Summit eyes equitable care strategies
Black youth are facing an escalating crisis of mental health. Some doctors are taking action
As a child and adolescent psychiatrist working primarily in acute care on the inpatient unit in the emergency room, Olabode Akintan learnt very quickly that having an inquisitive and open-ended way of engaging patients was essential to building trust. And that trust was essential to giving good care.
“If somebody comes to me, and they’re passionate about their child’s welfare, the way they express that it’s going to be unique to them. How I take that passion is going to be something that I have to consider.”
If the person then raises their voice, Akintan says, “it’s important that I don’t immediately assume that they’re being aggressive towards me and engage them from that perspective. For I cannot de-escalate if I really feel like I’m defensive.”
A repetitive feature in antiBlackness that often leads to brutality is that Black people’s actions are unnecessarily read as threatening and therefore their presence a danger.
“The way you de-escalate is going to be informed by the way you’re interpreting what you’re dealing with,” Akintan said.
This is the kind of conversation, linked to lived experience and to data, that the Black Physicians’ Association of Ontario (BPAO) is holding with doctors and other health-care professionals at a mental-health conference focusing on Black youth in Toronto on May 4. It aims to guide medical professionals to respond better to the particular challenges faced by these youngsters.
“We want to see more primary care physicians do better when it comes to our community and also be able to understand certain more complex issues,” said Chenai Kadungure, executive director of the association.
Rates of depression amongst Black Canadians are six times higher than the general population, according to a 2021 study. It reflected that racism can be a cause of mental distress and also found that more than 53 per cent of Black participants reported significant experiences of racism when interacting with health-care professionals.
Like Canadian youth across populations, Black youth are facing an escalating crisis of mental health vis-à-vis anxiety, depression and early psychosis. But they face unique barriers to getting care.
According to research by Pathways to Care, a five-yearcollaborative project between Black health organizations, Black youth in Canada are four times more likely to first enter the mental health-care system through the emergency department than white youth.
In other words, by the time they get care, they’re in crisis. At least half of Black youth have encounters with the police on their way into the mental health-care system, it found.
As a researcher at this project, Tiyondah Fante-Coleman is able to reel off a list of barriers faced by young Black people in Ontario’s disjointed public-private care model.
There are geographical barriers, for one. There is a heavy concentration of services in downtown Toronto and not in the northwest of the city or Scarborough or other areas of the province where Black populations often live. Other barriers include cultural stigma associated with getting help for mental health, cost of care and wait times. Fante-Coleman’s research found that Black youth wait twice as long for mental health treatment as white youth, at 16 months on average.
Once youths go through all these hoops, they may then endure something that so many of those who face racism experience at the hands of medical professionals: gaslighting.
They are told their experiences with racism aren’t real.
“That sense of, ‘I’m being followed,’ or ‘I’m being persecuted,’ is seen as a symptom when actually it’s a real lived experience,” Fante-Coleman said. “They’re spending an inordinate amount of time explaining their own realities and their own experiences to their practitioner, which isn’t necessarily a bad thing, but it does take away from that precious therapeutic time.”
It’s this moment — what happens when the doctor meets the patient — that is the conference experts will zoom in on. They plan to focus on de-escalation strategies, pharmacological advice for family doctors on what to prescribe while patients await care, and how sexuality and gender overlap with mental health, among other topics.
For instance, how a physician might engage a trans or nonbinary Black person could be different from someone else. Mojola Omole, president of the Black Physicians’ Association of Ontario, is a breast surgical oncologist and general surgeon. She gives the example of a Black patient, who is non-binary but does not use that term. They might say, “These boobs bother me,” Or, “I just don’t feel comfortable in them,” Or, “They just feel weird to me.”
“So how do you approach your patient who might say just a little kernel of something, recognizing that kernel to be able to go deeper to explore this with them?”
Omole said the conference aims to help doctors, especially when they are racially or ethnically different from the patient, to understand what they should be looking for that might be different from their classic understanding of a mental health crisis.
Omole works in Scarborough where she comes across patients who are Tamil or Filipino. Akintan was previously a psychiatrist administering care to Indigenous youth in acute crisis in northern Ontario.
They both say it essential for a doctor to build trust with the patient in culturally appropriate ways, and as Akinton said, “by coming from a place of humility and a place of curiosity.”
For instance, a doctor has to be open to knowing there are a variety of constellations to the family. Instead of asking a patient “Where’s your mum or dad?” maybe ask “Who’s in your family?” It allows youths to know that they can answer that question freely by signalling an openness to atypical family structures.
As Omole said, the point of the conference is “not to harm or shame anybody. It’s to say, OK, what can I do better to serve our community?”