White supremacy culture and the assimilation trauma of medical training: ungaslighting the physician burnout discourse.

The physician burnout discourse emphasises organisational challenges and personal well-being as primary points of intervention. However, these foci have minimally impacted this worsening public health crisis by failing to address the primary sources of harm: oppression. Organised medicine's whiteness, developed and sustained since the nineteenth century, has moulded training and clinical practice, favouring those who embody its oppressive ideals while punishing those who do not. Here, we reframe physician burnout as the trauma resulting from the forced assimilation into whiteness and the white supremacy culture embedded in medical training's hidden curriculum. We argue that 'ungaslighting' the physician burnout discourse requires exposing the history giving rise to medicine's whiteness and related white supremacy culture, rejecting discourses obscuring their harm, and using bold and radical frameworks to reimagine and transform medical training and practice into a reflective, healing process.

Telepsychiatry in an Alaska Native Residential Substance Abuse Treatment Program.

Introduction: Alaska Native communities experience high rates of alcohol and substance abuse and face challenges accessing quality, culturally appropriate treatment. Telepsychiatry could help bridge this gap, but no publications have examined its impacts for alcohol and substance abuse treatment directed at Alaska Native communities. This study explores one telepsychiatry clinic's impact on a residential substance abuse treatment serving the Alaska Native community in Anchorage, Alaska. Methods: Using a matched case - control design, 103 cases receiving telepsychiatry services between 2007 and 2012 were matched with 103 controls who did not. Outcome measures included length of stay, discharge plans, emergency room visits, and hospital admissions; clinical history, including previous suicide attempts, history of violence, and trauma history; social stressors such as current legal issues, unemployment, and homelessness; mental health, medical, and substance abuse diagnoses; and number of telepsychiatry appointments and nature of telepsychiatry services rendered. Results: Both groups exhibited high rates of mental and medical illness, socioeconomic challenges, and substance abuse. However, the telepsychiatry group demonstrated a significantly higher rate of post-traumatic stress disorder, history of violence, ongoing legal issues, and children in outside custody. It also remained engaged in treatment longer, had fewer discharges against medical advice, and was more likely to complete treatment. Discussion/Conclusions: Our study highlights this telepsychiatry clinic's real-world difference serving the complex substance abuse treatment needs of Alaska Native individuals. It also reinforces telepsychiatry's promise in serving other communities facing a high burden of addiction and mental illness yet facing barriers to high-quality, culturally competent services.

Reimagining the CARE in Systems to Combat the Pediatric Mental Health Crisis in America: A Healing-Centered Approach.

The US child mental health care system requires a revival and reimagination. We need to shift toward healing-centered models of care and prioritize access to high-quality mental health care through policy changes and resource allocation. Funding community-based programs that provide culturally responsive, antiracist, and equitable (CARE) systems is essential. Policies must be implemented to reduce barriers to accessing mental health services for underresourced communities. By prioritizing (CARE) over control, we can build a just workforce that is equipped to address the needs of a growing diverse population and ensure that all children and families can heal and thrive.

Reimagining Medical Education Toward Antiracist Praxis.

Medicine has a longstanding history of racism that promulgates existing health inequities. Current medical education, largely based on the biomedical framework, omits critical discourse on racism and White supremacy, which continue to harm individuals and communities of color. Such ahistorical and apolitical orientation inadequately trains learners to identify and address racism in clinical practice. Although curricula on racial health disparities, social determinants of health, cultural competency, and implicit bias have been operationalized by several medical schools, they do not identify the racism embedded in systems of care, nor do they provide transformative steps toward true health equity and justice. As such, this article proposes bold radical frameworks as the foundation for reimagining medical education in the United States. Founded on critical race theory, abolition, and decolonization, the authors provide a view of an antiracist medical education, one that highlights the history and legacy of racism in medicine and positions medical trainees and practicing physicians as active agents in medicine's antiracist transformation.

Teaching the Legacy of Slavery in American Medicine and Psychiatry to Medical Students: Feasibility, Acceptability, Opportunities for Growth.

