Racial and Ethnic Minority Mental Health Advocacy: Strategies for Addressing Racism

  • Chelsi West OhueriEmail author
  • Virginia A. Brown
  • William B. Lawson
Part of the Current Clinical Psychiatry book series (CCPSY)


The past few years have witnessed increased discussion of physician and health advocacy. This chapter discusses the concept of the physician as an advocate in addressing issues of race and racism in the field of psychiatry. The authors argue that physician advocacy is necessary for addressing multiple forms of racism and the ways in which racism shapes disparate health and health care outcomes. The chapter reviews definitions of clinician advocacy and traces historical examples of advocacy within the field of psychiatry. A multidisciplinary framework of anthropology, sociology, and psychiatry is employed to examine race and racism in the field of psychiatry. Finally, specific strategies to address racism are provided, including strategies pertaining to curricula, training, and research. Ultimately, there is a need to advocate beyond the needs of the individual patient, and the field of psychiatry and the broader field of medicine need more systemic and robust forms of advocacy to address racism.


Advocacy Racism Ethnic and racial minorities Structural racism Medical education Social justice 


  1. 1.
    Earnest M, Wong S, Federico S. Physician advocacy: what is it and how do we do it? Acad Med. 2010;85(1):63–7.CrossRefGoogle Scholar
  2. 2.
    Dharamsi S, Ho A, Spadafora SM, Woollard R. The physician as health advocate: translating the quest for social responsibility into medical education and practice. Acad Med. 2011;86(9):1108–13. Scholar
  3. 3.
    Croft D, Jay S, Meslin E, Gaffney M, Odell J. Perspective: is it time for advocacy training in medical education? Acad Med. 2012;87(9):1165–70.CrossRefGoogle Scholar
  4. 4.
    Dobson S, Voyer S, Hubinette M, Regehr G. From the clinic to the community: the activities and abilities of effective health advocates. Acad Med. 2015;90(2):214–20. Scholar
  5. 5.
    Hubinette M, Dobson S, Regehr G. Not just ‘for’ ‘but’ ‘with’: health advocacy as a partnership process. Med Educ. 2015;49(8):796–804. Scholar
  6. 6.
    Funk M, Minoletti A, Drew N, Taylor J, Saraceno B. Advocacy for mental health: roles for consumer and family organizations and governments. Health Promot Int. 2006;21(1):70–5. Scholar
  7. 7.
    Association AM. Declaration of professional responsibility: medicine’s social contract with humanity. Mo Med. 2002;99(5):195. Accessed 1 July 2017.
  8. 8.
    Dobson S, Voyer S, Regehr G. Perspective: agency and activism: rethinking health advocacy in the medical profession. Acad Med. 2012;87(9):1161–4. Scholar
  9. 9.
    Huddle T. Perspective: medical professionalism and medical education should not involve commitments to political advocacy. Acad Med. 2011;86(3):378–83.CrossRefGoogle Scholar
  10. 10.
    Ashton J. Virchow misquoted, part-quoted, and real McCoy. J Epidemil Community Health. 2006;60(8):671.Google Scholar
  11. 11.
    Washington H. Medical apartheid: the dark history of medical experimentation on black Americans from colonial times to the present. New York: Harlem Moon; 2006.Google Scholar
  12. 12.
    Cartwright S. Report on the diseases and physical peculiarities of the Negro race. New Orleans Med Surg J. 1851;1851:691–715.Google Scholar
  13. 13.
    Metzl J. The protest psychosis: how schizophrenia became a black disease. Boston: Beacon Press; 2009.Google Scholar
  14. 14.
    Lowe TB. Nineteenth century review of mental health care for African Americans: a legacy of service and policy barriers. J Sociol Soc Welf. 2006;33(4 December):29–50.Google Scholar
  15. 15.
    Primm AB, Lawson WB. Diparities among ethnic groups: African Americans. In: Ruiz P, Primm A, editors. Disparities in psychiatric care: clinical and cross-cultural perspectives Baltimore. Philadelphia: Lippincott Williams & Wilkins; 2010. p. 19–29.Google Scholar
  16. 16.
    Adebimpe V. Overview: white norms and psychiatric diagnosis of black patients. Am J Psychiatr. 1981;138(3):279–85.CrossRefGoogle Scholar
  17. 17.
    Office of the Surgeon General (US); Center for Mental Health Services (US); National Institute of Mental Health (US). Mental health: culture, race, and ethnicity: a supplement to mental health: a report of the surgeon general. Rockville: Substance Abuse and Mental Health Services Administration (US), 2001.Google Scholar
  18. 18.
    Flaherty JA, Meagher R. Measuring racial bias in inpatient treatment. Am J Psychiatry. 1980;137(6):679–82. Scholar
