Nourished Health Anti-Racism and Anti-Discrimination Action Plan: Behavioral Health and Mental Health Coaching

I am saddened and disgusted by the ongoing police brutality and the rising death toll of the Black community as the result of racism, racist policing, and racist policies of the US. I took a break from blogging, social media, and my private practice to redirect my time to educating myself on the ways that I perpetuate racism through my day-to-day engagements and through Nourished Health. While I continue to educate myself, I stand in solidarity with BIPOC in denouncing police brutality, racialized violence and systemic oppression in all forms. I may not always know the best actions to take, but I WILL take action and I will admit when I am wrong and learn from my mistakes.

I am working to recognize the multitude of ways my privilege serves me and how the result of my skin, educational, financial, cultural, sexuality, and other privileges affect the lens of how I look at the world, interact with people on a day-to-day basis, and how my work with clients can serve to reinforce or challenge institutional oppression long propped-up through psychology, cultural appropriation, the Western medical system, the American Dietetic Association, and more. 

I recognize that words are often empty and that more important than statements of anti-racism are actions. This is the starting place for Nourished Health’s Anti-Racism and Anti-Discrimination Action Plan that will continue to be expanded upon and strengthened. 

Nourished Health’s Anti-Racism and Anti-Discrimination Action Plan

Mental health issues disproportionately impact marginalized or under-resourced groups and there is cultural bias in the field of mental health, which I am a part of as a mental health coach. Coaching from a place of compassion should mean actively recognizing inequality and working to ensure support and understanding for clients’ lived and cultural experiences. This writing is focused on what I am committing to, as an anti-racist mental health and behavioral health coach to address inequity and privilege in the mental health sphere; where the gaps are in Nourished Health around offering culturally competent, anti-racist coaching; the steps I am taking to improve support; and some of the mistakes I’ve made through my lens of privileges. 

1. I am committed to recognizing cultural diversity and will acknowledge the cultural beliefs and values of my clients, my own, and our communities.

In my first session with clients I open-up discussion about age, ethnicity, cultural background, spiritual beliefs, gender identity, and answer any questions clients have about my background and identity to support open dialogue to facilitate more culturally competent care and to increase comfort and understanding between the client and myself when there are differences in background and identity. 

An example in which I failed to do this resulted in me making assumptions about a client based on her name in a phone session in which I assumed her to be a white anti-racist ally instead of an Indian woman touched much more personally than a white ally by the murder of George Floyd. In this situation, I was able to apologize and take ownership of the lens through which I view clients but certainly there are many more times that I have made assumptions through my lens of privilege or engaged in a microaggression and my privilege allowed for me to ignore my behavior instead of owning and correcting it. While grateful for being called out in the moment so I could identify my mistake, it is my responsibility, not the responsibility of people of color, to call out my microaggressions and behaviors that support the institutions of racism. 

I have also made assumptions of the gender identity of my clients and am working to refer to all clients as they/them/their unless a client has specifically indicated to me their gender identity. I have changed my intake forms to allow for clients to share their gender identity and what their current preferred pronouns are. 

I am committed to building my awareness of how my experiences as a white woman of financial privilege, my values, and my biases influence psychological processes and to work toward correcting these prejudices and biases when I make them and when I make other mistakes. I am asking myself in and after sessions, “Is it appropriate for me to view this client or organization any differently than I would if the client was of the same ethnicity and cultural (or co-cultural) group as myself?”

Therapist training is shifting but there is still an expectation for clinicians to be “neutral” or “objective” as opposed to actively reflecting on the ways we bring our own biases/ideas into coaching and treatment. I am working to explore my own identity and am committed to acknowledging what biases and lenses I am viewing and connecting with my clients through. I have learned so much from my clients about racism, cultural expectations, homophobia, ageism, and other means of oppression by working to remain curious and open, willing to make mistakes in communication, apologizing for my mistakes, staying open to constant learning, and committing to self- and other-discovery. 

I pledge to stay in communication with my clients to understand my limits of competency and expertise. When I don’t possess the knowledge or training about an ethnic group or culture, we will discuss my limitations, I will gather information and make referrals to appropriate support, as needed. 

