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Mental Health and Students of Color

By Sarah Vinson posted 08-24-2021 15:42


As a black child psychiatrist, I’m often asked about the mental health of black students and/or students of color. My first response? The lived experiences and racial identities of students of color - even those who identify as the same race - are remarkably diverse. This reality underscores the need for cultural humility. Additionally, despite our desire to serve, healthcare providers, and the systems in which we operate, are not immune to racism and bias. Here are three key (though by no means sufficient) steps in providing care in inter-racial treatment settings.

1. Be Humble – Healthcare providers should strive for cultural humility rather than competence - Though cultural competency is often put forward as a goal for inter-racial treatment interactions, it has definite shortfalls. It presumes that an entire group of people can be summarized in a webinar, training, or information sheet. It implies an endpoint and can lead providers to come to rely on inaccurate assumptions about a given student or family. In contrast, cultural humility encourages curiosity and bi-directional learning. Rather than the provider as “expert” because of their course work or CEU, they rely on the student and family as the experts of their lived experiences and values.

2. Know Thyself – And Act – It’s not just the students and families of color that brings their culture to the treatment experience, white healthcare providers do too. Often white culture is treated as an invisible norm; however, there are of course lived experiences of white people that shape their values, views, and traditions as well. American society is one that is rife with narratives and imagery that foster numerous biases (including but not limited to) negative associations with certain racial groups and positive associations with others.

A healthcare provider’s self-examination can be helpful in identifying blind spots and areas where disconnects are more likely to occur. One way to explore biases is the Implicit Association Test, which is available for free online. Awareness of bias is just the beginning. The next step should include something more direct and substantive that can quantify that bias. A possible approach is to do a retrospective review of documentation and treatment approaches to students by race to identify, and then intentionally correct for, racial inequities. In this way, clinicians can draw a connection between their bias identified through the IAT and their assessment, diagnosis and treatment process.

3. Know Your Students’ Community – Many often-used measures, such as the original ten question Adverse Childhood Experiences (ACE) study, are not normed on racially representative populations. This can lead to under-recognition of traumas that impact the population you serve, but not the largely middle class, college educated, white population that was part of the original study.

For example, racialized trauma such as highly publicized killings of black individuals, has documented detrimental mental health impacts that differentially affect people of the same color as the victim. Also, myriad intersecting structural traumas have resulted in hyper-segregated communities with exposures to community violence and limited vocational opportunities. The ACE questionnaire captures neither. Providers who rely on this to identify trauma will miss important factors that can shape the way children think, feel and behave. While students should be asked about their individual experiences, zip code data regarding a given school’s catchment area can provide valuable insight into these neighborhood level characteristics. This fact finding is of particular importance when school nurses do not live in the same neighborhoods as the students they serve.