  19. 19.
    Association NM. History—National Medical Association: Silver Spring 2017. Accessed 31 Aug 2017.
  20. 20.
    Williams E. The Howard department of neurology and psychiatry. J Natl Med Assoc. 1967;59(6):447–54.PubMedPubMedCentralGoogle Scholar
  21. 21.
    Elam L. Development of the department of psychiatry at Meharry Medical College. In: Spurlock J, editor. Black psychiatrists and American psychiatry. Washington, DC: American Psychiatric Association; 1999.Google Scholar
  22. 22.
    Pierce C. Black psychiatry one year after Miami. J Natl Med Assoc. 1970;62:471–63.PubMedPubMedCentralGoogle Scholar
  23. 23.
    Carter J. Racism’s impact on mental health. J Natl Med Assoc. 1992;86(7):543–7.Google Scholar
  24. 24.
    Sabshin M, Diesenhaus H, Wilkerson R. Dimensions of institutional racism in psychiatry. Am J Psychiatr. 1970;127(6):787–93.CrossRefGoogle Scholar
  25. 25.
    Hoberman J. Black and blue: the origins and consequences of medical racism. Oakland: University of California Press; 2012.CrossRefGoogle Scholar
  26. 26.
    Hocker C. America’s leading doctors, psychiatry: the leading medical practitioners of treatment of mental health issues including depression, eating disorders and substance abuse. 2008. Accessed 31 Aug 2017.
  27. 27.
    Carmichael S. Black Power, a critique of the system of international white supremacy and international capitalism. In: Cooper D, editor. The dialectics of liberation. New York: Penguin; 2003.Google Scholar
  28. 28.
    Metzl J, Hansen H. Structural competency: theorizing a new medical engagement with stigma and inequality. Soc Sci Med. 2014;103(February 2014):126–33.CrossRefGoogle Scholar
  29. 29.
    Feagin J, Bennefield Z. Systemic racism and US health care. Soc Sci Med. 2014;103:7–14.CrossRefGoogle Scholar
  30. 30.
    Brown PC, Closser S. Understanding and applying medical anthropology. 3rd ed. New York: Routledge; 2016.CrossRefGoogle Scholar
  31. 31.
    Weitz R. The sociology of health, illness, and health care: a critical approach. 6th ed. Boston: Wadsworth; 2013.Google Scholar
  32. 32.
    Association of American Medical Colleges. Behavioral and social science foundations for future physicians. Washington, DC: Association of American Medical Colleges; 2011.Google Scholar
  33. 33.
    Starr P. The social transformation of American medicine. New York: Basic Books; 1982.Google Scholar
  34. 34.
    Cooke M, Irby DM, Sullivan W, Ludmerer KM. American medical education 100 years after the Flexner report. N Engl J Med. 2006;355(13):1339–44. Scholar
  35. 35.
    World Health Organization. Constitution of WHO: principles. Accessed 24 Aug 2017.
  36. 36.
    Noonan AS, Velasco-Mondragon HE, Wagner FA. Improving the health of African Americans in the USA: an overdue opportunity for social justice. Public Health Rev. 2016;37(12):1–29.Google Scholar
  37. 37.
    Byrd WC, Clayton LA. An American health dilemma: a history of African Americans and the problem of race: beginnings to 1900, vol. (volume 1. New York: Routledge; 2000.Google Scholar
  38. 38.
    Metzl JM, Petty J, Olowojoba OV. Using a structural competency framework to teach structural racism in pre-health education. Soc Sci Med. 2017;199:189–201. Scholar
  39. 39.
    Berberoglu B. An introduction to classical and contemporary social theory. 2nd ed. General Hall: Dix Hill; 1998.Google Scholar
  40. 40.
    Omi M, Winant H. Racial formation in the United States. 3rd ed. New York: Routledge; 2015.Google Scholar
  41. 41.
    Omi M, Winant H. Blinded by sight: the racial body and the origins of the social construction of race. Law Soc Inq. 2016;41(4):1062–8.CrossRefGoogle Scholar
  42. 42.
    Jones CP. Levels of racism: a theoretic framework and a gardener’s tale. Am J Public Health. 2000;90(8):1212–5.CrossRefGoogle Scholar
  43. 43.
    McGuire TG, Alegria M, Cook BL, Wells KB, Zaslavsky AM. Implementing the institute of medicine definition of disparities: an application to mental health care. Health Serv Res. 2006;41(5):1979–2005.CrossRefGoogle Scholar
  44. 44.
    Lawson WB. Racial and ethnic factors in psychiatric research. Hosp Community Psychiatry. 1986;37(1):50–4.PubMedGoogle Scholar
  45. 45.
    Horvitz-Lennon M, Zhou D, Normand SL, Alegria M, Thompson WK. Racial and ethnic service use disparities among homeless adults with severe mental illnesses receiving ACT. Psychiatr Serv. 2011;62(6):598–604. Scholar
  46. 46.
    Han E, Liu GG. Racial disparities in prescription drug use for mental illness among population in US. J Ment Health Policy Econ. 2005;8(3):131–43.PubMedGoogle Scholar
