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. Author manuscript; available in PMC: 2022 Mar 1.
Published in final edited form as: Traumatology (Tallahass Fla). 2020 Dec 10;27(1):60–69. doi: 10.1037/trm0000292

How Mental Health Professionals Can Address Disparities in the Context of the COVID-19 Pandemic

Tamra Burns Loeb 1, Megan T Ebor 1, Amber M Smith-Clapham 1, Dorothy Chin 1, Derek M Novacek 1,2, Joya N Hampton-Anderson 3, Enricka Norwood-Scott 1, Alison B Hamilton 1,4, Arleen F Brown 5,6, Gail E Wyatt 1
PMCID: PMC8132617  NIHMSID: NIHMS1640495  PMID: 34025223

Abstract

The Coronavirus 2019 (COVID-19) pandemic is an unparalleled crisis, yet also a unique opportunity for mental health professionals to address and prioritize mental and physical health disparities that disproportionately impact marginalized populations. Black, Indigenous, and People of Color (BIPOC) have long experienced structural racism and oppression, resulting in disproportionately high rates of trauma, poverty, and chronic diseases that span generations and are associated with increased COVID-19 morbidity and mortality rates. The current pandemic, with the potential of conferring new trauma exposure, interacts with and exacerbates existing disparities. To assist mental health professionals in offering more comprehensive services and programs for those who have minimal resources and the most profound barriers to care, four critical areas are highlighted as being historically problematic and essential to address: (a) recognizing psychology’s role in institutionalizing disparities; (b) examining race/ethnicity as a critical variable; (c) proactively tackling growing mental health problems amidst the COVID-19 crisis; and (d) understanding the importance of incorporating historical trauma and discrimination in research and practice. Recommendations are provided to promote equity at the structural (e.g., nationwide, federal), professional (e.g., the mental health professions), and individual (e.g., practitioners, researchers) levels.

How Providers Can Address Mental Health Disparities in the Context of the COVID-19 Pandemic

The COVID-19 pandemic has highlighted longstanding, unaddressed inequities in mental and physical health access and outcomes. These disparities became the focus of national attention when reports of elevated COVID-19-related illnesses and mortality rates among Black, Indigenous groups, and other People of Color (BIPOC) were released. Providers are responding to this crisis by providing critically needed services for clients who are struggling with a broad range of economic, medical and mental health issues exacerbated by the COVID-19 pandemic (Shullman, 2020). In addition to the increase in services, this pandemic has brought increased attention to some of the long-established policies and practices that have fostered the creation of health disparities that BIPOC cope with daily such as the historical and intergenerational effects of stress and discrimination due to racial/ethnic, gender and sexual orientation. Mental health professionals must also consider these factors along with the impact of structural inequalities in housing, education, health, workplace positions and salaries for over four centuries that have resulted in marginalized people being overly burdened by public health crises, natural disasters and pandemics like COVID-19 (Novacek et al., 2020; Purtle, 2012). Disparities in health outcomes are not new, but if they remain in place when this pandemic is contained, the mental health community will have accomplished little. This is the time to provoke change, not a time to return to “normal” (Obama, 2020).

In order to assist mental health professionals in offering more comprehensive services and programs for those who have the fewest resources and most profound barriers to care, the following four areas are presented to remind providers of some of the roles that psychology has played in history and in practices: (a) recognizing psychology’s role in institutionalizing disparities; (b) examining race/ethnicity as a critical variable; (c) proactively tackling growing mental health problems amidst the COVID-19 crisis; and (d) understanding the importance of incorporating historical trauma and discrimination in research and practice.

Owning the Past

The Role That Psychology Has Played in Institutionalizing Disparities

Mental health professionals and clinicians at all levels of training and professionalism need to be reminded that the fields of psychology and psychiatry emerged in the late 1800’s at a time when there was little attention paid to ongoing factors that could impact the health and mental health of marginalized populations such as racial injustice, discrimination, gender, poverty, and violence in families, communities and institutions. To the contrary, more attention was paid to supporting the structural systems of oppression (e.g., slavery, the Jim Crow era, Native American genocide and displacement and the exploitation of migrant labor); (Dews, 2014; Wilkins et al., 2012). Many of these historical periods were borne out of or supported by the Eugenics movement. The Eugenics movement, supported by some psychologists, impacted social, educational, housing, immigration and labor policies to separate and protect people from ‘undesirables’ (Greenwood, 2017; Washington et al., 2016). Eugenics-era policies created suspicion among marginalized populations, causing them to suppress their symptoms and not seek health care due to fundamental mistrust in the government and in healthcare institutions (Hastings et al., 2015). Efforts initiated by the Centers for Disease Control and Prevention (CDC) and other public health institutions remained under high suspicion of not being in the best interest or well-being of people of color (CNPAAEMI, 2003). Social welfare policies and public housing for poor and marginalized people were initially intended to serve as assistance for individuals and families, but in fact promoted the separation of families. Underserved populations, including BIPOC, were alienated and disenfranchised from the US healthcare system (Medlock et al., 2016), the effects of which are still apparent today.

The Use of Science to Justify the Inferiority of Non-White Groups.

For hundreds of years, the mental health professions have used science and the assessment of mental health to justify discriminatory policies against BIPOC, including the creation of diagnostic nomenclature, theories, and psychological tests that offered “proof” of the inferiority of non-Whites and solidified the rationale for racial separation (Tucker, 2009). Historically, psychological diagnoses (e.g., drapetomania, dysaesthesia aethiopica) were created to pathologize expected responses due to separation of families, sexual exploitation and violence against anyone who resisted oppression to slavery (Cartwright, 2004). In the early to mid 1800s, physicians (e.g., Charles Caldwell) used the field of phrenology to justify biological differences between races, as well as slavery, segregation, and medical experimentation with people of color, against the backdrop of the abolitionist movement (Ktitowsky, 2017; Washington, 2008). Phrenology was also used by physiologists (e.g., Samuel Morton) to identify skull differences and to allege intellectual deficits of Native Americans to justify their removal from their ancestral lands (Ktitowsky, 2017).

Intelligence tests, widely used and among the most psychometrically validated of psychological tests, were pioneered by the American Psychological Association (APA) and notable psychologists throughout the past century who were proponents of the Eugenics movement (e.g., Goddard, Terman, Cattell); (Benjamin, 2009; Brookwood, 2016; Healey, 2018; Tucker, 2010). The tests offered Eugenics a scientific methodology to classify individuals according to their intelligence and emotional maturity, and identify purportedly unbiased physiological bases justifying the inferiority of BIPOC (Healey, 2018; Washington et al., 2016). Eugenicists and ethnocentrists supported racial hygiene, fearing a decline in the intellectual genetic pool if individuals with low intelligence reproduced (Washington, 2008). They attributed differences in intelligence to biology and race, discounting important differences in environmental conditions and asserted biological superiority when differences by class and race were observed (Martschenko, 2017; Washington et al. 2016). These terms were also found in reports by mental health professionals to justify racial segregation, restricted immigration policies, institutionalization, and the forced sterilization of thousands of impoverished people of color in 31 U.S. states until as recently as 1977 (Greenwood, 2017; Severson, 2011). Intelligence testing has also been used to justify the prohibition of racial mixing or interracial marriages (i.e., miscegenation) between whites and people of color (Greenwood, 2017), a practice that was often illegal and could be punishable by death via lynching (Martschenko, 2017; Washington, 2008). Clinicians used these tests more to confirm notions of inferiority that further marginalized people of color (Medlock et al., 2016; Olsen, 2017; Williams & Mohammad, 2013) than to identify potential talent or to improve the educational or social status of a person of color (Martschenko, 2017).

Using Racial and Biological Differences to Justify a Hierarchy of Humans.