I recognize that cultural competency can’t ever be achieved and that cultural responsiveness requires a constant recommitment to self-education, exploration, and vulnerability. The trainings I have participated in over the last few years:

• Affinity Group Immersion Session for White Identified/Passing, 10/27/20, Stronghold.
• Race, Belonging, and Identity Development, 8/26/20, Stronghold.
• Engaging in LGBTQ+ Affirmative Counseling: Skillful Engagement and Authentic Support, 8/5/20, Lisa Aasheim, LPC, PhD.
• Clinician Training: Providing Culturally Competent Care and Addressing Racial Trauma, 7/8/20, Dana Udall, PhD.
• Clinician Training: Understanding & Responding to Microaggressions, 7/8/20, Tanika Johnson, EdD, MA, NCC
• Coaching on Racial Trauma, 6/3/20, Erica Hayes, MSW, NBC-HWC
• Coaching in an International Context, 4/1/20, Gillian Rader, NBC-HWC
• Culture Mapping: How Communication Differs in Navigating International Engagements, 7/17/19, Erica Hayes, MSW, NBC-HWC
• Cross-Cultural Communication: Coaching in an International Context and a Cultural Snapshot for Brazil, Mexico, India, Japan, Thailand, Singapore, South Korea, Taiwan, and the United Arab Emirates, 6/19/19,  Erica Hayes, MSW, NBC-HWC & Gillian Rader, NBC-HWC
• Diversity & Cultural Humility: Creating an Inclusive Culture, San Francisco, CA, 4/17/2019, Denise Boston, PhD, RDT
• Cross-Cultural Communication: Coaching in an International Context and a Cultural Snapshot for Canada, the United Kingdom, Australia, Germany, the Netherlands, Belgium, Spain, & Italy, 1/16/19, Erica Hayes, MSW, NBC-HWC
• Mental Healthcare in Canada, 9/13/18, Erica Hayes, MSW, NBC-HWC
• A Cultural Snapshot for Coaching Australians, 8/28/18, Erica Hayes, MSW, NBC-HWC
• Coaching Support for LGBTQ Challenges, 5/29/18, RP Whitmore-Bard, MA
• Cross-Cultural Communication: The Why and the How, San Francisco, 3/8/18, Dana Udall, PhD
• Coach-Client Identity Awareness, San Francisco, 10/26/17, Dana Udall, PhD

2. I am committed to understanding the role that culture, ethnicity, and race play in the sociopsychological and economic development of ethnic and culturally diverse populations and understand that socioeconomic and political factors significantly impact the psychosocial, political, and economic development of ethnic and culturally diverse groups.

I am committed to respecting the roles of family members and community structures, hierarchies, values, and beliefs within my clients’ cultures and identify resources within that community for client support. Previously my expectation had been to offer one-on-one coaching interventions and energy work which comes from my own very individualistic-based culture. Now I open-up sessions to community and family members at the client’s request, as a number of different First Nations among other peoples, center family and the entire community, in healing practices for the individual. 

I respect clients’ religious and/or spiritual beliefs and values, including attributions and taboos, as they affect world view, psychosocial functioning, and expressions of distress. In studying different shamanic practices around the world, I have become more familiar with a few indigenous beliefs and practices and will work to hold them from a place of respect without appropriation while I commit to learning more about appropriation and microaggressions. I know that traditional healers (e.g., shamans, curanderos, espiritistas) have an important place in many cultures. I am grateful to consult with and/or include traditional healers relevant to my client’s cultural and belief systems when requested.

My coming from a non-religious, animist, earth-centered spiritual focus in my own life previously raised obstacles for my understanding of different religions and non-earth-based spiritual practices. I recognize that particulars of religious or spiritual beliefs do not matter as much as the individual connection to them. I see that praying or meditating, of any form/means, is self-care that supports mindfulness, self-awareness, and hope. Community-based religious and spiritual gatherings support the individual through connection and understanding. I am always open to consult with and/or include religious/spiritual leaders/practitioners relevant to the client’s cultural and belief systems when requested.

I recognize that the language I use can feel exclusionary to individuals whose first language is not English and to English-speakers who have not had the opportunity to, or chosen not to, participate in the same forms of education I received. If I cannot interact in the language requested by the client or am not communicating in a way that is understood by the client, I will make an appropriate referral. I am learning to provide psycho-education in wording that is not dense in jargon. A gap in my practice is that I do not currently work with any translators. 

English is my first language. I am conversational in Spanish but do not feel competent enough in my Spanish-speaking capabilities to offer trauma coaching or to coach through psychological blocks in Spanish. I have a list of therapists and coaches who can provide services in Spanish. I am continuing to improve my Spanish communication skills so that I can eventually coach in Spanish. I am also learning Portuguese, Chinese, and German but am nowhere near conversational in any of those languages! I am working to expand my referral list for clients to access services in their language of preference.