  47. 47.
    Neighbors HW, Caldwell C, Williams DR, Nesse R, Taylor RJ, Bullard KM, et al. Race, ethnicity, and the use of services for mental disorders: results from the national survey of American life. Arch Gen Psychiatry. 2007;64(4):485–94. Scholar
  48. 48.
    Lawson WB, Hepler N, Holladay J, Cuffel B. Race as a factor in inpatient and outpatient admissions and diagnosis. Hosp Community Psychiatry. 1994;45(1):72–4.PubMedGoogle Scholar
  49. 49.
    Snowden LR, Masland MC, Wallace NT, Evans-Cuellar A. Effects on outpatient and emergency mental health care of strict Medicaid early periodic screening, diagnosis, and treatment enforcement. Am J Public Health. 2007;97(11):1951–6. Scholar
  50. 50.
    Delphin-Rittmon ME, Flanagan EH, Andres-Hyman R, Ortiz J, Amer MM, Davidson L. Racial–ethnic differences in access, diagnosis, and outcomes in public-sector inpatient mental health treatment. Psychol Serv. 2015;12(2):158–66. Scholar
  51. 51.
    Stergiopoulos V, O'Campo P, Gozdzik A, Jeyaratnam J, Corneau S, Sarang A, et al. Moving from rhetoric to reality: adapting housing first for homeless individuals with mental illness from ethno-racial groups. BMC Health Serv Res. 2012;12:345. Scholar
  52. 52.
    Acosta D, Ackerman-Barger K. Breaking the silence: time to talk about race and racism. Acad Med. 2017;92(3):285–8.CrossRefGoogle Scholar
  53. 53.
    People’s Institute for Survival and Beyond. Accessed 23 Aug 2017.
  54. 54.
    Racism Review: Scholarship and Activism Toward Racial Justice. About us—Racism Review. Accessed 23 Aug 2017.
  55. 55.
    Harvard University. Project Implicit. Accessed 23 Aug 2017.
  56. 56.
    Carpenter-Song E, Whitley R, Lawson WB, Quimby E, Drake RE. Reducing disparities in mental health care: suggestions from the Dartmouth–Howard collaboration. Community Ment Health J. 2011;47(1):1–13.CrossRefGoogle Scholar
  57. 57.
    WhiteCoats4BlackLives. About WC4BL. Accessed 31 July 2017.
  58. 58.
    Wear DZ, Joseph AJ, Chyatte M, Kumagai A. Remembering Freddie Gray: medical education for social justice. Acad Med. 2017;92(3):312–7.CrossRefGoogle Scholar
  59. 59.
    Bevis WM. Psychological traits of the southern Negro with observations as to some of his psychoses. Am J Psychiatr. 1921;1921:69.CrossRefGoogle Scholar
  60. 60.
  61. 61.
    Lawson WB. Biological markers in neuropsychiatric disorders: racial and ethnic factors. In: Sorel E, editor. Family, culture, and psychobiology. New York: Legas; 1990.Google Scholar
  62. 62.
    Lawson WB. Anxiety disorders in African Americans and other ethnic minorities. In: Andrews G, Charney D, Sirovatka P, Regier D, editors. Stress-induced and fear circuitry disorders—advancing the research agenda for DSM-V. Arlington: American Psychiatric Publishing; 2009. p. 139–44.Google Scholar
  63. 63.
    Roy B. The Tuskegee syphilis experiment: biotechnology and the administrative state. J Natl Med Assoc. 1995;87(1):56–67.PubMedPubMedCentralGoogle Scholar
  64. 64.
    Ejiogu N, Norbeck JH, Mason MA, Cromwell BC, Zonderman AB, Evans MK. Recruitment and retention strategies for minority or poor clinical research participants: lessons from the healthy aging in neighborhoods of diversity across the life span study. The Gerontologist. 2011;51(Suppl 1):S33–45. Scholar
  65. 65.
    Gara MA, Vega WA, Arndt S, Escamilla M, Fleck DE, Lawson WB, et al. Influence of patient race and ethnicity on clinical assessment in patients with affective disorders. Arch Gen Psychiatry. 2012;69(6):593–600. Scholar
  66. 66.
    Thompson M, Newell S, Carlson MJ. Race and access to mental health and substance abuse treatment in the criminal justice system. J Offender Rehabil. 2016;55(2):69–94. Scholar
  67. 67.
    Virginia M, Stephen D, Joseph EJ. Racial and ethnic recidivism risks: a comparison of postincarceration rearrest, reconviction, and reincarceration among white, black, and hispanic releasees. Prison J. 2009;89(3):309–27. Scholar
  68. 68.
    Thompson M. Mad or bad? Race, class, gender, and mental disorder in the criminal justice system. El Paso: LFB Scholarly Publishing; 2010.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Chelsi West Ohueri
    • 1
    Email author
  • Virginia A. Brown
    • 1
  • William B. Lawson
    • 2
  1. 1.Department of Population HealthDell Medical School, The University of Texas at AustinAustinUSA
  2. 2.Department of PsychiatryDell Medical School, The University of Texas at AustinAustinUSA

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