Historically false premises that once perpetuated myths about biological differences between African Americans and European Americans (Villarosa, 2019) have reemerged during the COVID-19 pandemic. In the late 1700s, misinformation about African Americans’ purported immunity to the yellow fever epidemic in Philadelphia spread and resulted in delays in healthcare treatment and death among persons of color (Hogarth, 2019). Most recently, the false belief that Black individuals might be biologically immune to COVID-19 stemmed from a low initial number of reported cases earlier on in the pandemic that was later attributed to a lack of testing (Kendi, 2020; Mock, 2020; Poston et al., 2020). This led to questions surrounding the necessity of social distancing mandates, that when coupled with daily fluctuations in COVID-19 information provided to the public, resulted in differing interpretations of risks and plans for protection from infection (Pfefferbaum & North, 2020).

While disparities in COVID-19-related mortality rates are fueled by pre-existing conditions that are more prevalent among Black Americans, the role of clinician and implicit bias cannot be overlooked (Healey, 2018; Wyatt et al., 2009). There is evidence that patient group identity can affect clinicians in areas including clinical interviewing, diagnostic decision-making, symptom management and treatment recommendations (van Ryn et al., 2015). Amid the COVID-19 pandemic, this implicit bias may negatively impact testing and access to care among BIPOC (Griffith, 2020). The culture of American medicine continues to reflect larger societal beliefs that support racial myths and resulting inequities.

Mistrust of Physical and Mental Health Practice and Providers.

Disparities in mental health care access and utilization are complicated by a longstanding distrust of healthcare professionals and the healthcare system among people living in marginalized communities. This is particularly relevant for African Americans, who have a painful history of victimization at the hands of professionals in medicine, psychology, and in research (Kennedy et al., 2007; Steiner, 2018). One prominent example is that of Henrietta Lacks, whose body tissue was taken without her or her family’s consent. Her cancer cells, as well as her children’s blood samples and medical records, were utilized in research around the world without their knowledge, leading eventually to the award of two Nobel prizes and corporate financial gain, but marginal compensation to the Lacks family (Harris, 2013). Another example is the Tuskegee Syphilis experiments based in Macon County, Alabama where participants were denied treatment for syphilis in the context of a forty-year study marked by deception (Gamble, 1997).

Concerns about fears of medical experimentation are likely to reemerge when human vaccine trials begin recruitment for those at most risk for COVID infection. Medical trials have a significant history: Africans were subjected to horrific medical experimentation performed without anesthesia on slave ships (Bachynski, 2018; Villarosa, 2019). In the 1600s, physicians routinely performed involuntary experimentation with enslaved Africans and Native Americans to develop procedures to effectively treat European Americans (Rothman, 2017). When enslaved Africans died, their bodies were used for further experimentation, despite cultural and religious beliefs about the importance of preserving bodies after death (Rothman, 2017). Experimental mishandlings were often downplayed or misrepresented as therapeutic in the medical literature (Washington, 2008). Today, written accounts of these abuses, intended only for the medical community, are chronicled in medical journals, memoirs, and documented oral speeches that were not accessible to lay people and enslaved Africans (Washington, 2008). These candid accounts, written by medical researchers, provide supporting evidence of the extensive and troubling history of enslaved Africans as research subjects that contribute to mistrust that prevails today. Information about vaccine trials and their benefits and risks will need to be carefully articulated, differentiating the experimental nature of these trials from past medical experimentation conducted at the expense of African American communities.

It is necessary to keep the role that the mental health profession has played in institutionalizing disparities at the forefront of our thinking regarding how we move forward to aid in the crisis response to the COVID-19 pandemic. This reckoning with our past will allow us to proceed from a space of humility and desire for change in critical areas that can help foster trust so that we can work collaboratively with individuals to promote wellbeing in physical and mental health.

How the Past Affects the Present Pandemic

Overlooking Race/Ethnicity as a Critical Variable

Although the spread of COVID-19 was widely recognized by mid-to late January 2020, initial reports focused on older adults with preexisting conditions; racial/ethnic data was initially not reported. It was not until Early April, 2020 that Federal officials, pressed to release racial demographic data, confirmed what health disparities advocates and researchers feared: the most vulnerable American citizens are disproportionately affected (Berry, 2020). While high infection and mortality rates of these groups, particularly Black Americans, were presented as breaking news, this state of affairs is not surprising, as this population has long experienced higher rates of chronic diseases that increase COVID-19 mortality, including diabetes, high blood pressure, obesity, and asthma (Chow et al., 2020; Lahut, 2020; Poston et al., 2020). The states that have collected and released race-based data show alarming but predictable trends—Black Americans are dying from COVID-19 complications at significantly higher rates than other groups (Haynes, 2020; Yancy, 2020). This oversight parallels the historic downplaying of race/ethnicity as a critical variable in the field of clinical psychological research (Roberts et al., 2020).

In order to prioritize health equity, it is paramount that the public health officials standardize, collect and make available existing race and ethnicity data in a timely manner. This data is central to understanding healthcare inequalities and ensuring optimal health and fairness for all (Maybank, 2020). There are opposing views on the necessity of collecting race-based data within the US government. However, in mid-April, 2020, the Congressional Black Caucus introduced legislation, The Equitable Data Collection and Disclosure on COVID-19 Act, to ensure that the Department of Health and Human Services (DHHS) would begin to collect and post essential demographic data such as race, ethnicity, sex, age, and socioeconomic and disability status, daily on the CDC website along with COVID-19 related testing, treatment and outcomes (Atkins, 2020; Pressley, 2020). As of early June, 2020, states were required to report COVID-19 data by race and ethnicity, which is essential for the identification of community needs and the best ways to allocate vital resources (Shelton, 2020).

Mental health disparities and the likely impact of COVID-19

The lack of attention paid to the mental health needs of BIPOC, who are disproportionately represented in risk for mental illness (APA, 2017e), continues today. Further, due to various historical, linguistic, and cultural factors, BIPOC often experience psychological symptoms that are undiagnosed, under-diagnosed or misdiagnosed (APA, 2017b; Skosireva et al., 2014; Wyatt, 2009). High rates of deep poverty, unemployment, and social isolation are consistently linked to increased risks for mental illness, trauma exposure, and poor health outcomes (APA, 2017c, 2019; Deluca et al., 2020; Gopalkrishnan, 2018; Reger et al., 2020). Although untreated mental illness is not associated with higher criminality, BIPOC as well as those living in poverty are most likely to experience homelessness and incarceration before they receive effective treatment (APA, 2017e; Dreyer, 2020; Greenberg & Rosenheck, 2008; Lurie et al., 2015). Disparities are also fueled by stigma associated with mental illness, lack of insurance, unaffordable treatment and culturally irrelevant practices stemming from a scarcity of clinicians trained to address the needs of ethnically diverse populations who speak languages other than English (APA, 2017e; Shushanksy, 2017; Weiner, 2020). Those who have long experienced barriers to mental health access, treatment, and quality care will likely experience exacerbated disparities and mental health risks, given increased stress and uncertainty surrounding the COVID-19 pandemic (Greenberg & Rosenheck, 2008; Novacek et al., 2020; Shushanksy, 2017; Walravens, 2020). Further, emerging data suggests that COVID-19 may be associated with increased anxiety and depression by way of impacts to the central nervous system (Speth et al., 2020,), therefore, the direct and indirect impacts of the COVID-19 pandemic are critical to understand when considering the mental health impacts on vulnerable individuals.

For BIPOC who have experienced both historical and contemporary practices of enforced separation of family members, physical distancing mandates may be regarded with fear and suspicion (Garcia & Hellerstein, 2020; Kendi, 2020). For BIPOC, virus-related anxiety, coupled with mandates to socially isolate, may increase psychological distress (Novacek et al., 2020). Moreover, social support and church-going have been shown to be protective factors against depression for Black Americans (Lincoln et al., 2005), thus physical distancing could increase risk for mental health issues by limiting access to loved ones and to a worship community. Those who are already emotionally vulnerable may experience increased suicidal ideation, substance abuse and self-medication, and interpersonal violence (Deluca et al., 2020; Galea et al., 2020; Pfefferbaum & North, 2020; Reger et al., 2020).