Introduction: Understanding the legacy of slavery in the United States is crucial for engaging in anti-racism that challenges racial health inequities' root causes. However, few medical educational curricula exist to guide this process. We created a workshop illustrating key historical themes pertaining to this legacy and grounded in critical race theory. Methods: During a preclinical psychiatry block, a second-year medical school class, divided into three groups of 50-60, attended the workshop, which comprised a 90-minute lecture, 30-minute break, and 60-minute small-group debriefing. Afterwards, participants completed an evaluation assessing self-reported knowledge, attitudes and beliefs, and satisfaction with the workshop. Results: One hundred eighty students watched the lecture, 15 attended small-group debriefings, and 132 completed the survey. Seventy-six percent (100) reported receiving no, very little, or some prior exposure to the legacy of slavery in American medicine and psychiatry. Over 80% agreed or strongly agreed that the workshop made them more aware of this legacy and that the artwork, photographs, storytelling, and media (videos) facilitated learning. Qualitative feedback highlighted how the workshop improved students' knowledge about the legacy of slavery's presence in medicine and psychiatry. However, students criticized the lecture's scripted approach and requested more discussion, dialogue, interaction, and connection of this history to anti-racist action they could engage in now. Discussion: Though this workshop improved awareness of the legacy of slavery, students criticized its structure and approach. When teaching this legacy, medical schools should consider expanding content, ensuring opportunities for discussion in safe spaces, and connecting it to immediate anti-racist action.

The Color of Child Protection in America: Antiracism and Abolition in Child Mental Health.

This article illuminates the color of child protection by exposing the risks of racist and white supremacist harm intrinsic to the child welfare, public education, and juvenile injustice systems, specifically when they intersect with the child mental health system. Relying on bold and radical frameworks, such as abolition, critical race theory, and decolonization, it positions child mental health providers to confront the color of child protection while protecting minoritized children against these systems of harm. These frameworks inspire a daily antiracist practice whereby child mental health providers challenge racist inequities and the historical arcs driving them; protect minoritized children and families against the systems of care designed to harm them; and work toward the longer-term goal of abolishing these systems altogether. In a white supremacist society, child mental health providers have no choice but to engage in such antiracist practices in order to uphold their fundamental oath to first do no harm. The failure to do so amounts to negligence and malpractice.

Nurturing Children's Mental Health Body and Soul: Confronting American Child Psychiatry's Racist Past to Reimagine Its Antiracist Future.

This paper unpacks the legacy of racism and white supremacy in American child psychiatry, connecting them to current racist inequities, to reimagine an antiracist future for the profession, and to serve all children's mental health body and soul. History reveals how child psychiatry has neglected and even perpetuated the intergenerational trauma suffered by minoritized children and families. By refusing to confront racial injustice, it has centered on white children's protection and deleted their role in white supremacist violence. An antiracist future for the profession demands a profound historical reckoning and comprehensive reimagining, a process that this paper begins to unfold.

An Abolitionist Approach to Antiracist Medical Education.

Medical education is limited to the biomedical model, omitting critical discourse about racism, the harm it causes minoritized patients, and medicine's foundation and complicity in perpetuating racism. Against a backdrop of historical resistance from medical education leadership, medical students' advocacy for antiracism in medicine continues. This article highlights a medical student-led antiracist curricular effort that moves beyond a biomedical model and uses abolition as the guiding framework in the creation process, the content itself, and iterative reflection through further study and dissemination.

La educación médica se encuentra limitada al modelo biomédico, mientras que omite el discurso crítico sobre el racismo, el daño que causa a los pacientes minoritarios y el fundamento y complicidad de la medicina en la historia de perpetuar el racismo. En un contexto de resistencia histórica por parte de los líderes de la educación médica, los estudiantes de medicina continúan militando por la necesidad del antirracismo en la medicina. Este artículo destaca un esfuerzo curricular antirracista dirigido por estudiantes de medicina que va más allá de un modelo biomédico y utiliza la abolición como marco de referencia en el proceso de creación, el contenido en sí mismo y el reflejo repetitivo a través de un mayor estudio y difusión.

How to Measure Racism in Academic Health Centers.

Institutional racism is a set of practices and policies that disadvantage individuals not part of societies' dominant groups. In academic health centers (AHCs), institutional racism mediates structural racism; it is embedded in institutional policies, clinical practice, health professional training, and biomedical research. Measuring institutional racism in AHCs at the individual, intra-organizational, and extra-organizational levels renders visible how AHCs mediate structural racism by implementing policies that unfairly treat minority groups.

