3 Questions with Dr. Isom: Equity in Mental Health
Mental health has become an increasingly prominent focus for organizations both in the public and private sector as the COVID-19 pandemic continues into its third year. According to a Kaiser Family Foundation national survey, nearly one third of American adults have reported symptoms of anxiety and depression and one fourth of children and adolescents have reported an uptick in emotional and mental health challenges. Both demographics have reported an increase in substance use, highlighting the need for urgent intervention. This data represents the needs of the general population, but, when disaggregated by race and ethnicity, the urgency is even more apparent for racialized minorities. Real Chemistry spoke with Jessica Isom, M.D. M.P.H., community psychiatrist at Codman Square Health Center, clinical instructor at Yale University Department of Psychiatry, and owner of Vision for Equity LLC, to get her take on the issue of equity in mental health.
1. What are the three biggest mental health challenges impacting communities of color?
As individuals and families navigate the mental health system and services, racialized minorities are also contending with a lack of pharmacoequity. Health care professionals have identified this as a lack of access to the highest quality, evidence-based medical therapy indicated for the conditions that are of increasing concern since the pandemic began. In addition to access and quality concerns, racialized minority communities are dealing with an incredible level of stigma, which is reinforced by a relative lack of targeted public messaging campaigns to destigmatize mental illness. Stigma has been shown to affect health behaviors such as disclosing symptoms, seeking out traditional mental health support, and following through on suggested interventions. A lack of culturally sensitive and responsive services within the mental health system compounds stigma, making it harder for racialized minorities to engage and continue participating in treatment.
An opportunity exists for biopharma companies to support communities of color in navigating the challenges of stigma, lack of access and poorer quality care.
2. How are biopharma companies reaching communities of color with mental health products and services?
Biopharma companies have primarily highlighted the need for intervention in addressing the lack of racial-ethnic diversity within clinical trial participation as a means toward achieving mental health equity. Several companies, including Johnson & Johnson, Abbot, Novartis and Eli Lilly, have committed to increasing the number of racialized minorities in clinical trials through various efforts and initiatives. For example, they plan to collaborate with historically Black colleges and universities (HBCU) and research centers located in areas with a high density of racialized minorities, and create partnerships to reduce stigma and increase medical trust. Biopharma companies also are investing in increased diversity within the STEM fields by creating outreach programs for underprivileged youth and college scholarships to support their education.
3. What is the gap between these challenges and what biopharma companies are currently doing to address them?
One of the most noteworthy gaps in the focus of interventions geared toward medical mistrust is the lack of focused efforts to reduce medical racism – defined as the systematic and pervasive disparate treatment of racialized minorities that persists despite level of education, socioeconomic class or insurance type and coverage. While the consequences of medical racism are felt both directly and indirectly by patients, their families and entire communities, the downstream impacts must be considered by biopharma companies as well. In a study of more than 2,300 Californians who self-identified as racialized minorities, patient and family exposure to racial discrimination, bias and stereotyping was strongly correlated with medical mistrust. The study also found that lack of a consistent relationship with a health care professional contributed to medical mistrust. Interventions on medical mistrust must not start and end with patient education. Instead, they should challenge the limited and often narrow understanding of health care professionals and institutions that value increasing patient trust more than increasing their workforce and organizational trustworthiness.
Addressing this gap also requires identifying and investing in scalable solutions for mental health equity that tackle disparities in access to care as well as quality of care. One promising approach is digital tech solutions such as the Patient Orator application, which supports the patient’s sharing of health-related information in the clinical setting. This application is intended to address medical racism and health inequities by closing the communication gap between patients and their health teams. Because a proper diagnosis is the primary gateway to accessing medical therapeutics, accurate history-taking is an essential cornerstone for achieving mental health equity. Training programs for psychiatrists, psychologists, social workers and other mental health professionals should focus on improving communication. Pioneering efforts in medical education stand to increase the cultural sensitivity and responsiveness of the mental health workforce.
Finally, innovations for mental health equity should sample the solutions offered by those from the very communities that have experienced neglect in the face of significant need. Establishing partnerships with community-based clinics and federally qualified health centers can provide biopharma companies with the relationships and perspectives necessary for creating informed solutions that meet the needs of the community.
In summary, many efforts are ongoing to address mental health inequities that are deserving of recognition. Yet, much more needs to be done as rates of mental health challenges and substance use continue to rise among racially minoritized communities. Innovation coupled with an understanding of the mental health system and its shortcomings will be key to closing the gap and eliminating mental health inequity.
Dr. Isom is a community psychiatrist, public speaker, medical educator and consultant for diversity, equity, inclusion and antiracism projects. Driven by a passion for collaborative leadership, she takes pride in providing the conceptual frameworks and psychological safety necessary to expand the growing edges of her clients and peers. Dr. Isom draws on her psychiatric training and humble background to connect across differences in power, education and perspective to foster a collaborative approach to achieving racial justice and equity in medicine and beyond. Find her on LinkedIn, Twitter and Clubhouse.
As our Global Chief Inclusion and Health Equity Officer, Mary Stutts leads our DE&I strategy, bringing together a unique combination of internal inclusion initiatives with multiple customer-facing efforts across the entire health ecosystem. She believes in the work Real Chemistry is doing and knows we are uniquely poised to build a new kind of DE&I ecosystem based on our data-driven, tech-enabled solutions, health care expertise and creativity. Find her on LinkedIn.
