Lessons Learned: Preparing Racial Unrest and Mental Health Educational Materials
Jennifer Duan, B.A. (1), Kimberlye E. Dean, Ph.D. (2)
(1) Massachusetts General Hospital
(2) Massachusetts General Hospital/Harvard Medical School
Amid the COVID-19 pandemic, we have seen a rise in targeted, racially motivated violence and open aggression towards people of marginalized groups (FBI Uniform Crime Reporting Program, 2022). To illustrate, race and ethnicity-based hate incidences increased by 16% from 2019 to 2020, along with an increased rate of hate incidents in Asian Americans[i], Black Americans[ii], and Hispanic[iii] individuals from 2018 to 2020. Individuals across racial groups have thus experienced a growing trend of negative mental health consequences (Twenge, J. M. et al., 2021). Furthermore, these events have contributed to an exacerbation of previously unmet mental health needs across racial groups (Conroy, J. et al., 2021). Given these significant challenges, it is imperative that the current clinical workforce be equipped to manage symptoms exacerbated by racially motivated violence.
To equip the clinical workforce with actionable tools to mitigate lasting impact of racially motivated violence, we prepared a presentation highlighting the rise of mental health issues among racially and culturally diverse communities due to growing racial unrest. Our audience included clinicians working in an urban teaching hospital. To accommodate various background levels of understanding race, we were intentional in creating materials for this topic. Thus, we created the following guidelines to inform interested scholars of our process on navigating racial health disparities and to serve as a resource for anyone interested in diving deeper.
This decision was made following input from all coauthors including: (1) first author, a Chinese American woman with research interest in mental health disparities and cultural psychology; (2) second author, a Black American woman with a research focus on equity in mental health care accessibility and the intersection of trauma, substance use, and racism.
Our Objectives
In preparation for this presentation, our team consisted of three women of color from diverse educational backgrounds (one BA, two PhDs). This presentation focused on historically underserved communities, which includes Asian Americans, Black Americans, Hispanic people, and Indigenous people[iv]. Our presentation links the current political climate of increased racial hate incidences to poor mental health outcomes and then establish steps for clinicians to better serve their clients/patients of color. While the presentation was prepared for clinicians, this guide is intended for everyone interested in learning more about race and health disparities.
Our responsibilities were divided into three categories: (1) the first author was responsible for researching statistical trends of hate incidences, mental health outcomes, and access to mental health resources for minority groups; (2) the second author was responsible for establishing how providers can take actionable steps to approach client experience of racism at the clinic; (3) another researcher in our team provided overarching expertise in implementation science, community work, and planning support, but unfortunately had to step back due to other time commitments and responsibilities.
Our Approach
When initially developing our content, we used the following theories as part of our foundational framework: Bronfenbrenner’s ecological systems theory (Bronfenbrenner, 1992) and the minority stress theory (Meyer, 2003). Bronfenbrenner’s theory brought in the framework that an individual’s development from an early age is affected by multi-level systems (ex., family, access to healthcare, culture). While the minority stress theory was originally established for the LGBTQ+ community, this framework can examine how stress affects people of color and historically underserved communities (Shagani et al., 2019). By utilizing these frameworks, we made sure that our source materials aligned with viewing racial identity and health disparities as multifaceted and nuanced.
Challenges
1. Tailoring an interdisciplinary topic to a specific audience
Research can be inaccessible to a general audience, especially with complex jargon. Since we did not know our audience’s background on racial health disparities, we ensured that our presentation covered a baseline of foundational material and minimized jargon. The presentation had a 30-minute time limit, which was challenging for an extensive topic like racial health inequity. Therefore, we carefully considered which concepts to expand upon and omit. When speaking or writing about race, it is important to acknowledge the definition of race[1] and its nuances, as well as the difference in how race is interpreted and utilized in different fields, such as within public health, psychology, and ethnic studies. When working together, we also had to be mindful of balancing the presentation. The presentation started by establishing a background of current events, which involved headlines of racially motivated hate incidents scattering 2019 to early 2022 across underserved groups. To prioritize our time, we emphasized microaggressions and functional health outcomes, while cutting down material on differentiating race and ethnicity, as well as racial traumatic stress theory.
2. Scattered data
Pulling data from multiple reputable sources is a tedious but necessary part of the literature search. Since there was no centralized open-source database that encompasses health disparities from all racial groups, we encountered the issue of scattered data and having to create our own graphs from multiple sources (Figures 1 & 2). As we include multiple racial groups in our presentation, being intentional about sourcing from inclusive research articles is a must. We had to be mindful of other external factors increasing mental health disorders, such as the ongoing COVID-19 pandemic affecting disadvantaged communities. We also recognized that not all statistics will match the claims we are looking for – and that is okay. In this case, we found that there was not an increase in reported racial hate incidents for Indigenous people, according to the FBI. To be true to the literature search, including data that may counter our initial claims is just as important.
3. Importance of actionable steps
Actionable steps are especially important in educational materials. Based on our team’s presentation feedback, we noticed that participants (clinicians) found it helpful to identify actionable ways to address one’s own racial bias in a patient-provider setting.
Actionable steps for our audience included:
1. Navigating discussions of race in treatment instead of avoiding it – self-reviewing pros and cons
2. Interacting with patients from diverse backgrounds with empathy and an open mind
3. Developing and implementing trainings in racially and culturally based frameworks
4. Reviewing books that discuss the history and current events of race-based stressors
Tips Before Researching and Writing
Finally, we want to introduce actionable steps before exploring your own curiosity towards racial health disparities, which can aid your writing process as well.