A validation study of the Zanmi Lasante Depression Symptom Inventory (ZLDSI) in a school-based study population of transitional age youth in Haiti.

BACKGROUND: The Zanmi Lasante Depression Symptom Inventory (ZLDSI) is a screening tool for major depression used in 12 primary care clinics in Haiti's Central Plateau. Although previously validated in a clinic-based sample, the present study is the first to evaluate the validity and clinical utility of the ZLDSI for depression screening in a school-based population in central Haiti. METHODS: We assessed depressive symptoms in a school-based sample of transitional age youth (18-22 years; n = 120) with the ZLDSI. Other mental health-related assessments included a modified Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID) for current Major Depressive Episode, the Center for Epidemiologic Studies Depression Scale, and selected items adapted from the Global School-Based Health Survey mental health module. Diagnostic assignments of major depressive episode (MDE) were based on modified SCID interviews. RESULTS: The ZLDSI demonstrated good overall accuracy in identifying current MDE (Area under the Curve = .92, 95% CI = .86, .98, p < .001). We ascertained ≥12 as the optimal cut-off point to screen for depression with a sensitivity of 100% and a specificity of 73.9%. In addition, the ZLDSI was associated with other measures of depressive symptoms, suggesting that it demonstrates construct validity. CONCLUSIONS: Study findings support that the ZLDSI has clinical utility for screening for depression among school-going transitional age youth.

Child and Adolescent Mental Health in Haiti: Developing Long-Term Mental Health Services After the 2010 Earthquake.

This article presents an overview of child and adolescent mental health in Haiti, emphasizing the role of structural violence and the factors shaping child protection. The 2010 Haiti earthquake is discussed as an acute on chronic event that highlighted the lack of pre-existing formal biomedical mental health services and worsened the impact of structural violence. Considerations for long-term, sustainable, culturally relevant child and adolescent mental health care in Haiti are also provided.

Dissemination and implementation of evidence-based practices for child and adolescent mental health: a systematic review.

OBJECTIVE: Although there has been a dramatic increase in the number of evidence-based practices (EBPs) to improve child and adolescent mental health, the poor uptake of these EBPs has led to investigations of factors related to their successful dissemination and implementation. The purpose of this systematic review was to identify key findings from empirical studies examining the dissemination and implementation of EBPs for child and adolescent mental health. METHOD: Of 14,247 citations initially identified, 73 articles drawn from 44 studies met inclusion criteria. The articles were classified by implementation phase (exploration, preparation, implementation, and sustainment) and specific implementation factors examined. These factors were divided into outer (i.e., system level) and inner (i.e., organizational level) contexts. RESULTS: Few studies used true experimental designs; most were observational. Of the many inner context factors that were examined in these studies (e.g., provider characteristics, organizational resources, leadership), fidelity monitoring and supervision had the strongest empirical evidence. Albeit the focus of fewer studies, implementation interventions focused on improving organizational climate and culture were associated with better intervention sustainment as well as child and adolescent outcomes. Outer contextual factors such as training and use of specific technologies to support intervention use were also important in facilitating the implementation process. CONCLUSIONS: The further development and testing of dissemination and implementation strategies is needed to more efficiently move EBPs into usual care.

A history of physician suicide in America.

Over the course of the last century, physicians have written a number of articles about suicide among their own. These articles reveal how physicians have fundamentally conceived of themselves, how they have addressed vulnerability among their own, and how their self-identification has changed over time, due, in part, to larger historical changes in the profession, psychiatry, and suicidology. The suicidal physician of the Golden Age (1900-1970), an expendable deviant, represents the antithesis of that era's image of strength and invincibility. In contrast, the suicidal physician of the modern era (1970 onwards), a vulnerable human being deserving of support, reflects that era's frustration with bearing these unattainable ideals and its growing emphasis on physician health and well-being. Despite this key transition, specifically the acknowledgment of physicians' limitations, more recent articles about physician suicide indicate that Golden Age values have endured. These persistent emphases on perfection and discomfort with vulnerability have hindered a comprehensive consideration of physician suicide, despite one hundred years of dialogue in the medical literature.