Coping with Racism: a Perspective of COVID-19 Church Closures on the Mental Health of African Americans.

Academic medical literature and news outlets extensively document how older individuals in communities of color, especially African American communities, are dying disproportionately of COVID-19 due to ongoing societal, racial, and healthcare disparities. Fear of death and suffering are acutely elevated in Black communities; yet, African Americans have been facing, coping with, and overcoming American societal racism and subsequent detriments to our mental health for centuries. Predominately African American churches (hereafter referred to as the "Black Church") have always served a historical, cultural, contextual, and scientifically validated role in the mental health well-being of African American communities coping with American racism. Nonetheless, buildings of worship closed due to the COVID-19 pandemic in mid-March 2020. This article is a first-hand perspective of five Black internists/psychiatrists who are deeply involved in both academic medicine and leadership positions within the Black Church. It will explore how the physical closure of Black Churches during this period of increased mental stress, as caused by healthcare inequities revealed by the COVID-19 epidemic, is likely to be uniquely taxing to the mental health of African Americans, particularly older African Americans, who must cope with American racism without physical access to the Black Church for the first time in history.

A Call for Behavioral Emergency Response Teams in Inpatient Hospital Settings.

Medical rapid response teams, now ubiquitous throughout hospitals, were designed to identify and proactively treat early warning signs of acute medical decompensation. Behavioral emergencies-including clinical psychiatric emergencies, coping/stress reactions, and iatrogenic injuries-are not responded to with the same vigor. At worst, behavioral crises are treated as unarmed security threats. Limited or inappropriate responses to such crises can lead to suboptimal outcomes on numerous levels, especially avoidable harm to patients and frontline clinicians. Widespread implementation of behavioral emergency response teams for patient-centered behavioral interventions has been impeded by a pervasive perception that these endeavors are medically unnecessary and optional. This article calls for a paradigm shift in responding to behavioral emergencies by arguing that security-driven risk management practices during behavioral emergencies are incompatible with fundamental medical and ethics principles.

The Face of Medicine Is Not My Face But, It Should Be.

The "face of medicine" is a term commonly used to describe the leaders and decision-makers of medicine. Medical ethics often discuss past historical atrocities committed by the "face of medicine," such as the American eugenics movement and medical experimentation. However, a great irony persists: the "faces of medicine" do not resemble the faces of the oppressed populations. Nevertheless, the discussion of white supremacy and systemic racism, structures which fueled historical medical atrocities, is often omitted. This reflection discusses the need for education, conversation, and action surrounding these topics to adequately combat racial and ethnic health disparities. We also argue that the decision-makers of medicine should be a diverse group of stakeholders, thereby representative of and personally invested in a diverse group of populations.

Achieving Equity in Informed Consent: A Culturally-Informed Perspective for the Consideration and Consent of Minority Patients for Electroconvulsive Therapy.

Electroconvulsive therapy (ECT) is highly efficacious to treat severe depression in older adults. Yet, patients of ethnic and racial minorities are consistently underrepresented amongst those who receive ECT across all age groups. One strong hypothesis to explain this disparity is that minority patients are less likely to trust medical professionals and are therefore less likely to consent for ECT. Increasing participation of depressed, elderly, minority patients is uniquely challenging. Senior minority individuals have survived decades of medical and social injustices that no other demographic, specifically younger minorities or clinically-matched Caucasian peers, can truly comprehend from a first-hand perspective. This article provides a perspective based in cultural translational science to conversations of informed consent for ECT that removes our self-imposed stigma against discussing past and ongoing injustices with minority patients. Reducing disparities to geriatric minorities through equity of informed consent means that clinicians must validate the unique minority experience in medicine as it pertains to agreeing to a treatment modality as emotionally, socially, and historically laden as ECT.

Psychiatric Emergencies in Nonpsychiatric Settings: Perception Precludes Preparedness.

BACKGROUND: The implementation of emergency codes has become standard practice in hospitals to provide system-wide preparedness for the early detection and prevention of crises. Psychiatric emergencies in medical/surgical locations, however, are not typically regarded as distinct entities from general security threats. The "security-first" paradigm is a nonclinical intervention that focuses on behavioral containment rather than on the treatment of underlying psychopathology. OBJECTIVE: This article provides the perspective that countless opportunities to medically intervene upon mental health emergencies are being overlooked due to a national misconception of these entities as security-based functions. A secondary consequence of this misperception is that hospital systems often fail to prioritize an infrastructure onto which clinically-informed emergency response protocols similar to other medical emergency codes may be dependably mounted in the event of accurately detecting psychiatric emergencies. Numerous adverse clinical, workplace safety, and financial outcomes ensue. Using a behavioral emergency response team as a collaborative care model in medical/surgical locations is a promising alternative. CONCLUSIONS: Behavioral emergency response teams re-establish patient care within the intervention without omitting security containment. They help rapidly address acute comorbid psychiatric needs without demanding additional psychiatric resources by functioning as trained surrogates of consult-liaison psychiatry as they provide direct clinical oversight into primary teams who would otherwise be unsupported in navigating clinical scenarios extending beyond their typical range of expertise. An analysis using the "Swiss cheese" model of human error trapping offers a comprehensive illustration of how behavioral emergency response teams add multilayered perceptual and mechanistic advantages to barriers commonly encountered when psychiatric emergencies arise in nonpsychiatric settings.