Text- and email-based coaching is offered for clients that are hearing-impaired and I work with vision-impaired clients to ensure I am offering resources that can go through text-to-speech software. That said, I know that working with a therapist or coach with similar needs and lived experiences is most beneficial. I am committed to connect with more coaches that are hearing or vision-impaired. At this time, I can only make referrals to a vision-impaired colleague for energy work. I have not learned any sign language yet and recognize that this often prevents meaningful connection and support. 

I work to match the psychoeducation and strategies to the client’s level of need (e.g., Maslow’s hierarchy of needs). For example, taking into account that my low income clients may be facing additional stressors of malnutrition, substandard housing, and poor medical care. Rural residency may preclude accessibility of some services.  I offer virtual and sliding-scale appointments to decrease some of these obstacles though this does not overcome these barriers.

I completely understand that some clients distrust the medical system and mental health providers because of previous experiences (e.g., refugees’ status may be associated with violent treatments by government officials and agencies). I find virtual appointments help clients feel safer by them being home and with their loved ones and I do not push clients to disclose personal information that they are not comfortable sharing. The benefit of not being able to accept insurance is that I am not under the same requirements to gather information or report on that information. In these situations, I recognize that more sessions can be needed as rapport-building and trust will take longer to develop if trust can be developed at all. I am committed to taking ownership for the ways that I inhibit or support a feeling of safety in sessions.

3. I  will help clients to understand/maintain their own sociocultural identification, if desired. I am learning about the interaction of culture, gender, and sexual orientation on behavior and needs.

I look to learn about my clients’ familiarity and comfort with the majority culture. I believe that an important part of creating the life we want to live is to identify our values and how much we are living into our values. A part of this is helping my clients identify their own cultural values and norms and making sense of how those impact their lives. 

I have noticed significant generational and cultural conflicts happening between my clients and their first generation parents or grandparents in which the expectation from the clients’ elders may conflict with the expectations the client has acculturated to or the expectations of friends of the client around dating, relationships, living with family, finances, and more. Likewise, my clients that are parents who did not grow up in the states and are living here now, are struggling with what their children are learning that differ from what they learned and experienced. This also impacts parents when their children are growing up in the states versus their country of origin. These conversations have so much more at stake because of being a conflict of cultural values and require different discussions around boundary setting and creating understanding in communication than when not a cultural conflict. There is no easy solution. I can provide a listening ear, a sounding board, and an opportunity for my clients to explore what matters to them and to understand what matters to their family and where shared values can support better communication and understanding.

I am educating myself to uncover and explore more writings, talks, and research by members of marginalized groups so that when offering psycho-education and resources in sessions I can offer resources that clients can see their own experiences within. I am not always able to do this, but part of the discomfort of seeking mental health support is that the space is disproportionately white, middle-class, heterosexual, middle-aged women and given that my participation in mental health upholds this system of inequity, it is essential to bring in other voices and to have a toolkit of a diversity of resources. 

4. I recognize that racism, sexism, ableism, ageism, homophobia, and transphobia are traumas and may result in PTSD. I am committed to supporting my clients to build resilience as they navigate these traumas. 

There is a currently heightened awareness of racism; however, the backlash to that awareness has resulted in even more violence against BIPOC and an increase in the trauma response being experienced.

I offer a space for clients to talk through their experiences of oppression and explore whether a problem stems from racism, discrimination or another bias in others to hopefully minimize the tendency to internalize negative experiences that result in anger, sadness, or anxiety. Developing defensive behaviors in response to discrimination has been termed, “healthy paranoia,” because it is protective. Fearing police, given the history of police brutality against Black and Latino men (particularly), is a protective fear.

When traumas of racism are triggered, instead of jumping into previous goals-work and action steps as is traditional with coaching, I will make space to discuss the discrimination or fear response being activated and support my client to find their center in the face of racist discrimination, danger, lack of understanding, and microaggressions. Self-care, mindfulness, community/spiritual/religious support, social connection, means of resistance, boundary setting, and mindful communication become areas that coaching can support. I am also finding the recommendations by the Institute for the Study and Promotion of Race and Culture helpful.

I am committed to recognizing and acknowledging relevant discriminatory practices at the social and community level that may be affecting the emotional health of my clients. For example, clients experiencing depression or anxiety that may be associated with frustrated attempts to climb the corporate ladder in an organization that is dominated by a top echelon of white, heterosexual, males.

Powerful BIPOC Mental Health Advocates to Follow and Hire

This is a very short list of BIPOC mental health advocates and organizations to explore for more information. I do not have any affiliation directly with any provider mentioned here and none of these providers are endorsing Nourished Health. All professional conduct and liability falls within the clinician’s ethical and legal obligations of their respective licensing body.

