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    Changing the Conversation

    To Providers Who Do their Best: Thank You!

    I often write about relationships between providers and people they serve. It is very easy to look at services and write about what is wrong and what needs fixing. However, I do think that there are more respectful and caring providers and agency personnel than not.

    As a young adult, I was homeless. I had been in and out of hospitals and was discouraged about my chances of being successful in therapy. My moods were all over the place, and I was having intrusive memories. I was trying very hard to find housing. I showed up for appointments. I was so scared and angry at the possibility of being turned down that my intolerance for disappointment was reflected in my attitude. I was anxious and certain that no one wanted to help. 

    Providing Quality Minority Mental Health Care

    Research on “health care disparities,” the euphemism for unnecessary deaths and adverse outcomes among people from low socioeconomic groups and from communities of color, often attribute them to individual characteristics and structural barriers within mental health systems. Most often an individual’s use of services as well as the way services are arranged and delivered are cited as causes.

    I want to begin by commenting on what is going wrong and then discuss what is hopeful in the provider-client relationship. Although research is taking place, there is little agreement about best practices and ethical standards in minority mental health care. The issues of staff bias, racism, institutional racism, prevailing practices, and methods of prioritizing who gets time and attention are omitted from the discussion. Also, questions of discrimination that stem from preconceived notions and racial profiling of African American people and/or questions of how stigma influences medical decisions are absent, if not actively avoided, in discussions of healthcare disparities.

    Trauma among Physicians: Healthcare Implications

    Too often, trauma research focuses solely on impact on patients in health services—especially people who experience mental illness, trauma, substance use disorders, and homelessness. We need to expand the research questions to include the following: How does trauma impact physicians and what are the implications for their relationships with patients?

    Healthcare Disparities: Is Racism in Play?

    We know that healthcare disparities exist! Statistics can tell us where disparities are occurring, which providers have the worst outcomes, and what medical decisions are contributing to the problem.

    Resolving healthcare disparities is hampered when we refuse to ask hard questions about conscious and unconscious bias among service providers and staff. For example, research on obesity has documented that physician attitudes greatly impact service use, quality, and outcomes. Studies on the impact of physician attitudes demonstrate that examining bias is critical for understanding how patients use services and how well they do.

    Empathy: A Critical Communication Skill

    Empathy is a critical communication skill for all people and is especially important for health care providers. Some individuals lack the capacity to understand how their actions make others feel. Adults with cognitive difficulties, histories of repeated trauma, and even so-called “normal” people can have difficulty connecting and understanding other people’s experiences. These people lack empathy.

    Speaking About the Unspoken: Sharing Our Experiences of Trauma, Mental Illness and Substance Abuse


    Integrating LGBTQ Youth into the Mental Health System: What I Learned from Marc Dones’ Webcast

    Throughout this week's webcast, Marc articulated the importance of understanding and integrating the experiences and needs of LGBTQ youth in the mental health system in several ways that grabbed my attention and gave me new ideas and perspectives.

    A Universal Design in Healthcare

    While the United States ranks as the international leader in biomedical research, one doesn’t have to look far to find complaints about the quality of healthcare in the United States. From service users to the Institute of Medicine, a universal cry has gone out for more compassionate, person-centered care. In short, people want to be heard and understood by their providers. They want their visits to start out with the two simple questions posed by Mitch Kaminski: What are your goals for your care? How can I help you? However, these questions can’t be asked in a vacuum. They have to be asked within a continuous, healing relationship that focuses not just on disease and illness, but strengths and wellness.

    “Trauma? That Is Not My Territory”: A Call for Universal Trauma-Informed Care

    I made excuses for over two years before allowing my male primary care doctor to complete a thorough physical exam. He turned down my request to be examined by a female physician. Over time I agreed to be examined by my male doctor because I was afraid of being branded as too demanding and unreasonable.

    But What Do I know?

    I remember when I was first doing clinical training we had an advanced psychopathology course every Wednesday after rounds. When we started, we looked at the syllabus and there were a number of familiar texts: the DSM-IV-TR, and Adult Psychopathology and Diagnosis. But sprinkled throughout the texts were other readings: Nabokov, Dostoyevsky, Rilke. After we’d had a moment to look it over the teacher said, You will no doubt notice that there are a number of texts that you have not seen before. This is because I assume that your clinical training to be largely complete. Otherwise how would you get here? But now you have to learn what things actually look like. And, over the course of my career, I have found that anywhere a psychiatrist would go a great writer has been there before and has described it better.

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