During the COVID-19 pandemic, reports of domestic violence and child abuse have decreased as safer at home mandates result in limited options for victims to distance themselves from their abusers and children are not able to interact with their teachers and other mandated reporters at school (Santhanam, 2020). Schools, community centers, centers of faith, parks and other public spaces that served as safe havens have been restricted or closed for prolonged periods of time (Galea et al., 2020; Reger et al., 2020). Although abuse incidents are known to increase after natural disasters, due to exacerbated levels of stress and financial instability, insufficient documentation of these incidents impedes effective identification and response efforts (Santhanam, 2020). However, given the elevated stress conferred by the pandemic in general, it is likely that child abuse and interpersonal violence rates have risen despite fewer reports, a circumstance that is concerning and will demand the attention of mental health professionals.

Increased rates of mental health symptoms due to COVID-19 are coupled with physical distancing mandates that exacerbate barriers to treatment. Research documents the negative effects of untreated mental health symptoms, including exposure to violence and alcohol and substance use (NIDA, 2020). Self-medication of mental health symptoms includes using drugs that are smoked or inhaled (e.g.., crack, heroin, methamphetamine, marijuana, tobacco) that negatively impact lung function and increase the risk of chronic lung disease that drives COVID-19 mortality and morbidity (NIDA, 2020), while also increasing suicide, overdose, and interpersonal violence-related deaths. Mental health treatment, currently inaccessible in person, may be restricted to those with access to phone or online platforms (Reger et al., 2020; Scheiber et al., 2020; Wind et al., 2020). Low-income individuals may be especially disadvantaged by these restrictions in access to care during the pandemic.

The Importance of Incorporating Historical Trauma and Discrimination in Research and Practice

Mental health providers typically do not receive training in how to address the mental and physical consequences of historical trauma and discrimination due to race/ethnicity, sexual orientation, or gender. Research has established that trauma can be transmitted across generations, unfavorably impacting marginalized groups and communities that share a history of subjugation, persecution, or group trauma (Mohatt et al, 2014; Wyatt, 2009). Historical trauma negatively impacts both mental and physical health, yet its significance to mental health remains inadequately addressed (Grills et al., 2016). While the historical trauma literature originated from research describing the plight of children of Holocaust survivors (Kellerman, 2001), the term has also been applied to Indigenous groups that include Black, Latinx, and Native Americans (APA, 2017d; Mohatt et al., 2014). Although mental health professionals are called on to understand the role of racism and unequal power dynamics in research and clinical settings (Medlock et al., 2016; Szymanski, 2010; Williams et al, 2018; Williams et al., 2019), the impact of historical trauma on the recovery process among BIPOC is not adequately addressed or supervised in practice (Grills, 2016). To effectively meet the needs of BIPOC, providers must have academic, training, and continuing education opportunities to assess and treat survivors of historical trauma.

The Diagnostic and Statistical Manual (DSM)-5 criteria for trauma specifies, “exposure to actual or threatened death, serious injury or sexual violence” (Holmes et al., 2016; Jones & Cureton, 2014, p 261). Racial, historical, and discriminatory trauma may not meet this definition of trauma, nor does it meet the criteria for a billable diagnosis, posing yet another barrier to treatment. Rates of post-traumatic stress disorder are elevated among African Americans (Himle et al., 2009), yet clinicians who are aware of the impact of historical trauma and discrimination are left without a pathway to diagnose and provide treatment for affected BIPOC (Comas-Díaz et al., 2019; Moffic, 2015; Williams et al., 2018). Mental health and primary care providers receive limited training on historical trauma and discrimination and how to address it in the therapeutic process (Grills, 2016). For example, the generational effects of slavery continue to be evident both in currently racist institutions, seen in practices such as redlining, as well as in the descendants of enslaved people themselves. Interventions such as Emotional Emancipation Circles (Grills, 2016) make explicit these effects and empower participants with historical knowledge, understanding, and an active and engaged community.

Experiences of discrimination and other forms of trauma should be routinely included in clinical interviews and research examining the effects of trauma (Loeb et al., 2018) and screeners that assess for these experiences should be adopted in primary care and mental health settings (Chin et al., 2020; Liu et al., 2015; Myers et al., 2015).

Next Steps for Mental Health Professionals

The COVID-19 pandemic highlights the deep-rooted historical and structural inequities that disproportionately impact BIPOC. A return to the norm is simply not enough for the marginalized; this global crisis is an opportunity to initiate long overdue structural changes that will address health disparities and promote health equity for all. To do this, mental health providers must also be willing to confront how they have been complicit in the formation of these inequalities and lead efforts to confront and remedy them at the structural (e.g., nationwide, federal), professional (e.g., the psychology industry), and individual (i.e. the practitioner/researcher) levels.

Structural Level Recommendations

Mental health professionals must advocate for Federal wrap-around programs similar to the established Ryan White HIV/AIDS programs to increase access to health care and mental health parity during and after COVID-19. Such programmatic efforts will provide the holistic and integrated care needed for underserved populations by way of addressing barriers related to cost and provider availability (Novacek et al., 2020; Weiser et al., 2015). These efforts could not only provide needed mental and physical healthcare for complications that arise as a result of contracting and recovering from COVID-19 but could also provide broader wellness programming that enhances recovery and resiliency, such as nutrition, stress management, and exercise, all areas likely to be negatively impacted by COVID-19.

As providers are increasingly using telehealth interventions in the midst of the COVID-19 crisis, providers should advocate for its cost effectiveness, coverage, and continuance post-pandemic in order to increase access and promote retention in mental health treatment for marginalized groups (Novacek et al., 2020). Mental health professionals need to advocate for multidisciplinary mental health teams and multisector collaborations and essential services for BIPOC, not only for basic needs that have been adversely affected by the interaction of systemic inequalities and the pandemic (e.g., food, housing, transportation), but assisting in the therapeutic process as well (Dunseith, 2020). Partnerships across a range of sectors are necessary to address more pronounced gaps in care and to address physical/mental health disparities at various levels of influence (Brown et al., 2019). All of the above recommendations can be better tailored if informed by accurate data.

In health crises such as the COVID-19 pandemic, disaggregated data by race/ethnicity is essential when determining how to focus these efforts to meet the needs of the most vulnerable. This information is vital because it saves lives and informs where resources are directed. Finally, disparities in funding to BIPOC scientists needs to be addressed. Mental health professionals need to advocate for BIPOC to receive funding for mental health disparities research, including the effects of COVID-19 on mental health. In a recent study on major research grants (RO1 mechanism) awarded by the NIH, Black American scientists were found to be 13% less likely to be awarded NIH grants compared to White American scientists (Ginther, 2011; Hoppe et al., 2019); this disparity may be due in part to differences in research topics proposed. African American scientists are more likely to submit community or population-level work as opposed to basic science proposals, the latter of which has higher funding rates (Hoppe et al., 2019).

Professional Level Recommendations

In order to commit to structural changes in the system, the mental health profession must examine its history and current practices that reflect the racism that exists in society today (Eakin, 2000). While the APA has established advocacy efforts to both bring attention to and mitigate disparities through its Health Disparities Program (Keita, 2012) and Political Action Committee (PAC); (APA, 2017g), health and mental health disparity outcomes, inexorably linked (APA, 2017f; Ohrnberger et al., 2017), nonetheless persist. Although the mental healthcare workforce has become more diverse, there continues to be a lack of representation of BIPOC among professional mental health providers including social workers, therapists, psychologists and physicians, which serves as a barrier to effective treatment and reduces BIPOC willingness to entertain the possibility of an academic career in mental health (AAMC, 2019; Lin et al., 2018). Approximately half (44.8%) of licensed psychologists in the United States work in private practice settings, primarily providing services to (96%) White populations (Hamp et al., 2016). Despite the fact that a large proportion of the population identifies as BIPOC, only 52.7% of psychologists indicate that they feel well-prepared to provide services to diverse populations. Those who report being knowledgeable about working with diverse populations cite academic (i.e., peer-reviewed journals, books, and colleagues) sources of this information (Hamp et al, 2016), rather than training or professional experiences.