Adriana Alejandre: @latinxtherapist Check out her Therapist Directory

Dr. Jennifer Mullan: @Decolonizingtherapy

Dr. Rocío Rosales Meza: @Dr.Rosalesmeza

Elyse Fox of Sad Girls Club: @Sadgirlsclub

Inclusive Therapists Directory

Joy Harden Bradford of Dr. Joy: Explore her Provider Directory for Therapists for Black Girls

LGBTQ Psychotherapists of Color (QTOC)

Minaa B.: @Minaa_b

National Queer and Trans Therapists of Color Network: @nqttcn

QTPOC Mental Health and Rest for Resistance: @qtpocmentalhealth 

Rebecca Borucki Of Bexlife:  @Bexlife

Sahaj Kohli: @Browngirltherapy. See Her List Of Mental Health Care Professionals Of Color Who Are Currently Accepting New Clients For Teletherapy Right Now

South Asian Mental Health Initiative and Network: @samhinorg. Check out their Mental Health Provider Directory

The Asian Mental Health Project: @asianmentalhealthproject

The Boris Lawrence Henson Foundation

The Loveland Foundation: @thelovelandfoundation

The National American Indian and Alaska Native MHTTC of the Mental Health Technology Transfer Center

Readings on the Mental Health and Trauma Impacts of Racism

Adam EK, Heissel JA, Zeiders KH, et al. Developmental histories of perceived racial discrimination and diurnal cortisol profiles in adulthood: A 20-year prospective study. Psychoneuroendocrinology. 2015;62:279-291. doi:10.1016/j.psyneuen.2015.08.018

Anglin DM, Lighty Q, Greenspoon M, Ellman LM. Racial discrimination is associated with distressing subthreshold positive psychotic symptoms among US urban ethnic minority young adults. Soc Psychiatry Psychiatr Epidemiol. 2014;49(10):1545-1555. doi:10.1007/s00127-014-0870-8

Assari S, Moghani Lankarani M, Caldwell CH. Discrimination Increases Suicidal Ideation in Black Adolescents Regardless of Ethnicity and Gender. Behav Sci (Basel). 2017;7(4):75. Published 2017 Nov 6. doi:10.3390/bs7040075

Berger M, Sarnyai Z. “More than skin deep”: stress neurobiology and mental health consequences of racial discrimination.Stress. 2015 Jan;18(1):1-10. Doi: 10.3109/10253890.2014.989204. 

Bor J, Venkataramani AS, Williams DR, & Tsai AC. Police killings and their spillover effects on the mental health of African American Americans: a population-based, quasi-experimental study. Lancet. 2018;392(10144):302‐310. doi:10.1016/S0140-6736(18)31130-9.

Brooks Holliday S, Dubowitz T, Haas A, Ghosh-Dastidar B, DeSantis A, Troxel WM. The association between discrimination and PTSD in African Americans: exploring the role of gender. Ethn Health. 2020;25(5):717-731. doi:10.1080/13557858.2018.1444150

Brownlow BN, Sosoo EE, Long RN, Hoggard LS, Burford TI, Hill LK. Sex Differences in the Impact of Racial Discrimination on Mental Health Among Black Americans. Curr Psychiatry Rep. 2019;21(11):112. Published 2019 Nov 4. doi:10.1007/s11920-019-1098-9

Currie C, Wild TC, Schopflocher D, Laing L. Racial discrimination, post-traumatic stress and prescription drug problems among Aboriginal Canadians. Can J Public Health. 2015;106(6):e382-e387. Published 2015 Jun 24. doi:10.17269/cjph.106.4979

Currie CL, Wild TC, Schopflocher DP, Laing L, Veugelers P, Parlee B. Racial discrimination, post traumatic stress, and gambling problems among urban Aboriginal adults in Canada. J Gambl Stud. 2013;29(3):393-415. doi:10.1007/s10899-012-9323-z

Downs, K. When black death goes viral, it can trigger PTSD-like trauma. PBS. 2016; 7/22.

