rates of continuity follow-up and treatment for Black individuals with mental illness. Black patients accordingly present in greater percentages to emergency departments for crisis stabilization and are more likely to experience traumatizing or criminalizing approaches to acute management of their behavioral health conditions. For instance, if a patient in the emergency department requires inpatient care, they are typically handcuffed and shackled while en route to the treatment center.
Providing Care in the ED
Physician assistant Spencer Simon, a member of the behavioral health team in the Duke University Hospital Emergency Department (ED), has dedicated his life to fulfilling his calling to serve others by helping them improve their health as holistically as possible—and he wears many hats in service of that calling. First and foremost, he is a clinician who works to see his patients in their entirety as human beings.
During the day, Simon manages a panel of psychiatric patients seeking outpatient care at his private practice; at night, he’s on service in Duke’s ED. He also contributes to advocacy efforts, serving on the leadership council of Sandhills Local Mental Health Entity Managed Care Organization.
After working in private practice for a few years, Simon sought the advanced practice provider position at Duke to “continue to have the supervision, the tutelage, the oversight and the connection of being in a teaching environment or hospital” to help him provide the best care possible for his patients. He also actively seeks opportunities to advocate for equitable care and treatment and true, humility-based cultural competency as a key to unlock opportunities for meaningful improvement. He completed a graduate degree in chaplaincy, and he taps into his deep spiritual purpose to understand wholeness and healing as more than merely physical. He is driven to help patients find holistic mind-body-spiritual health.
Rewards and Challenges
At its most fulfilling, Simon’s work in mental health provides him with an opportunity “to give hope to the hopeless.” He explains, “When it’s all said and done, no matter if a patient has a mood disorder, trauma, PTSD—if there is a measure of hopelessness there, if I can somehow help them propel to a period of wholeness, that’s very satisfying.”
He acknowledges that working in the ED can be difficult, given the rapid pace, the number of individuals involved in a patient’s care, the challenge of connecting meaningfully with patients in a short time frame, persisting inequities and bias, systemic barriers, and the limitations of providing care in that setting. Even more challenging, he notes, is the realization that current resources are insufficient to meet patients’ needs. “All service areas are stretched, and there’s only so much we can do,” he laments.
As part of his holistic approach to patient care, Simon emphasizes the need to recognize the role socioeconomic factors play in one’s health and well-being—and that unmet socioeconomic needs often persist across generations. “There are so many variables there that we don’t see within that limited 40-minute visit,” he notes. “If we can be sensitive to that, we can have that discussion with our patients to help break down significant barriers.”
On the occasion of BIPOC Mental Health Month, Simon praises the idea of applying evidence-based methodologies to improve mental health for all. At the same time, he notes that investment in mental health must be ongoing: “The mental health of many people in this nation is slowly degrading … because [as a society] we haven’t really put our time, our energy, our efforts or our money where they need to be put.”
To help improve this bleak outlook, Simon offers a call-to-action for behavioral health professionals: engage in lifelong learning. “We can’t help where we come from, how we were raised, what we were taught, what we were exposed to … but we have a higher calling as medical professionals.” Reflecting on his ongoing quest to address his own blind spots and improve his knowledge and ability to relate to patients, he notes, “We’re never too far beyond our professional education to learn how to relate better to our patients.”
References
- Hoffman KM, Trawalter S, Axt JR, et al. Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between Blacks and Whites. Proc Natl Acad Sci USA 2016;113:4296–301.
- Wildeman C, Wang EA. Mass incarceration, public health, and widening inequality in the USA. Lancet 2017;389:1464–74.
- Willoughby CDE. Running away from drapetomania: Samuel A. Cartwright, medicine, and race in the Antebellum South. J South Hist 2018;84:579–614.
- Lowe TB. Nineteenth century review of mental health care for African Americans: a legacy of service and policy barriers. J Sociol Soc Welf 2006;33:29–50.
- Spaulding JM. The canton asylum for insane Indians: an example of institutional neglect. Hosp Community Psychiatry 1986; 37:1007–11.
- Bacher-Hicks, A., Billings, S., Deming, D. (2021). Proving the school-to-prison pipeline: Stricter middle schools raise the risk of adult arrest. Education Next, 21(4), 52-57. www.educationnext.org/proving-school-to-prison-pipeline-stricter-middle-schools-raise-risk-of-adult-arrests/. Accessed 7/6/2022.
- www.nami.org/NAMI/media/NAMI-Media/Infographics/NAMI_CriminalJusticeSystem-v5.pdf. Accessed 7/6/2022.
- Interview with Spencer Simon. Conducted by Jane Gagliardi 7/6/2022 4:30-5:20 p.m.