Although providers’ formal education may include information about how to work with underserved populations and/or the effects of structural inequalities, students’ training experiences often do not include working with community populations of individuals who are disproportionately more likely to live in deep poverty and are therefore more likely to be impacted by COVID-19 (APA, 2018, 2019, 2020). Additionally, language and cultural barriers experienced by clients and mental health providers add barriers to effective care (APA, 2017b, 2017c, 2017e); there remains a lack of mental health professionals that can deliver services in clients’ native languages. For instance, Latinx/Hispanic populations constitute the largest racial/ethnic minority group in the U.S., constituting almost 18% of the population. However, in a national survey, only 5.5% of psychologists indicated that they can provide services in Spanish (Smith, 2018). The most frequently reported treatment areas reported by these clinicians included anxiety, depressive, and trauma and stressor-related disorders, illnesses disproportionately experienced by BIPOC (Myers et al., 2015), providing the opportunity for mental health professionals with community training to meet the needs of these populations (Hamp et al., 2016). An assessment should be conducted to evaluate how clinicians are trained to include enhanced diversity and bias training at the graduate and internship training levels, postdoctoral level, and at the licensure level through continuing education requirements (APA, 2020). How this material is implemented in supervision, classes, administrative activities or in research needs to be evaluated (APA, 2018).

To address disparities and improve relations with BIPOC, it is important to partner with community-based organizations, such as churches and local nonprofit organizations as well as community stakeholders to help build bridges. This would not only help increase trust of mental health providers which is a barrier to treatment (Kennedy et al., 2007; Wyatt, 2009), but also allow for the expansion of research activities outside of the laboratory into more naturalistic settings, increasing the diversity of samples, and ultimately increasing the generalizability of research findings (Hamilton et al., 2020; Wyatt et al., 2020). In addition, these partnerships and enhanced connections with communities of color will assist in the development and dissemination of race-conscious interventions that effectively meet the needs of marginalized groups.

Training programs should also emphasize advocacy in accordance with existing APA efforts, including (a) advocating for the provision of phone-only services, (b) encouraging support for COVID-19 related research, (c) lobbying for universal physical and mental health care and/or Medicare options to cover health costs, and (d) informing law makers of COVID-19-related mental and behavioral health needs. In addition, coursework on the effects of social determinants of mental and physical health, as well as formal training opportunities with community populations, should be required (Compton & Shim, 2015; Siegel et al., 2018). Including advocacy training as part of graduate education and training programs would better prepare emerging practitioners in the field to understand the issues facing BIPOC as well as feel supported and confident in their abilities to work with those most disenfranchised. Partnering with other healthcare disciplines will amplify efforts to advocate for policies that help reduce poverty, better prevent and manage chronic diseases, and promote socioeconomic well-being of disenfranchised groups (Thorpe et al., 2017). Emphasizing mental health professionals’ role as advocates for health equity and parity should be included in continuing education requirements for licensure. Without advocacy, BIPOC living in marginalized communities will be exposed to ever widening disparity gaps. Licensing requirements and continuing education must address the historical issues that have impacted the field and contributed to the present-day disparities.

Mentoring the Mentors

While most APA-approved mental health training programs describe diversity in training and in didactic learning as well as supervision in research, there is no program that specifically addresses the needs of mentors of trainees and faculty whose backgrounds represent groups that are diverse and marginalized. It is assumed that faculty members with doctorates can mentor trainees or faculty from diverse backgrounds, processing and addressing race, gender and sexual orientation related experiences that trainees and young faculty may be reluctant to disclose, yet which may interfere with their ability to feel a part of the system and receive needed assistance (Wyatt et al., 2009; Wyatt et al., 2019). When a trainee or faculty fails to succeed, it is rarely understood as a failure in the support system around that person; rather, it is deemed a failure of the person’s ability to ‘make it’. There are Mentoring the Mentors workshops available to professionals in academic settings where mentors are the focus. These workshops are designed to develop the skills to facilitate conversations about ‘imposter syndrome’, implicit and explicit biases, the value of code-switching in White-dominated settings, and identifying internalized racism in people of color, among other important issues (Wyatt et al, 2019). Through videos and role playing, mentors learn how to develop new skills of communication around the race/ethnicity of the trainee or faculty member who represents diverse populations. Universities and institutions should require all faculty to learn to mentor diverse trainees and early career researchers and educators.

Individual Level Recommendations

In addition to advocacy at both the structural and industry levels, personal responsibility and buy-in as professionals is essential to take ownership of these goals and act in accordance with them. Awareness of APA-led advocacy efforts (i.e., APA’s Psychology Advocacy Network, and Advocacy training) should be emphasized in education and training programs (APA, 2017a). Mental health professionals are uniquely positioned to use their expertise to address stress and distress experienced by medical professionals and patients coping with the COVID-19 pandemic (Shullman, 2020). Clinicians can lead these efforts by providing services that address a broad spectrum of mental health needs, including stresses related to unemployment, interpersonal violence, and mental health (e.g., depression, anxiety, post-traumatic stress disorder, substance use disorders) (Shullman, 2020).

To accomplish this, mental health professionals must strive for continual growth in the area of cultural humility. This commitment to understanding issues such as racism, discrimination, and historical trauma will aid in the development of clinical practice that is inclusive, safe, and promotes the understanding and validation of the lived experience of patients (D’Anna et al., 2018). Mental health professionals must also acknowledge and understand the history of the profession and the role it has played in the formation of disparities. This level of awareness and humility may act to cultivate rapport with clients that experience apprehension or distrust of the therapeutic process. Such an environment will encourage healing within the relationship between patient and provider.

Interventions designed to minimize health and mental health risks must account for critical vulnerabilities (e.g., housing, food, and transportation instability) that increase mental health problems, lead to research study attrition, and reduce intervention gains (Hamilton et al., 2020). Additionally, clinicians must be aware of an individual’s personal history of trauma as it can negatively impact treatment utilization, engagement, and adherence, as well as trust and communication with providers (Green et al., 2015; Saha et al., 2011). Mental health providers must be willing to develop relationships with community leaders, faith leaders, community stakeholders and others who are not traditional partners of the mental health community in order to ascertain how one could best meet the needs of these communities through dedicated work. Such working relationships help foster trust between the profession and underrepresented groups (Hall et al., 2002; Kelch-Oliver & Smith, 2014). Collaborations between mental health clinicians and other colleagues will increase their effectiveness when confronted by the disparities experienced by their clients (Dreyer, 2020). These structural, professional, and individual level changes could help best serve most vulnerable to the negative impacts of the COVID-19 pandemic.

Conclusion

In sum, the catastrophic impacts of COVID-19 serve as an important juncture for the mental health professions to make long overdue changes at the structural, professional and individual levels. With the nation stopped in its tracks and its people especially attuned to inequities, it would be remiss to let this moment pass without fighting for structural change. This is a call to action for the discipline to put mental and physical health equity at the forefront of the national conversation to help create a tomorrow that is better than yesterday’s norms. For every crisis that occurs, no matter how tragic, one can also see an opportunity for change. The mental health professions have not done enough to fully understand how to assess individual differences and the many paths to success and wellbeing that exist. There is no better time than now to make a difference.