1. Know your audience
We recognize that our audience for this piece may already be interested in racial disparities. While there is potentially a range of knowledge and educational backgrounds, this audience has a commonality of genuine interest and curiosity. In contrast, presenting information to an audience with little knowledge of racial health disparities requires a different approach. For a newer audience, there may not be enough time to explore the depth of your findings. Consider what fundamental frameworks can guide your team and support your goals (ex., Bronfenbrenner, Critical Race Theory).
Talking about race can elicit different emotional responses depending on an individual’s comfort, identity, and cultural background. Depending on the racial group, recognizing and connecting to one’s racial identity has been shown to have varied effects on one’s mental health (Woo, et al. 2019). Be prepared to expect a range of emotional reactions when presenting your work; do not be discouraged by fear and dampen the message of your work.
2. Recognize your own biases
Even in a diverse team, personal biases may guide us towards a specific research direction outside of inclusivity, and it is important to hold each other accountable. However, different perspectives can yield nuanced discussions, as well as opportunities to fill in any gaps, such as carefully representing different racial groups and making sure all voices are heard.
Additional Readings
As navigating racial disparities can be daunting, we hope these resources can provide a steppingstone in learning about this interdisciplinary and growing field:
Crenshaw, K., Gotanda, N., and Peller, G. (1995). Critical Race Theory: the key writings that formed the movement. The New Press.
Kendi, I. X. (2019). How to Be an Antiracist. One World.
DiAngelo, R. (2018). White Fragility: Why It's So Hard for White People to Talk About Racism. Beacon Press.
Having a foundational framework to drive one’s research or presentation is crucial to grounding one’s own understanding of the topic and communicating with an audience. We hope this guide can aid future readers and presenters in navigating race and health.
References
Bronfenbrenner, U. (1992). Ecological systems theory. Jessica Kingsley Publishers.
Bird, M. Y. (1999). What we want to be called: indigenous peoples’ perspectives on racial and ethnic identity Labels. American Indian Quarterly, 23(2), 1–21.
Crime Data Explorer. https://crime-data-explorer.fr.cloud.gov/pages/explorer/crime/hate-crime
FBI Uniform Crime Reporting Program (2022). Federal Bureau of Investigation
Conroy, J., Lin, L., & Stamm, K. (2021, April). The demographics of unmet need for mental health services. Monitor on Psychology, 52(3). http://www.apa.org/monitor/2021/04/datapoint-mental
Junn, J., & Masuoka, N. (2008). Asian American Identity: Shared Racial Status and Political Context. Perspectives on Politics, 6(4), 729–740. http://www.jstor.org/stable/20446825
Lopez, M. H. (2020). Three-Fourths of Hispanics Say Their Community Needs a Leader. Pew Research Center. Retrieved June 29, 2022, from https://www.pewresearch.org/hispanic/2013/10/22/3-hispanic-identity/
Meyer I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychological bulletin, 129(5), 674–697.
Shangani, S., Gamarel, K. E., Ogunbajo, A., Cai, J., & Operario, D. (2020). Intersectional minority stress disparities among sexual minority adults in the USA: the role of race/ethnicity and socioeconomic status. Culture, health & sexuality, 22(4), 398–412.
Twenge, J. M., McAllister, C., & Joiner, T. E. (2021). Anxiety and depressive symptoms in U.S. Census Bureau assessments of adults: Trends from 2019 to fall 2020 across demographic groups. Journal of Anxiety Disorders, 83, 102455.
Woo, B., Fan, W., Tran, T. V., & Takeuchi, D. T. (2019). The role of racial/ethnic identity in the association between racial discrimination and psychiatric disorders: A buffer or exacerbator?. SSM - population health, 7, 100378.
Notes
[1] The American Psychological Association defines race as "a socially defined concept sometimes used to designate a portion, or “subdivision,” of the human population with common physical characteristics, ancestry, or language.
[i] "Asian American" was coined in 1968 by Yuji Ichioka and Emma Gee, UC Berkeley students and founders of the Asian American Political Alliance, who wanted to encourage pan-Asian amongst political turmoil (Junn & Masuoka 2008). "Asian American" now encompasses all Asian ethnicities, including East Asian, South Asian, and Southeast Asian groups. While our sources and the U.S. census have used “Asian” to describe this demographic, we wanted to specifically note that this population is within the U.S.
[ii] "Black Americans" includes individuals with ancestry tied to enslaved Americans, immigrants from Africa or the Caribbean to the U.S, and other individuals from the African diaspora. The term has been used to be inclusive of the Black experience in America.
[iii] "Hispanic" refers to individuals who are "a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race," according to the U.S census. While this is a more cultural term, we decided to include this due to our sources using this term. According to Pew Research Center (2013), "Hispanic" was the most popular preference for the community to describe themselves.
[iv] “Indigenous people” refers to the descendants of culturally distinct ethnic groups who first inhabited a specific land, in this case the United States. According to the Smithsonian National Museum of the American Indian, Indigenous people prefer being called by their tribe's name. While "American Indian" is used in the U.S. census and "Native American" has been used throughout our sources, we intentionally researched opinions of scholars with this identity, where most participants (Yellow Bird, 1999) preferred another term other than “American Indian” or “Native American.” "American Indian" was coined during a period of colonialism, and "Native American" has been used by people who are not indigenous to the United States. Since “Indigenous” is the more inclusive of all tribes, we decided on this term.
Disclaimer: The opinions expressed in this guest blog are those of the authors. The authors do not purport to reflect the opinions or views of the Center.
