It’s a Systems Thing: Racism in Mental Health
In May 2022 I decided to write an article on racism in mental health as this is an area that I work in every single day with clients, and as a mental health practitioner. By virtue of my own personal experiences I can also – unfortunately – consider myself somewhat of an expert in this subject matter.
I originally wrote this article after receiving a request and offer to be paid for some of my writing of my choosing about mental health to be included in an online publication. When the “powers that be” decided it was too controversial, I never got paid for it.
What I did not expect was receiving racist and discriminatory feedback upon submission of this piece from people in the very mental health field I wrote about.
The irony here is not lost on me.
The racist feedback that was thinly veiled under critique of my writing style included:
1) Who is the audience for this article?
– answer: racialized clients, not white clients like you were hoping.2) Hoping that this article would drive more people to use services, and serve as an adjunct to therapy sessions.
– answer: any competent therapist should be able to speak to this content if they are working with any client – Racialized or not.3) What about the benefits of Cognitive Behavioural Therapy (CBT)?
– answer: this has been spoken about…ad nauseum…in almost every single article about CBT published, and is not the point of what I’m writing about.4) This doesn’t represent the experience of racialized people in therapy.
– answer: bold of a non-racialized person to suggest to a Racialized person that their own experience and knowledge about being Racialized is wrong.5) If unwilling to make our changes we will not pay you for this work.
– answer: I will not make changes to my own writing to support an agenda of white supremacy, this piece remains my intellectual property, and this conversation is done.
I am not the person to write the fluff piece and I am not the person to polish the truth to make it look pretty. I am the person to tell truths, to speak from not only education but also experience, and to advocate for and provide transparency – not defamation.
Below is my piece It’s a Systems Thing – Racism in Mental Health.
Edited for clarity, maintained with integrity, and published with honesty.
Systemic racism is alive and well in basically any institution that you can think of – yes, including the mental health system.
For those unfamiliar - systemic racism is the pervasive type of racism that is embedded in the very fabric of the institutions of governments, policy, housing, employment, education, healthcare, and everything in between or outside.
Systemic racism unjustly benefits those who exist with the privilege to not experience racial discrimination, not based on anything they have done but by virtue of how they exist. With this understanding you may be able to agree that systemic racism seems. . . well, bad. So, why does it still exist?
At times systemic racism is so deeply embedded that it is difficult to recognize its presence at all; at other times people are so deeply embedded in systemic racism that they refuse to recognize its presence at all and risk their own privilege.
Systemic racism is alive and well in mental health.
Consider the popular therapeutic modality Cognitive Behavioural Therapy (CBT); it focuses on challenging what are called “cognitive distortions” through reframing your thoughts, feelings or actions.
While CBT certainly has its benefits, it also has its limitations in that this therapy will not apply the same to a Racialized client as it does a White client. While not unique to this modality alone, CBT was developed through research that at the time would have focused primarily on White people – which means that systemic racism is embedded in the very creation of this therapy.
The challenge here – for example – is that the experience of racism as a Racialized person is not a cognitive distortion; having a way to reframe your thoughts, feelings, and actions around an experience of racism centres you as the problem instead of society or the individual wielding racism as the problem. Ultimately, this is not going to be helpful to you or your mental health.
If you wanted to, you could read heaps of blog posts, articles, and journal entries on why CBT and all evidenced based therapies are fantastic and help people worldwide. The fact of the matter is that when applied by the book, most therapeutic modalities even beyond the aforementioned CBT are rooted in systemic racism.
The reality of accessing therapy as a racialized person is that you will likely have to face racism at some turn, just like we are unfortunately used to living in our day to day lives.
This is not to say that you, as a Racialized person, can never receive CBT or any other type of therapy. What is important is an effective, competent, and Anti-Racist clinician.
Being Anti-Racist is to actively oppose racism instead of complicity sitting in and benefitting from racism. It comes down to the clinician to ensure that they are aware of – but also taking action on – their internal bias, the bias in the therapeutic modality they are working with, as well as the limitations and racism of the system in which they work.
So, how can you possibly know that a clinician does these things?
Look for a clinician who you feel safe being your authentic self with, who can be curious about your experience as a Racialized person, how those experiences intersect with mental health, and who acknowledges their own positionality.
Often it can feel good to find a clinician who looks like you, or who belongs to some of the same communities as you. It is nice to not have to educate your clinician on what racism is and how you might experience it – a clinician who looks like you sometimes just gets it.
Your clinician needs to be curious about all of your intersections of identity and how they influence your behaviour, beliefs, and actions. They also need to be curious about how systems have interacted back with you throughout your life based on those same intersections.
Beyond this you are also going to want your clinician to be able to acknowledge and understand how systemic racism, racism, and bias can and will show up between the two of you in session.
Yes, even the most well-intentioned clinician can accidentally have racial bias and systemic racism slip into their sessions.
Being able to call out and work with whatever is happening in the here and now is such an important therapeutic skill that encourages ongoing rapport building, clearing of the proverbial “elephant in the room”, and above all else – safety for you as the client.
Therapy, the mental health system, and indeed all structures and systems have a long way to go before they can support every person in the way that they are meant to. Equity does not come from moving into the privileged class, but rather from dismantling the inequitable system.
On the macro level, systemic racism will continue to exist until we all agree rewrite those systems in which it is embedded – this is a process in which we all have a part to play.
On the micro level, systemic racism will continue to influence and inform individual racism, and each one of us is responsible for our individual actions, learnings, and decolonization of our minds as clinicians, clients, and people.
Systemic racism is alive and well in mental health today and it is my hope that our bottom-up approach will one day render articles like this of warning, guidance, and experience as relics of the past.
After all, it’s a systems thing.