Acknowledgments

Funding provided by the National Heart, Lung, and Blood Institute (U01HL142109) and (3U01HL142109-02S1), the UCLA David Geffen School of Medicine COVID-19 Research Award Program (HE-06), the HIV/AIDS, Substance Abuse and Trauma Training Program (HA-STTP) – National Institute on Drug Abuse (R25DA035692), the Veterans Affairs Advanced Fellowship in Mental Illness Research and Treatment, and the AIM Clinical Science Foundation Postdoctoral Fellowship.

Footnotes

We have no known conflict of interest to disclose.

References

  1. Alfonso F (2020, April 7). Why some people of color say they won’t wear homemade masks. CNN. https://www.cnn.com/2020/04/07/us/face-masks-ethnicity-coronavirus-cdc-trnd/index.html [Google Scholar]
  2. American Psychological Association. (2017a). Be an advocate for psychology. https://www.apa.org/advocacy/guide
  3. American Psychological Association. (2017b). Disparities in mental health status and mental health care. https://www.apa.org/advocacy/health-disparities/health-care-reform
  4. American Psychological Association. (2017c). Ethnic and racial minorities & socioeconomic status. https://www.apa.org/pi/ses/resources/publications/minorities
  5. American Psychiatric Association. (2017d). Mental health disparities: American Indians and Alaska Natives. https://www.psychiatry.org/File%20Library/Psychiatrists/Cultural-Competency/Mental-Health-Disparities/Mental-Health-Facts-for-American-Indian-Alaska-Natives.pdf
  6. American Psychiatric Association. (2017e.). Mental health disparities: Diverse populations. https://www.psychiatry.org/psychiatrists/cultural-competency/education/mental-health-facts
  7. American Psychological Association. (2017f). Physical & mental health advocacy. https://www.apa.org/advocacy/health
  8. American Psychologiacal Association. (2017g). Psychology Politcal Action Committee(PAC). PracticeUpdate. https://www.apaservices.org/practice/update/2017/01-12/political-action-committee [Google Scholar]
  9. American Psychological Association. (2018). Facing the divide: Psychology’s conversation on race and health. American Psychological Association, Office of Ethnic Minority Affairs Video Series. https://www.apa.org/education/undergrad/diversity/facing-divide-instructor-guide.pdf [Google Scholar]
  10. American Psychological Association. (2019). APA deep poverty initiative. https://www.apa.org. from https://www.apa.org/about/governance/president/deep-poverty-initiative
  11. American Psychological Association. (2020). Advocacy Impact. https://www.apa.org/advocacy/2020-advocacy-priorities.pdf
  12. Association of American Medical Colleges (AAMC) (2019). Diversity and Inclusion. Figure 18. Percentage of all active physicians by race/ethnicity, 2018. AAMC. https://www.aamc.org/data-reports/workforce/interactive-data/figure-18-percentage-all-active-physicians-race/ethnicity-2018 [Google Scholar]
  13. Atkins K (2020, April 7). Pressley wants race-specific coronavirus data requirement in next relief bill. WBUR News. https://www.wbur.org/ [Google Scholar]
  14. Bachynski K (2018). American medicine was built on the backs of slaves. And it still affects how doctors treat patients today. The Washington Post. https://www.washingtonpost.com/news/made-by-history/wp/2018/06/04/american-medicine-was-built-on-the-backs-of-slaves-and-it-still-affects-how-doctors-treat-patients-today/ [Google Scholar]
  15. Barnes P (2020, April 9). Facing potential liability, employers act to protect regular workers from COVID-19. Forbes. https://www.forbes.com/ [Google Scholar]
  16. Berry DB (2020, March 30). Health issues for blacks, Latinos and Native Americans may cause coronavirus to ravage communities. USA Today. https://www.usatoday.com/ [Google Scholar]
  17. Benjamin LT(2009). The birth of American intelligence testing. Monitor on Psychology 40(1)20. https://www.apa.org/monitor/2009/01/assessment [Google Scholar]
  18. Brookwood M (2016). Eugenics, Lewis Terman, and tests of intelligence: One hundred years and counting [Unpublished manuscript]. Harvard University. 10.13140/RG.2.1.2037.5929 [DOI] [Google Scholar]
  19. Brown AF, Ma GX, Miranda J, Eng E, Castille D, Brockie T, Jones P, Airhihenbuwa CO, Farhat T, Zhu L, & Trinh-Shevrin C (2019). Structural interventions to reduce and eliminate health disparities. American Journal of Public Health, 109(S1), S72–S78. 10.2105/ajph.2018.304844 [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Cartwright SA (2004). Report on the diseases and physical peculiarities of the Negro race. Health, Disease, and Illness: Concepts in Medicine, 28–39. (Original work published 1851) [Google Scholar]
  21. Chin D, Loeb TB, Zhang M, Liu HH, Cooley-Stickland M, & Wyatt GE(2020) Racial/ethnic discrimination: Dimensions and relation to mental health symptoms in a marginalized urban population. American Journal of Orthopsychiatry. In press [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Chow N, Fleming-Dutra K, Gierke R, Hall A, Hughes M, Pilishvili T, Ritchey M, Roguski K, Skoff T, & Ussery E (2020). Preliminary estimates of the prevalence of selected underlying health conditions among patients with coronavirus disease 2019 — United States, February 12–March 28, 2020. MMWR. Morbidity and Mortality Weekly Report, 69(13), 382–386. 10.15585/mmwr.mm6913e2 [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Comas-Díaz L, Hall GN, & Neville HA (2019). Racial trauma: Theory, research, and healing: Introduction to the special issue. American Psychologist, 74(1), 1–5. 10.1037/amp0000442 [DOI] [PubMed] [Google Scholar]
  24. Compton MT, & Shim RS (2015). The social determinants of mental health. Clinical Synthesis, 13(4),419–425. doi: 10.1176/appi.focus.20150017 [DOI] [Google Scholar]
  25. CNPAAEMI - Council of National Psychological Associations for the Advancement of Ethnic Minority Interests. (2003). Psychological treatment of ethnic minority populations. Association of Black Psychologists. https://www.apa.org/pi/oema/resources/brochures/treatment-minority.pdf [Google Scholar]
  26. DeLuca S, Papageorge N, & Kalish E (2020). The unequal cost of social distancing. Johns Hopkins Coronavirus Resource Center. https://coronavirus.jhu.edu/from-our-experts/the-unequal-cost-of-social-distancing [Google Scholar]
  27. Dews F (2014, October 9). Why does racial inequality persist long after Jim Crow? Brookings. https://www.brookings.edu/blog/brookings-now/2014/10/09/why-does-racial-inequality-persist-long-after-jim-crow/ [Google Scholar]
  28. Dreyer BP (2020). Racial/ethnic bias in pediatric care and the criminalization of poverty and race/ethnicity—Seek and ye shall find. JAMA Pediatrics 10.1001/jamapediatrics.2020.1033 [DOI] [PubMed] [Google Scholar]
  29. Dunseith L (2020). Black, Latino renters far more likely to be facing housing displacement during pandemic. UCLA Newsroom. https://newsroom.ucla.edu/releases/blacks-latinos-more-likely-to-face-housing-displacement [Google Scholar]
  30. D’Anna LH, Hansen M, Mull B, Canjura C, Lee E, & Sumstine S (2018). Social discrimination and health care: A multidimensional framework of experiences among a low-income multiethnic sample. Social Work in Public Health, 33(3), 187–201. 10.1080/19371918.2018.1434584 [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Eatkin E (2000, January 15). Bigotry as mental illness or just another norm. New York Times. https://www.nytimes.com/2000/01/15/arts/bigotry-as-mental-illness-or-just-another-norm.html [Google Scholar]