English D, Lambert SF, Evans MK, Zonderman AB. Neighborhood racial composition, racial discrimination, and depressive symptoms in African Americans. Am J Community Psychol. 2014;54(3-4):219-228. doi:10.1007/s10464-014-9666-y

English D, Lambert SF, Ialongo NS. Longitudinal associations between experienced racial discrimination and depressive symptoms in African American adolescents. Dev Psychol. 2014;50(4):1190-1196. doi:10.1037/a0034703

Ferdinand AS, Paradies Y, Kelaher M. Mental health impacts of racial discrimination in Australian culturally and linguistically diverse communities: a cross-sectional survey. BMC Public Health. 2015;15:401. Published 2015 Apr 18. doi:10.1186/s12889-015-1661-1

Gee GC, Ryan A, Laflamme DJ, Holt J. Self-reported discrimination and mental health status among African descendants, Mexican Americans, and other Latinos in the New Hampshire REACH 2010 Initiative: the added dimension of immigration. Am J Public Health. 2006;96(10):1821-1828. doi:10.2105/AJPH.2005.080085

Hagiwara N, Alderson CJ, Mezuk B. Differential Effects of Personal-Level vs Group-Level Racial Discrimination on Health among Black Americans. Ethn Dis. 2016;26(3):453-460. Published 2016 Jul 21. doi:10.18865/ed.26.3.453

Heard-Garris NJ, Cale M, Camaj L, Hamati MC, Dominguez TP. Transmitting Trauma: A systematic review of vicarious racism and child health. Soc Sci Med. 2018;199:230-240. doi:10.1016/j.socscimed.2017.04.018

Henderson Z. In Their Own Words: How Black Teens Define Trauma. J Child Adolesc Trauma. 2017;12(1):141-151. Published 2017 Jun 30. doi:10.1007/s40653-017-0168-6

Hoggard LS, Volpe V, Thomas A, Wallace E, Ellis K. The role of emotional eating in the links between racial discrimination and physical and mental health. J Behav Med. 2019;42(6):1091-1103. doi:10.1007/s10865-019-00044-1

Janzen B, Karunanayake C, Rennie D, et al. Racial discrimination and depression among on-reserve First Nations people in rural Saskatchewan. Can J Public Health. 2018;108(5-6):e482-e487. Published 2018 Jan 22. doi:10.17269/cjph.108.6151

Kogan SM, Yu T, Allen KA, Brody GH. Racial microstressors, racial self-concept, and depressive symptoms among male African Americans during the transition to adulthood. J Youth Adolesc. 2015;44(4):898-909. doi:10.1007/s10964-014-0199-3

Lambert SF, Robinson WL, Ialongo NS. The role of socially prescribed perfectionism in the link between perceived racial discrimination and African American adolescents’ depressive symptoms. J Abnorm Child Psychol. 2014;42(4):577-587. doi:10.1007/s10802-013-9814-0

Lee DB, Peckins MK, Heinze JE, Miller AL, Assari S, Zimmerman MA. Psychological pathways from racial discrimination to cortisol in African American males and females. J Behav Med. 2018;41(2):208-220. doi:10.1007/s10865-017-9887-2

Macedo DM, Smithers LG, Roberts RM, Paradies Y, Jamieson LM. Effects of racism on the socio-emotional wellbeing of Aboriginal Australian children. Int J Equity Health. 2019;18(1):132. Published 2019 Aug 22. doi:10.1186/s12939-019-1036-9

McKenzie K. Tackling the root cause. There are clear links between racism and the higher rates of mental illness among ethnic minority groups. Ment Health Today. 2004;30-32.

McLoyd VC. The impact of economic hardship on black families and children: psychological distress, parenting, and socioemotional development. Child Dev. 1990;61(2):311-346. doi:10.1111/j.1467-8624.1990.tb02781.x

Mouzon DM, McLean JS. Internalized racism and mental health among African-Americans, US-born Caribbean Blacks, and foreign-born Caribbean Blacks. Ethn Health. 2017;22(1):36-48. doi:10.1080/13557858.2016.1196652

Mouzon DM, Taylor RJ, Keith VM, Nicklett EJ, Chatters LM. Discrimination and psychiatric disorders among older African Americans. Int J Geriatr Psychiatry. 2017;32(2):175-182. doi:10.1002/gps.4454

Nelson CA. Of Eggshells and Thin-skulls: a consideration of racism-related mental illness impacting Black women. Int J Law Psychiatry. 2006;29(2):112-136. doi:10.1016/j.ijlp.2004.03.012

Saleem FT, Anderson RE, Williams M. Addressing the “Myth” of Racial Trauma: Developmental and Ecological Considerations for Youth of Color. Clin Child Fam Psychol Rev. 2020;23(1):1-14. doi:10.1007/s10567-019-00304-1

Shepherd CCJ, Li J, Cooper MN, Hopkins KD, Farrant BM. The impact of racial discrimination on the health of Australian Indigenous children aged 5-10 years: analysis of national longitudinal data. Int J Equity Health. 2017;16(1):116. Published 2017 Jul 3. doi:10.1186/s12939-017-0612-0

Vu M, Li J, Haardörfer R, Windle M, Berg CJ. Mental health and substance use among women and men at the intersections of identities and experiences of discrimination: insights from the intersectionality framework. BMC Public Health. 2019;19(1):108. Published 2019 Jan 23. doi:10.1186/s12889-019-6430-0

Wallace S, Nazroo J, Bécares L.Cumulative Effect of Racial Discrimination on the Mental Health of Ethnic Minorities in the United Kingdom. Am J Public Health. 2016 Jul;106(7):1294-300. doi: 10.2105/AJPH.2016.303121.

