T he former surgeon general’s supplementary report on race and mental health identifies mistrust as a major barrier to people of color receiving mental health treatment.’ Indeed, an impressive body of evidence suggests that the reason people of color mistrust medicine in general, and the mental health system in particular, is linked to a unique and troubling history-a history of racism entrenched in medical research, diagnosis and clinical management.2’0 The importance of historical context is not unfamiliar to healthcare practitioners who regularly elicit a present, past and familial history of illness from their patients. Mental health providers must often explore the meaning and interpretation patients assign to their histories, an approach we refer to as “history sensitive.”
Beyond providing useful information that can be gleaned to determine an accurate diagnosis and course of treatment, a history-sensitive approach to treatment of people of color offers motivated clinicians a unique opportunity to explore their histories as well. Consideration of one’s intentional or unintentional racial biases or assumptions, for example, may not only increase clinician sensitivity but provides an important internal resource from which they can draw to help implement culturally attractive and nuanced healthcare.” On the most fundamental level, history-sensitive mental healthcare represents one important way in which the mental health system can reduce people of color’s “cultural mistrust” of mental health, thereby enhancing utilization and reducing morbidity and mortality in these populations. An approach as such should also decrease patient-clinician misunderstanding and yield greater precision in diagnostic and prognostic judgments.
In this discussion, we shall: 1) offer a thumbnail sketch of the history of racism vis ‘a vis the practice of American medicine and mental health in particular; 2) exposit specific skeptical attitudes many people of color harbor toward medicine based on their historical experiences, and 3) explore important challenges facing mental health clinicians in light of the impact, dynamics and consequences of racism and mental health.