  32. Galea S, Merchant RM, & Lurie N (2020). The mental health consequences of COVID-19 and physical distancing. JAMA Internal Medicine 10.1001/jamainternmed.2020.1562 [DOI] [PubMed] [Google Scholar]
  33. Gamble VN (1997). Under the shadow of Tuskegee: African Americans and health care. American journal of public health, 87(11), 1773–1778. 10.2105/ajph.87.11.1773 [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Garcia J, & Hellerstein E (2020, April 14). Un documented workers face obstacles qualifying for benefits during the pandemic. Northern California Public Media. https://norcalpublicmedia.org/2020041442842/news-feed/undocumented-workers-face-obstacles-qualifying-for-benefits-during-the-pandemic [Google Scholar]
  35. Ginther DK, Schaffer WT, Schnell J, Masimore B, Liu F, Haak LL, & Kington R (2011). Race, ethnicity, and NIH research awards. Science, 333(6045), 1015–1019. 10.1126/science.1196783 [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Gopalkrishnan N (2018). Cultural diversity and mental health: Considerations for policy and practice. Frontiers in Public Health, 6. 10.3389/fpubh.2018.00179 [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Green J, & Dmitrieva K (2020, March 18). Women, on the front lines of COVID-19, are at high economic risk. Bloomberg. https://www.bloomberg.com/news/articles/2020-03-18/women-on-the-front-lines-of-covid-19-are-at-high-economic-risk [Google Scholar]
  38. Green BL, Saunders PA, Power E, Dass-Brailsford P, Schelbert KB, Giller E, Wissow L, Hurtado de Mendoza A, & Mete M (2015). Trauma-informed medical care: Patient response to a primary care provider communication training. Journal of Loss and Trauma, 21(2), 147–159. 10.1080/15325024.2015.1084854 [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Greenberg GA, & Rosenheck RA (2008). Jail incarceration, homelessness, and mental health: A national study. Psychiatric Services, 59(2), 170–177. 10.1176/ps.2008.59.2.170 [DOI] [PubMed] [Google Scholar]
  40. Greenwood J (2017). Psychologists go to war. Behavioral Scientist, History. https://behavioralscientist.org/psychologists-go-war/ [Google Scholar]
  41. Griffith J (2020, April 25). Detroit health care worker dies after being denied coronavirus test 4 times, daughter says. NBC News. https://www.nbcnews.com/news/us-news/detroit-health-care-worker-dies-after-being-denied-coronavirus-test-n1192076 [Google Scholar]
  42. Grills CN, Aird EG, & Rowe D (2016). Breathe, baby, breathe: Clearing the way for the emotional emancipation of black people. Cultural Studies ↔ Critical Methodologies, 16(3), 333–343. 10.1177/1532708616634839 [DOI] [Google Scholar]
  43. Hall MA, Zheng B, Dugan E, Camacho F, Kidd KE, Mishra A, & Balkrishnan R (2002). Measuring patients’ trust in their primary care providers. Medical Care Research and Review, 59(3), 293–318. 10.1177/1077558702059003004 [DOI] [PubMed] [Google Scholar]
  44. Hamilton AB, Brown A, Loeb T, Chin D, Grills C, Cooley-Strickland M, Liu HH, & Wyatt GE (2020). Enhancing patient and organizational readiness for cardiovascular risk reduction among Black and Latinx patients living with HIV: Study protocol. Progress in Cardiovascular Diseases 10.1016/j.pcad.2020.02.014 [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. Hamp A, Stamm K, Lin L, & Christidis P (2016, September). 2015 APA survey of psychology health service providers. American Psychological Association. https://www.apa.org/workforce/publications/15-health-service-providers/ [Google Scholar]
  46. Harris P (2013, March 30). Fi nal twist to tale of Henrietta Lacks, the woman whose cells helped the fight against cancer. The Observer. https://www.theguardian.com/world/2013/mar/31/henrietta-lacks-cancer-research-genome [Google Scholar]
  47. Hastings JF, Jones LV, & Martin PP (2015). Permission to Heal, 2. African Americans and Depression: Signs, Awareness, Treatments, and Interventions, 15–36. Maryland: Rowman & Littlefield. [Google Scholar]
  48. Haynes C (2020, April 7). Data shows African Americans are dying at an alarming rate from COVID-19. Boston: 25 News. https://www.boston25news.com/ [Google Scholar]
  49. Healey M (2018, December 21). America’s psychologists want you to understand how racism holds our country back. Los Angeles Times. https://www.latimes.com/science/sciencenow/la-sci-sn-race-america-psychologists-20181221-story.html [Google Scholar]
  50. Himle JA, Baser RE, Taylor RJ, Campbell RD, & Jackson JS (2009). Anxiety disorders among African Americans, blacks of Caribbean descent, and non-Hispanic whites in the United States. Journal of Anxiety Disorders, 23(5), 578–590. 10.1016/j.janxdis.2009.01.002 [DOI] [PMC free article] [PubMed] [Google Scholar]
  51. Hogarth RA (2019). The myth of innate racial differences between white and Black people’s bodies: Lessons from the 1793 yellow fever epidemic in Philadelphia, Pennsylvania. American Journal of Public Health, 109(10), 1339–1341. 10.2105/ajph.2019.305245 [DOI] [PMC free article] [PubMed] [Google Scholar]
  52. Holmes SC, Facemire VC, & DaFonseca AM (2016). Expanding criterion a for posttraumatic stress disorder: Considering the deleterious impact of oppression. Traumatology, 22(4), 314–321. 10.1037/trm0000104 [DOI] [Google Scholar]
  53. Hoppe TA, Litovitz A, Willis KA, Meseroll RA, Perkins MJ, Hutchins BI, Davis AF, Lauer MS, Valantine HA, Anderson JM, & Santangelo GM (2019). Topic choice contributes to the lower rate of NIH awards to African-American/Black scientists. Science Advances, 5(10). 10.1126/sciadv.aaw7238 [DOI] [PMC free article] [PubMed] [Google Scholar]
  54. Jones LK, & Cureton JL (2014). Trauma redefined in the DSM-5: Rationale and implications for counseling practice. The Professional Counselor, 4(3), 257–271. 10.15241/lkj.4.3.257 [DOI] [Google Scholar]
  55. Kelch-Oliver K, & Smith CO (2014). Using an evidence-based parenting intervention with African American parents. The Family Journal, 23(1), 26–32. 10.1177/1066480714555697 [DOI] [Google Scholar]
  56. Kellerman NP (2001). Psychopathology in children of Holocaust survivors: a review of the research literature. Israel Journal of Psychiatry and Related Sciences, 38(1), 36–46. PMID: 11381585 [PubMed] [Google Scholar]
  57. Keita GP, (2012) How psychologists are helping to reduce health disparities. Monitor on Psycholoy, 43(7),42. https://www.apa.org/monitor/2012/07-08/itpi [Google Scholar]
  58. Kendi IX (2020, April 14). Stop blaming Black people for dying of the coronavirus. The Atlantic. https://www.theatlantic.com/ideas/archive/2020/04/race-and-blame/609946/ [Google Scholar]
  59. Kennedy BR, Mathis CC, & Woods AK (2007). African Americans and their distrust of the health care system: Healthcare for diverse populations. Journal of Cultural Diversity, 14(2), 56–60. [PubMed] [Google Scholar]
  60. Ktitowsky. (2017, March 5). Phrenology and “scientific racism” in the 19th century. Real Archaeology. https://pages.vassar.edu/realarchaeology/2017/03/05/phrenology-and-scientific-racism-in-the-19th-century/ [Google Scholar]