Weaver A, Taylor RJ, Chatters LM, Himle JA. Depressive symptoms and psychological distress among rural African Americans: The role of material hardship and self-rated health. J Affect Disord. 2018;236:207-210. doi:10.1016/j.jad.2018.04.117

Whaley, A. L. Cross-cultural perspective on paranoia: A focus on the Black American experience. Psychiatric Quarterly, 1998; 69, 325-343.

Williams, DR. Stress and the Mental Health of Populations of Color: Advancing Our Understanding of Race-Related Stressors. Journal of Health and Social Behavior, 59(4): 466-485, 2018.

Williams MT, Kanter JW, Ching THW. Anxiety, Stress, and Trauma Symptoms in African Americans: Negative Affectivity Does Not Explain the Relationship between Microaggressions and Psychopathology. J Racial Ethn Health Disparities. 2018;5(5):919-927. doi:10.1007/s40615-017-0440-3

Williams MT, Taylor RJ, Mouzon DM, Oshin LA, Himle JA, Chatters LM. Discrimination and symptoms of obsessive-compulsive disorder among African Americans. Am J Orthopsychiatry. 2017;87(6):636-645. doi:10.1037/ort0000285

Readings on Institutionalized Racism of the Mental Health Field

Adebimpe VR. Overview: white norms and psychiatric diagnosis of black patients. Am J Psychiatry. 1981;138(3):279-285. doi:10.1176/ajp.138.3.279

Arnett, J.J., The neglected 95%: why American psychology needs to become less American. American Psychologist, 2008; 63(7)

Bailey RK, Blackmon HL, Stevens FL. Major depressive disorder in the African American population: meeting the challenges of stigma, misdiagnosis, and treatment disparities. J Natl Med Assoc. 2009;101(11):1084-1089. doi:10.1016/s0027-9684(15)31102-0

Carrington CH. Clinical depression in African American women: diagnoses, treatment, and research. J Clin Psychol. 2006;62(7):779-791. doi:10.1002/jclp.20289

Coleman KJ, Stewart C, Waitzfelder BE, et al. Racial-Ethnic Differences in Psychiatric Diagnoses and Treatment Across 11 Health Care Systems in the Mental Health Research Network. Psychiatr Serv. 2016;67(7):749-757. doi:10.1176/appi.ps.201500217

Cummings JR, Druss BG. Racial/ethnic differences in mental health service use among adolescents with major depression. J Am Acad Child Adolesc Psychiatry. 2011;50(2):160-170. doi:10.1016/j.jaac.2010.11.004

Cummings JR, Wen H, Druss BG. Racial/ethnic differences in treatment for substance use disorders among U.S. adolescents. J Am Acad Child Adolesc Psychiatry. 2011;50(12):1265-1274. doi:10.1016/j.jaac.2011.09.006

Fleming M, Barner JC, Brown CM, Smith T. Treatment disparities for major depressive disorder: Implications for pharmacists. J Am Pharm Assoc. 2003; 2011;51(5):605-612. doi:10.1331/JAPhA.2011.10125

Kelaher MA, Ferdinand AS, Paradies Y. Experiencing racism in health care: the mental health impacts for Victorian Aboriginal communities. Med J Aust. 2014;201(1):44-47.

Khazan O. Not White, Not Rich, and Seeking Therapy. The Atlantic. 2016; 6/1.

Lucksted, A. Raising issues: Lesbian, gay, bisexual, & transgender people receiving services in the public mental health system. 2004; 10.1300/J236v08n03_03. 

