Structural Racism and Psychiatric Practice: A Call for Sustained Change

By Rachel M. Talley, MD, Matthew L. Edwards, MD, Jeffrey Berlant, MD, PhD, Elizabeth S. Wagner, MD, MPH, David A. Adler, MD, Matthew D. Erlich, MD, Beth Goldman, MD, MPH, Lisa B. Dixon, MD, MPH, Michael B. First, MD, David W. Oslin, MD, and Samuel G. Siris, MD

Abstract: Structural racism has received renewed focus over the past year, fueled by the convergence of major political and social events. Psychiatry as a field has been forced to confront a legacy of systemic inequities. Here, we use examples from our clinical and supervisory work to highlight the urgent need to integrate techniques addressing racial identity and racism into psychiatric practice and teaching. This urgency is underlined by extensive evidence of psychiatry's long-standing systemic inequities. We argue that our field suffers not from a lack of available techniques, but rather a lack of sustained commitment to understand and integrate those techniques into our work; indeed, there are multiple published examples of strategies to address racism and racial identity in psychiatric clinical practice. We conclude with recommendations geared toward more firmly institutionalizing a focus on racism and racial identity in psychiatry, and suggest applications of existing techniques to our initial clinical examples.