key: cord-0050389-e3hr279k
authors: Robinson, Diana M.; Taylor, Adrienne; Zein, Mira; Behbahani, Kayla; Khandai, Abhisek
title: A Call to Action: A New Era Calls for Incorporating Social Justice into Consultation-Liaison Psychiatry
date: 2020-09-20
journal: Psychosomatics
DOI: 10.1016/j.psym.2020.09.004
sha: 780d386593dbc005dad68bd42e1bd22729a073ec
doc_id: 50389
cord_uid: e3hr279k

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Psychiatrists increasingly recognize how structural disparities in our policies, communities, institutions, and even healthcare negatively impact individuals' psychiatric outcomes (1) (2) . Accordingly, recent efforts have been made to incorporate social justice principles into medical school and residency education (1, (3) (4) . The recent murder of George Floyd and Breonna Taylor and the shooting of Jacob Blake, as well as the impact of the coronavirus pandemic on people of color, has led to a national outcry and a renewed urgency to causes of social justice. Through these conversations, we have come to realize that it is not just law enforcement and the criminal justice system that were built on a framework of systemic racism, but that racial bias exists in healthcare, education, and their intersections, leading to innumerable health care disparities (5) . However, social justice has not, as of yet, been highlighted in consultation-liaison (C-L) psychiatry. We, a group of early career C-L psychiatrists, are committed to alleviating health disparities in marginalized populations through clinical care, academic and community projects, and advocacy work. We believe that C-L psychiatry is the setting best suited to apply social justice principles in the clinical setting, given its embedded role within the larger medical system, the potential entry point for vulnerable patients into mental health treatment, and opportunities for advocacy and education of physician peers and healthcare staff. Although Psychosomatics is a leading journal of consultation-liaison psychiatry and its mission is "to be the leading psychiatry journal focused on the care of patients with comorbid medical and psychiatric illnesses," since its first publication in 1960, to date it has not featured any articles on topics including social justice, racism, anti-racism, structural racism, structural vulnerability, or social determinants of health. There was a recent Psychosomatics article that explored the impact of collaborative care on racial/ethnic minorities, but it was not conceptualized in terms of social justice (2) . In comparison, these topics have been represented in other leading medical and psychiatric journals since at least 2015 (1, 3-4).

We call on and challenge C-L psychiatry and those working on C-L services, outpatient integrated medical clinics, and collaborative care settings to reframe C-L psychiatry from a social justice perspective. As physicians, our obligation is to address systemic racism and structural vulnerabilities. These health disparities not only affect the health of populations that we serve, but also infringe on the dignities of those who live and work in our health care systems. While identifying an opportunity for growth is an important first step, we must strive to do better and take the necessary steps to move towards a culture of equity and equality. We must continue to build on the steps that the Academic of Consultation Liaison Psychiatry (ACLP) has already taken, such as assembling a task force to address diversity, equity, and inclusion. We applaud the establishment of this task force but there is more to be done. To nurture a culture of inclusion and anti-racism, we propose concrete and attainable next steps including:

1. Dedicating an issue of Psychosomatics to social justice and structural racism topics, 2. Starting an ACLP special interest group on diversity/social justice, 3 . Increasing content at the ACLP annual meeting by encouraging submissions on social justice and diversity topics, 4. Encouraging and publishing more content in Psychosomatics on intersectionality of C-L with racial disparities. 5. Increasing outreach to medical students and residents by ACLP keeping registration affordable and allocating more poster slots for trainees in the poster session, 6. Increasing diversity within C-L faculty and fellowship training.

We believe that the implementation of these items will begin to provide for inclusivity, help to improve treatment and experiences of underrepresented populations, and consequently work to better the treatment of all patients. Thus, we call on our colleagues to improve and restore equity for patients at the intersection of psychiatry and general medicine through advancing social justice in the C-L setting.

From Cultural to Structural Competency-Training Psychiatry Residents to Act on Social Determinants of Health and Institutional Racism

The Effectiveness of Collaborative Care on Depression Outcomes for Racial/Ethnic Minority Populations in Primary Care: A Systematic Review

Introducing a Structural Competency Framework for Psychiatry Residents: Drawing Your Neighborhood. Acad Psychiatry

Structural Vulnerability: Operationalizing the Concept to Address Health Disparities in Clinical Care

Institute of Medicine (US) Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care