Malgady, R. G., Rogler, L. H., & Constantino, G.  Ethnocultural and linguistic bias in mental health evaluation of Hispanics. American Psychologist, 1987; 42(3), 228-234

McKenzie K, Bhui K. Institutional racism in mental health care. BMJ. 2007;334(7595):649-650. doi:10.1136/bmj.39163.395972.80

Nestor BA, Cheek SM, Liu RT. Ethnic and racial differences in mental health service utilization for suicidal ideation and behavior in a nationally representative sample of adolescents. J Affect Disord. 2016;202:197-202. doi:10.1016/j.jad.2016.05.021

Sclar DA, Robison LM, Schmidt JM, Bowen KA, Castillo LV, Oganov AM. Diagnosis of depression and use of antidepressant pharmacotherapy among adults in the United States: does a disparity persist by ethnicity/race?. Clin Drug Investig. 2012;32(2):139-144. doi:10.2165/11598950-000000000-00000

Shushansky, L. Disparities within minority mental health care. NAMI. 2017 July 31

Sohail Z, Bailey RK, Richie WD. Misconceptions of depression in african americans. Front Psychiatry. 2014;5:65. Published 2014 Jun 20. doi:10.3389/fpsyt.2014.00065

Stewart SM, Simmons A, Habibpour E. Treatment of culturally diverse children and adolescents with depression. J Child Adolesc Psychopharmacol. 2012;22(1):72-79. doi:10.1089/cap.2011.0051 

Storrs C. Therapists often discriminate against black and poor patients, study finds. CNN. 2016. 6/1.

Strakowski SM, Lonczak HS, Sax KW, et al. The effects of race on diagnosis and disposition from a psychiatric emergency service. J Clin Psychiatry. 1995;56(3):101-107.

Strakowski SM, Shelton RC, Kolbrener ML. The effects of race and comorbidity on clinical diagnosis in patients with psychosis. J Clin Psychiatry. 1993;54(3):96-102.

Wade JC. Institutional racism: an analysis of the mental health system. Am J Orthopsychiatry. 1993;63(4):536-544. doi:10.1037/h0079479

Walker DE. How the US Mental Health System Makes Natives Sick and Suicidal. Indian Country Today Media Network. 2015; 6/18.

Whaley, A. L. Cultural mistrust and the clinical diagnosis of paranoid schizophrenia in African American patients. Journal of Psychopathology and Behavioral Assessment, 2001; 23, 93-100.

READINGS ON Access and Stigma to Mental Health Care

Gary FA. Stigma: barrier to mental health care among ethnic minorities. Issues Ment Health Nurs. 2005;26(10):979-999. doi:10.1080/01612840500280638

Hoberman HM. Ethnic minority status and adolescent mental health services utilization. J Ment Health Adm. 1992;19(3):246-267. doi:10.1007/BF02518990

Jon-Ubabuco N, Dimmitt Champion J. Perceived Mental Healthcare Barriers and Health-seeking Behavior of African-American Caregivers of Adolescents with Mental Health Disorders. Issues Ment Health Nurs. 2019;40(7):585-592. doi:10.1080/01612840.2018.1547803

Lee SY, Xue QL, Spira AP, Lee HB. Racial and ethnic differences in depressive subtypes and access to mental health care in the United States. J Affect Disord. 2014;155:130-137. doi:10.1016/j.jad.2013.10.037

Sheehan AE, Walsh RFL, Liu RT. Racial and ethnic differences in mental health service utilization in suicidal adults: A nationally representative study. J Psychiatr Res. 2018;107:114-119. doi:10.1016/j.jpsychires.2018.10.019

Stafford AM, Draucker CB. Barriers to and Facilitators of Mental Health Treatment Engagement Among Latina Adolescents. Community Ment Health J. 2020;56(4):662-669. doi:10.1007/s10597-019-00527-0

Ward EC, Wiltshire JC, Detry MA, Brown RL. African American men and women’s attitude toward mental illness, perceptions of stigma, and preferred coping behaviors. Nurs Res. 2013;62(3):185-194. doi:10.1097/NNR.0b013e31827bf533

White, R. Commentary: Culturally competent care can help African-American mental illness stigma. Modern Healthcare. 2018; 9/22.

Wong EC, Collins RL, Cerully J, Seelam R, Roth B. Racial and Ethnic Differences in Mental Illness Stigma and Discrimination Among Californians Experiencing Mental Health Challenges. Rand Health Q. 2017;6(2):6. Published 2017 Jan 13.

Wynaden D, Chapman R, Orb A, McGowan S, Zeeman Z, Yeak S. Factors that influence Asian communities’ access to mental health care. Int J Ment Health Nurs. 2005;14(2):88-95. doi:10.1111/j.1440-0979.2005.00364.x

Resources for Mental Health Providers

Acosta, F., Yamamoto, J., & Evans, L. Effective psychotherapy for low income and minority patients. New York: Plenum Press. 1982

Alang SM. Mental health care among blacks in America: Confronting racism and constructing solutions. Health Serv Res. 2019;54(2):346-355. doi:10.1111/1475-6773.13115

American Psychological Association. Guidelines for Providers of Psychological Services to Ethnic, Linguistic, and Culturally Diverse Populations. 1990 Aug

American Psychological Association. Multicultural Guidelines: An Ecological Approach to Context, Identity, and Intersectionality. 2017 Aug.  

