Debra L. Kaysen, PhD, ABPP
July 30, 2020
The 2020 ISTSS Annual Meeting theme on addressing challenges in meeting the needs of underserved communities, although selected long in advance of the current moment, appears strangely prescient of the moment we are in. As we watch the unfolding impact of the global pandemic, it has amplified existing disparities and has disproportionately impacted vulnerable communities. Deaths from COVID-19 are higher among Black, Brown and Indigenous people, both within and outside of the United States. When we look at deaths per 100,000 people, the top five countries are the U.K., Chile, the U.S., Peru and Brazil. Within the United States Black, Native American and Alaska Native people have a hospitalization rate that is five times higher than non-Hispanic white people, and Latinx people have a rate that is approximately four times higher than non-Hispanic white people (CDC, 2020). Within the U.K., people of color make up 34% of those who are critically ill with COVID-19 despite representing only 14% of the overall U.K. population (Bhala et al., 2020). The safety of having economic means to spread out within a household, within a community or to be able to work from home is more prevalent among those working within high-income countries, and within those countries these privileges are more prevalent among white people. Impossible decisions of risking one’s own health and one’s family’s health against issues like food security are being faced by people all over the world. Because of these disparities, the mental health impact of traumatic events associated with COVID-19 will also be more prevalent within Black, Brown and Indigenous communities, where there were already higher rates of grief and loss.
These issues coupled with the murders of George Floyd, Breonna Taylor, Ahmaud Arbery, Tony McDade, Dion Johnson and countless other Black people have highlighted globally the disproportionate burden of structural racism and police brutality. The outcry has led to protests all over the world around treatment of Black communities by the police. And each of these deaths is a trauma for the community and the protests are a cry for justice.
And in the midst of a global discussion about racism and anti-Blackness, there has also been an increase in attention to the role of racism in the hallowed halls of academia (Murugesu & Vaughan, 2020). Within psychologists in academia in the U.S., only 6% are Black and only 5% are Latinx compared to 12% and 18% of the U.S. population (Lin, Stamm, & Christidis, 2018). The problem of underrepresentation is even more striking among Indigenous communities. Issues around racism within academia are profound and range from issues of overt to covert expressions of racism toward students and faculty members. This includes undue burdens of unpaid labor expected of Black, Brown and Indigenous faculty and issues around differential rates of NIH funding based on the race or ethnicity of the principle investigator along with many other issues (Ginther et al., 2011). For those of you on Twitter, I encourage you to explore #BlackintheIvory to listen to the stories of those who have experienced racism in academia (Subbaraman, 2020).
The issue of underrepresentation of people of color in academia has profound impacts on our ability to extend access to mental health care. For example, when we look at the global mental health workforce these disparities are even more striking. In an analysis of clinical capacity focusing on mental health needs and capacity across 58 countries, all of the low-income countries and 59% of the middle-income countries had a shortage of mental health personnel in relation to the mental health needs of their country (Bruckner et al., 2011). Overall, the analyses found that only 34% of the mental health need was met by the current trained workforce. Although the shortage of a trained mental health workforce locally and globally is complex and multiply determined, a lack of people of color in roles of faculty and trainers contributes to this. It is harder to follow a career pathway when there are not role models and supporters to help lead the way.
These issues are critically important for us to address as a field and to come together and listen, learn and implement changes. The problems of trauma and the mental health impact of these events are borne disproportionately by people of color and other minorities around the world. Fundamental questions such as what counts as a traumatic event, what symptoms are important in defining a trauma response, what is individual pathology versus macro-level pathology, what counts as a good treatment outcome, what strategies are effective in helping people heal, and more need to be asked from a broad array of perspectives and viewpoints. Solutions to the mental health burden of traumatic stress have to be developed with people who have lived experiences and are members of these communities. Moreover, the experience of science, of clinical practice, and of teaching and mentoring will be richer as a result. Our hope is that the 2020 Annual Meeting will provide some steps toward meeting the needs of underserved communities. Our hope is that in the years to come ISTSS will continue this process through focusing on the strategic goal of increasing the diversity of our membership and increasing our global impact.
Bhala, N., Curry, G., Martineau, A. R., Agyemang, C., & Bhopal, R. (2020). Sharpening the global focus on ethnicity and race in the time of COVID-19. The Lancet, 395(10238), 1673-1676.
Bruckner, T. A., Scheffler, R. M., Shen, G., Yoon, J., Chisholm, D., Morris, J., ... & Saxena, S. (2011). The mental health workforce gap in low-and middle-income countries: a needs-based approach. Bulletin of the World Health Organization, 89, 184-194.
Centers for Disease Control. COVID-19 in Racial and Ethnic Minority Groups https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/racial-ethnic-minorities.html
Ginther, D. K., Schaffer, W. T., Schnell, J., Masimore, B., Liu, F., Haak, L. L., & Kington, R. (2011). Race, ethnicity, and NIH research awards. Science, 333(6045), 1015-1019.
Lin, L., Stamm, K., & Christidis, P. (2018). How diverse is the psychology workforce? News from APA’s Center for Workforce Studies. Monitor on Psychology, 49(2), 19.
Murugesu, J. A., & Vaughan, A. (2020). Science's institutional racism.
Subbaraman, N. (2020). How# BlackInTheIvory Put a Spotlight on Racism in Academia. Nature, 582(7812), 327.