  61. Lahut J (2020) Fauci says the coronavirus is ‘shining a bright light’ on ‘unacceptable’ health disparities for African Americans. Business Insider. https://www.businessinsider.com/fauci-covid-19-shows-unacceptable-disparities-for-african-americans-2020-4 [Google Scholar]
  62. Levenson E (2020, April 7). Why black Americans are at higher risk for coronavirus. CNN. https://www.cnn.com/2020/04/07/us/coronavirus-black-americans-race/index.html [Google Scholar]
  63. Lin L, Stamm K, & Christidis P (2018). How diverse is the psychology workforce? Monitor on Psychology, 49(2),19. https://www.apa.org/monitor/2018/02/datapoint [Google Scholar]
  64. Liu H, Prause N, Wyatt GE, Williams JK, Chin D, Davis T, Loeb TB, Marchand E, Zhang M, & Myers HF (2015). Development of a composite trauma exposure risk index. Psychological Assessment, 27(3), 965–74. doi 10.1037/pas0000069 [DOI] [PMC free article] [PubMed] [Google Scholar]
  65. Loeb TB, Joseph NT, Wyatt GE, Zhang M, Chin D, Thames A, & Aswad Y (2018). Predictors of somatic symptom severity: The role of cumulative history of trauma and adversity in a diverse community sample. Psychological Trauma: Theory, Research, Practice, and Policy, 10(5), 491–498. 10.1037/tra0000334 [DOI] [PMC free article] [PubMed] [Google Scholar]
  66. Lurie K, Schuster B, & Rankin S (2015, May 8). Discrimination at the margins: The intersectionality of homelessness & other marginalized groups. Homeless rights advocacy project 8. https://digitalcommons.law.seattleu.edu/hrap/8/ [Google Scholar]
  67. Martschenko D (2017). IQ tests have a dark, controversial history — but they’re finally being used for good. Business Insider. https://www.businessinsider.com/iq-tests-dark-history-finally-being-used-for-good-2017-10 [Google Scholar]
  68. Maybank A (2020, April 7). The pandemic’s missing data. The New York Times. https://www.nytimes.com/2020/04/07/opinion/coronavirus-blacks.html [Google Scholar]
  69. Medlock M, Weissman A, Wong SS, & Carlo AD (2016). Addressing the legacy of racism in psychiatric training. American Journal of Psychiatry Residents’ Journal, 11(2), 13–13. 10.1176/appi.ajp-rj.2016.110206 [DOI] [Google Scholar]
  70. Mock B (2020, March 14). Why you should stop joking that black people are immune to coronavirus. CityLab. https://www.citylab.com/equity/2020/03/coronavirus-immunity-racism-history-disease-yellow-fever/607891/ [Google Scholar]
  71. Moffic HS (2015). ICD-10 and the diagnosis of racism Psychiatric Times. https://www.psychiatrictimes.com/cultural-psychiatry/icd-10-and-diagnosis-racism/page/0/1 [Google Scholar]
  72. Mohatt NV, Thompson AB, Thai ND, & Tebes JK (2014). Historical trauma as public narrative: A conceptual review of how history impacts present-day health. Social Science & Medicine, 106, 128–136. 10.1016/j.socscimed.2014.01.043 [DOI] [PMC free article] [PubMed] [Google Scholar]
  73. Myers HF, Wyatt GE, Ullman JB, Loeb TB, Chin D, Prause N, Zhang M, Williams JK, Slavich GM, & Liu H (2015). Cumulative burden of lifetime adversities: Trauma and mental health in low-SES African Americans and Latino/as. Psychological Trauma: Theory, Research, Practice, and Policy, 7(3), 243–251. 10.1037/a0039077 [DOI] [PMC free article] [PubMed] [Google Scholar]
  74. NIDA. (2020, April 6). COVID-19: Potential Implications for Individuals with Substance Use Disorders. Retrieved from https://www.drugabuse.gov/about-nida/noras-blog/2020/04/covid-19-potential-implications-individuals-substance-use-disorders
  75. Novacek DM, Hampton-Anderson JN, Ebor MT, Loeb TB,& Wyatt GE(2020) Mental health ramifications of the COVID-19 pandemic for Black Americans: Clinical and research recommendations. Psychological Trauma [DOI] [PMC free article] [PubMed] [Google Scholar]
  76. Obama B (2020, May 29). My statement on the death of George Floyd: [Tweet; ]. https://twitter.com/BarackObama/status/1266400635429310466 [Google Scholar]
  77. ODPHP-Office of Disease Prevention and Health Promotion (2020). Discrimination. Healthy People. https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health/interventions-resources/discrimination
  78. Ohrnberger J,Fichera E & Sutton M(2017) The relationship between physical and mental health: A mediation analysis. Social Science & Medicine 195, 42–49. 10.1016/j.socscimed.2017.11.008 [DOI] [PubMed] [Google Scholar]
  79. Olsen P (2017). Racial stereotypes: History and consequences. Augustana Digital Commons. https://digitalcommons.augustana.edu/celebrationoflearning/2017/presentations/4 [Google Scholar]
  80. Pfefferbaum B, & North CS (2020). Mental health and the COVID-19 Pandemic. The New England Journal of Medicine. 10.1056/NEJMp2008017 [DOI] [PubMed] [Google Scholar]
  81. Poston JT, Patel BK, & Davis AM (2020). Management of critically ill adults with COVID-19. JAMA. 10.1001/jama.2020.4914 [DOI] [PubMed] [Google Scholar]
  82. Pressley A (2020, April). Reps. Pressley Kelly, Bass Lee, & Sen. Warren introduce legislation to require federal government to collect & release COVID-19 demographic data including race and ethnicity [press release] retrieved from https://pressley.house.gov/media/press-releases/reps-pressley-kelly-bass-lee-sen-warren-introduce-legislation-require-federal [Google Scholar]
  83. Purtle J (2012). Racial and ethnic disparities in post-disaster mental health: Examining the evidence through a lens of social justice. Washington and Lee Journal of Civil Rights and Social Justice, 19(1). https://scholarlycommons.law.wlu.edu/crsj/vol19/iss1/7/ [Google Scholar]
  84. Reger MA, Stanley IH, & Joiner TE (2020). Suicide mortality and coronavirus disease 2019—A perfect storm? JAMA Psychiatry. 10.1001/jamapsychiatry.2020.1060 [DOI] [PubMed] [Google Scholar]
  85. Rivero E (2020) Counties with higher proportion of Black residents have more COVID-19 cases, deaths. [UCLA RESEARCH BRIEF; ] https://newsroom.ucla.edu/releases/counties-black-residents-more-covid-19-deaths [Google Scholar]
  86. Roberts SO, Bareket-Shavit C, Dollins FA, Goldie PD, & Mortenson E (2020). Racial Inequality in Psychological Research: Trends of the Past and Recommendations for the Future. Perspectives on Psychological Science, 174569162092770. 10.1177/1745691620927709 [DOI] [PubMed] [Google Scholar]
  87. Rothman L (2017, April 21). The disturbing history of African-Americans and medical research goes beyond Henrietta Lacks. Time. https://time.com/4746297/henrietta-lacks-movie-history-research-oprah/ [Google Scholar]
  88. Saha S, Varghese D, Slade T, Degenhardt L, Mills K, McGrath J, & Scott J (2011). The association between trauma and delusional-like experiences. Psychiatry Research, 189(2), 259–264. 10.1016/j.psychres.2011.03.019 [DOI] [PubMed] [Google Scholar]
  89. Santhanam L (2020, April 6). Why child welfare experts fear a spike of abuse during COVID-19. PBS News Hour. https://www.pbs.org/newshour/health/why-child-welfare-experts-fear-a-spike-of-abuse-during-covid-19 [Google Scholar]
  90. Scheiber N, Schwartz ND, & Hsu T, (2020, March 30) ‘White-collar quarantine’ over virus spotlights class divide. The New York Times. https://www.nytimes.com/2020/03/27/business/economy/coronavirus-inequality.html [Google Scholar]
  91. Severson K (2011) Thousands sterilized, a state weighs restitution. The New York Times. https://www.nytimes.com/2011/12/10/us/redress-weighed-for-forced-sterilizations-in-north-carolina.html [Google Scholar]