Brown-Iannuzzi JL, Adair KC, Payne BK, Richman LS, Fredrickson BL. Discrimination hurts, but mindfulness may help: Trait mindfulness moderates the relationship between perceived discrimination and depressive symptoms. Pers Individ Dif. 2014;56:10.1016/j.paid.2013.09.015. doi:10.1016/j.paid.2013.09.015

Bryant-Davis, T. Moving from cultural competence to antiracism. National Institute for the Clinical Application of Behavioral Medicine. 2020; 6/5

Bryant-Davis, T. Working With the Trauma of Racism. National Institute for the Clinical Application of Behavioral Medicine. 2020; 6/1

Comas-Díaz, L., & Griffith, E. E. H. (Eds.). Clinical guidelines in cross-cultural mental health. Wiley series in general and clinical psychiatry. John Wiley & Sons. 1988

Corneau S, Stergiopoulos V. More than being against it: anti-racism and anti-oppression in mental health services. Transcult Psychiatry. 2012;49(2):261-282. doi:10.1177/1363461512441594

Gallardo, M. When staying neutral isn’t the best approach. National Institute for the Clinical Application of Behavioral Medicine. 2020; 6/12

Harrell, S. When internalized stereotypes impact depression. National Institute for the Clinical Application of Behavioral Medicine. 2020; 7/17

Jernigan, M. M., Green, C. E., Perez-Gualdron, Liu, M. M, Henze, K. T., Chen, C….Helms, J. E. .#racialtraumaisreal. Institute for the Study and Promotion of Race and Culture. Chestnut Hill, MA. 2015

Li MJ, DiStefano AS, Thing JP, et al. Seeking refuge in the present moment: A qualitatively refined model of dispositional mindfulness, minority stress, and psychosocial health among Latino/a sexual minorities and their families. Psychol Sex Orientat Gend Divers. 2019;6(4):408-419. doi:10.1037/sgd0000338

Metzger IW, Anderson RE, Are F, Ritchwood T. Healing Interpersonal and Racial Trauma: Integrating Racial Socialization Into Trauma-Focused Cognitive Behavioral Therapy for African American Youth [published online ahead of print, 2020 May 5]. Child Maltreat. 2020;1077559520921457. doi:10.1177/1077559520921457

Ogden, P. Addressing white privilege in a session. National Institute for the Clinical Application of Behavioral Medicine. 2020; 6/8.

Pappas, S. New guidance on race and ethnicity for psychologists. Monitor on Psychology. 2019; 50(11). 

Rodriguez, R. How to address blindspots and racial bias in a session. National Institute for the Clinical Application of Behavioral Medicine. 2020; 7/9.

Root, Maria P. P. (1985). Guidelines for facilitating therapy with Asian American clients. Psychotherapy, 22(2s), 349-356.

Shallcross AJ, Spruill TM. The Protective Role of Mindfulness in the Relationship Between Perceived Discrimination and Depression. Mindfulness (N Y). 2018;9(4):1100-1109. doi:10.1007/s12671-017-0845-4

Taylor, R. E., & Kuo, B. C. H. (2019). Black American psychological help-seeking intention: An integrated literature review with recommendations for clinical practice. Journal of Psychotherapy Integration, 29(4), 325–337. https://doi.org/10.1037/int0000131

Watson-Singleton NN, Hill LK, Case AD. Past Discrimination, Race-Related Vigilance, and Depressive Symptoms: The Moderating Role of Mindfulness. Mindfulness (N Y). 2019;10(9):1768-1778. doi:10.1007/s12671-019-01143-5

Zapolski TCB, Faidley MT, Beutlich M. The Experience of Racism on Behavioral Health Outcomes: The Moderating Impact of Mindfulness. Mindfulness (N Y). 2019;10(1):168-178. doi:10.1007/s12671-018-0963-7

This is the start of a long-overdue conversation about racism and anti-racism within Nourished Health, within my life, and within the mental health field. If you have questions or concerns about anything I shared please reach out. You can post a message in the comments below or you can reach out privately to me through the contact form. If you are a mental health provider, I hope you will take advantage of the resources and readings above and as you encounter more, please share them with me so that I can add them. If you are a business owner or a practitioner of any kind and have created an Anti-Racism Action Plan or Statement for you or your company, please share it or a link to it below. I would love to read it. In solidarity and love…