Special issue of the American Journal of Psychiatry examines structural racism and mental health disparities, offers solutions

A special issue of the American Journal of Psychiatry, released today at the American Psychiatric Association’s Annual Meeting, highlights the pervasive negative consequences of structural racism on mental health and the importance of community and system-wide interventions and proposes mental health inequity research priorities.

“It is our intention,” writes AJP Editor-in-Chief Ned H. Kalin, M.D. in an editor’s note, that the June special issue “will motivate clinicians, educators, and researchers to take actions that will make a difference.” The issue was guest edited by Crystal L. Barksdale, Ph.D., M.P.H., health scientist administrator/program director with the National Institute on Minority Health and Health Disparities (NIMHD) and was developed based on work presented at 2020 NIMH/NIMHD workshop.

The articles in this issue capture the evolving shift in the mental health and biomedical research fields acknowledging the role of social and structural determinants of health (particularly structural racism and discrimination) in disparities and inequities. The articles provide examples of research on the complex mechanisms of disparities and how to translate this information into effective interventions that advance mental health equity.

In one article addressing structural racism and youth suicide prevention, lead author Kiara Alvarez, Ph.D. (Disparities Research Unit, Massachusetts General Hospital/Harvard Medical School), and colleagues look at the impact of structural racism in three key settings: mental health services, schools, and the justice system. They propose recommendations to address structural racism in suicide prevention, with a focus on systems that are “preventive, rather than reactive; restorative, rather than punitive; and community-driven, rather than externally imposed.”

In another article, Margarita Alegría, Ph.D. (Chief, Disparities Research Unit, Massachusetts General Hospital), and colleagues focus on the opportunity to redesign mental health research and service delivery with marginalized communities provided by the Biden-Harris Administration’s budget for community mental health. The authors present interventions that have sound evidence of improving mental health or related outcomes among people of color in the U.S. within five years by addressing social determinants of health. Examples include universal school meal programs, community-based interventions delivered by paraprofessionals in afterschool recreational programs, individual placement and support for employment, mental health literacy programs, senior centers offering health promotion activities, and a chronic disease self-management program.

Drs. Alvarez and Alegría, along with Dr. Barksdale, discussed their contributions to the June issue of the American Journal of Psychiatry at APA’s Annual Meeting. Additional articles in the special June issue 1) discuss research approaches that may help to advance efforts to reduce disparities and promote health equity and 2) conceptualize how structural racism and cumulative trauma can be fundamental drivers of the intergenerational transmission of depression.

The issue will be uploaded Monday morning at: https://ajp.psychiatryonline.org/toc/ajp/179/6.

American Psychiatric Association The American Psychiatric Association, founded in 1844, is the oldest medical association in the country. The APA is also the largest psychiatric association in the world with more than 37,000 physician members specializing in the diagnosis, treatment, prevention and research of mental illnesses. APA’s vision is to ensure access to quality psychiatric diagnosis and treatment. For more information, please visit www.psychiatry.org.