RESEARCH WEEKLY: Erasing Racial Disparities in Early Psychosis Family Psychoeducation
By Taylor Keane
Editor’s note: May is Mental Health Awareness month and it is more important than ever to raise awareness about severe mental illness. Each Research Weekly published this month is chosen with this in mind.
Black families with a family member who has schizophrenia seek family psychoeducation at a lower rate compared to white families, according to a study published in March in Psychiatric Services. Despite the fact that, on average, Black families have more contact with clinicians, fewer Black individuals seek out family psychoeducation and other essential aspects of the treatment process. The authors conclude that this could be, in part, due to historic mistrust of medical institutions, including mental health institutions.
This mistrust leads many Black families to face additional struggles when trying to help their family members with schizophrenia. Families who attend family psychoeducation have a “better understanding of the diagnosis, improved stress management skills, decreased family burden of navigating the mental health care system and decreased depression and anxiety” according to the authors. Unfortunately, some Black families are not reaping these benefits. The authors argue that it is the responsibility of mental health institutions and the health care providers working for them, including physicians and other psychiatrists, to heal the trauma and rebuild trust with the Black community.
Systematic mistrust
The article describes the mistrust of medical institutions that is rooted deeply inside the Black community as a result of generations of discrimination and trauma. This mistrust can be especially strong toward mental health institutions as Black people have historically been over diagnosed to discredit their authority when pushing for change. During the Civil Rights movement, opponents associated leaders of the movement with schizophrenia to explain their suspicions, hostility and paranoia. Additionally, Black people have been the unknowing victims of medical experimentation, like the Tuskegee experiment in the 1900s.
Even today, Black families often feel unheard and ignored in medical settings, leading to further mistrust. The authors cite a study of more than 1,000 Black adults, which found that 75% of participants believe that racial discrimination interferes with their ability to get good health care for members of their community. Some clinicians and doctors do not acknowledge the systematic racism that they may be unknowingly playing a part in. This denial of the struggles of Black people with schizophrenia can break the confidence of families who have already taken a big step in trusting the mental health system by participating in programs such as family psychoeducation.
An endless cycle
The mistrust detailed above creates a cycle that can lead to worse illness outcomes for Black people with schizophrenia. The authors note that Black people are at an increased risk of developing psychosis, in part due to high amounts of chronic stress and trauma as a result of systemic racism. Stress is one of the contributing factors to schizophrenia and chronic stress can severely worsen illness symptoms. Higher rates of schizophrenia and lower rates of seeking help can lead to worsened outcomes for Black individuals with schizophrenia and their family members, as untreated schizophrenia also leads to more severe symptoms and a lower chance of recovery. Improving family psychoeducation and transforming it into a safe place for Black families may help break this endless cycle.
Solutions to build trust
The article outlines three main ways to combat the mistrust in the mental health system so that more Black families become active participants in the treatment of schizophrenia. The article suggests employing more people of color in the mental health care workforce. Only 10.4% of the current workforce is from a minority background. Having representation within the mental health workforce can increase comfort and understanding between patient and doctor, allowing for more trust to be built.
Additionally, the authors highlight the need to decrease stigma around serious mental illness in Black communities. Stigma develops because mental illness is often seen as a weakness and Black communities in particular may place an emphasis on strength to push past the racism and discrimination they face. The authors suggest addressing stigma in psychoeducation sessions and developing strategies to decrease it. Lastly, the authors propose encouraging mental health care providers to build relationships with leaders in Black communities such as business owners and church leaders. Community leaders already have a level of trust with their constituents and can help influence public opinion on mental health practices and stigma. The authors suggest that these steps can help build trust between Black families and mental health institutions, allowing for more access to family psychoeducation, and decreasing the dangerous stigma surrounding serious mental illness.
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