  92. Shelton (2020, June 4). U.S to require states to report demographic data amid virus disparities. [Tweet; ] https://twitter.com/drrachelshelton/status/1268663446167523328?s=21 [Google Scholar]
  93. Shullman SL (2020, May 18). Sasse’s disrespectful remarks re psychologists ignore mental health crisis in America, says APA president. American Psychological Association. https://www.apa.org/news/press/releases/2020/05/sasse-mental-health-remarks
  94. Shushanksy L (2017). Disparities within minority mental health care. NAMI: National Alliance on Mental Illness. https://www.nami.org/Blogs/NAMI-Blog/July-2017/Disparities-Within-Minority-Mental-Health-Care [Google Scholar]
  95. Siegel J, Coleman DL, & James T (2018). Integrating social determinants of health into graduate medical education. Academic Medicine, 93(2), 159–162. 10.1097/acm.0000000000002054 [DOI] [PubMed] [Google Scholar]
  96. Skosireva A, O’Campo P, Zerger S, Chambers C, Gapka S, & Stergiopoulos V (2014). Different faces of discrimination: Perceived discrimination among homeless adults with mental illness in healthcare settings. BMC Health Services Research, 14(1). 10.1186/1472-6963-14-376 [DOI] [PMC free article] [PubMed] [Google Scholar]
  97. Smith BL (2018). Spanish-speaking psychologists in demand: By learning or perfecting their Spanish, practitioners can better serve a large and growing population. Monitor on Psychology, 49(6), 68. https://www.apa.org/monitor/2018/06/spanish-speaking [Google Scholar]
  98. Steiner A (2018). Advocates address deep distrust of mental health care among African-Americans. MinnPost. https://www.minnpost.com/mental-health-addiction/2018/11/advocates-address-deep-distrust-of-mental-health-care-among-african-americans/ [Google Scholar]
  99. Serwer A (2020, May 8th). The Coronavirus was an emergency until Trump found out who was dying. The Atlantic. https://www.theatlantic.com/ideas/archive/2020/05/americas-racial-contract-showing/611389/ [Google Scholar]
  100. Szymanski DM, & Stewart DN (2010). Racism and sexism as correlates of African American women’s psychological distress. Sex Roles, 63(3–4), 226–238. 10.1007/s11199-010-9788-0 [DOI] [Google Scholar]
  101. Thorpe KE, Chin KK, Cruz Y, Innocent MA, & Singh L (2017). The United States can reduce socioeconomic disparities by focusing on chronic diseases. Health Affairs. https://www.healthaffairs.org/do/10.1377/hblog20170817.061561/full/
  102. Tucker WH. (2009). The Cattell Controversy: Race, science, and ideology. The Cattell Controversy: Race, Science, and Ideology. 1–254. [Google Scholar]
  103. Tucker WH (2010). The Cattell controversy: Race, science, and ideology. University of Illinois Press. [Google Scholar]
  104. van Ryn M, Hardeman R, Phelan SM, PhD DJ, Dovidio JF, Herrin J, Burke SE, Nelson DB, Perry S, Yeazel M, & Przedworski JM (2015). Medical school experiences associated with change in implicit racial bias among 3547 students: A medical student changes study report. Journal of General Internal Medicine, 30(12), 1748–1756. 10.1007/s11606-015-3447-7 [DOI] [PMC free article] [PubMed] [Google Scholar]
  105. Vesoulis A (2020, March 11). Coronavirus may disproportionately hurt the poor–and that’s bad for everyone. Time. https://time.com/5800930/how-coronavirus-will-hurt-the-poor/ [Google Scholar]
  106. Villarosa L (2019, August 14). Myths about physical racial differences were used to justify slavery — and are still believed by doctors today. The New York Times Magazine. https://www.nytimes.com/interactive/2019/08/14/magazine/racial-differences-doctors.html [Google Scholar]
  107. Walravens S (2020, April 6). Half of Americans suffering mental health issues during coronavirus, new poll shows. Forbe. https://www.forbes.com/ [Google Scholar]
  108. Washington HA (2008). Medical apartheid: The dark history of medical experimentation on Black Americans from colonial times to the present. Knopf Doubleday Publishing Group [Google Scholar]
  109. Washington K, Malone C Briggs C, & Reed G, (2016) Testing and African Americans: Testing Monograph From the Association of Black Psychologists in Leong FTL & Park YS (Eds.),. (2016). Testing and assessment with persons & communities of color (pp 3–11). CNPAAEMI. https://www.apa.org/pi/oema/resources/testing-assessment-monograph.pdf [Google Scholar]
  110. Weiner S (2020) The new coronavirus affects us all. But some groups may suffer more. Association of American Medical Colleges. https://www.aamc.org/news-insights/new-coronavirus-affects-us-all-some-groups-may-suffer-more [Google Scholar]
  111. Weiser SD, Bukusi EA, Steinfeld RL, Frongillo EA, Weke E, Dworkin SL, Pusateri K, Shiboski S, Scow K, Butler LM, & Cohen CR (2015). Shamba Maisha. AIDS, 29(14), 1889–1894. 10.1097/qad.0000000000000781 [DOI] [PMC free article] [PubMed] [Google Scholar]
  112. Wilkins EJ, Whiting JB, Watson MF, Russon JM, & Moncrief AM (2012). Residual effects of slavery: What clinicians need to know. Contemporary Family Therapy, 35(1), 14–28. 10.1007/s10591-012-9219-1 [DOI] [Google Scholar]
  113. Williams DR, Lawrence JA, & Davis BA (2019). Racism and health: Evidence and needed research. Annual Review of Public Health, 40(1), 105–125. 10.1146/annurev-publhealth-040218-043750 [DOI] [PMC free article] [PubMed] [Google Scholar]
  114. Williams DR, & Mohammed SA (2013). Racism and health I: Pathways and scientific evidence. American Behavioral Scientist, 57(8), 1152–1173. 10.1177/0002764213487340 [DOI] [PMC free article] [PubMed] [Google Scholar]
  115. Williams MT, Metzger IW, Leins C, & DeLapp C (2018). Assessing racial trauma within a DSM–5 framework: The UConn racial/Ethnic stress & trauma survey. Practice Innovations, 3(4), 242–260. 10.1037/pri0000076 [DOI] [Google Scholar]
  116. Wind TR, Rijkeboer M, Andersson G, & Riper H (2020). The COVID-19 pandemic: The ‘Black swan’ for mental health care and a turning point for e-Health. Internet Interventions, 20, 100317. 10.1016/j.invent.2020.100317 [DOI] [PMC free article] [PubMed] [Google Scholar]
  117. Wyatt GE (2009) Enhancing Cultural and Contextual Intervention Strategies to Reduce HIV/AIDS Among African Americans. American Journal of Public Health 99(11),1941–1945. [DOI] [PMC free article] [PubMed] [Google Scholar]
  118. Wyatt GE, Williams JK, Henderson T, & Sumner L (2009). On the outside looking in: Promoting HIV/AIDS research initiated by African American investigators. American Journal of Public Health, 99(S1), S48–S53. 10.2105/ajph.2007.131094 [DOI] [PMC free article] [PubMed] [Google Scholar]
  119. Wyatt GE, Chin D, Milburn N, Hamilton A, Lopez S, Kim A, Stone JD, & Belcher HME (2019). Mentoring the mentors of students from diverse backgrounds for research. American Journal of Orthopsychiatry, 89(3), 321–328. 10.1037/ort0000414 [DOI] [PubMed] [Google Scholar]
  120. Wyatt GE, Hamilton AB, Loeb TB, Moss N, Zhang M, & Liu H (2020). A Hybrid Effectiveness/Implementation Trial of an Evidence-Based Intervention for HIV-Serodiscordant African American Couples. In press. American Psychologist [DOI] [PubMed] [Google Scholar]
  121. Yancy CW (2020). COVID-19 and African Americans. JAMA. 10.1001/jama.2020.6548 [DOI] [PubMed] [Google Scholar]

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