Journal Club Article

1. Addressing Structural
Racism in Child and
Adolescent Psychiatry
in Psychotherapy
Franklin N. Alier, MD
SIU CAP, 1stYear Fellow
Journal Club

2. Introduction:
▪ Increase in mental health issues among children and adolescents has
recently been declared a health crisis in the United States.
▪ COVID-19, Mass Shootings, Social Injustices..etc.
▪ In the first six months of 2021 there was a 45% increase in the
number of self-injury and suicide cases in 5 to 17-year-olds compared
to the same period in 2019.
▪ Self reported suicide attempts amongAfrican American adolescents
rose by 80% between 1991 and 2019.

3. Introduction continued:
▪ - Insufficient number of child and adolescent mental health
professionals, and although the numbers are increasing, there are
not enough to meet the growing demand.
▪ 36 states have fewer than 10 child psychiatrists for every 100,000
children.
▪ Disproportionate increase in mental health disorders among youth
with skin of color and this is combined with an inadequate number of
mental health care providers leading to an absence of culturally
competent care.
▪ This leads to misdiagnosis and/or underdiagnosis.This can have
lasting and devastating effects on social outcomes.

4. Racial Disparities in Child and Adolescent Psychiatry
Access to mental health resources is a major predictor of mental health
outcomes.
Comparing:
Upper 25% socioeconomic income bracket: 25% have access to a mental health
care provider.
Lower 25% socioeconomic income bracket: 8% have access to a mental health
care provider.
The shortage of Child and Adolescent mental health care providers is most acute
in the lower socioeconomic bracket, predominantly in minority communities.

5. Results of recent studies:
ER visits due to suicidal behavior in adolescents ages 15 to 19 are on a steep increase.
The most affected populations are the AfricanAmerican and Latino communities.
African American male adolescents had the highest increase in suicide attempts
compared to all other groups.
African American males tend to be disproportionately and often incorrectly
diagnosed with severe disorders. (Schizophrenia)
There is a common bias among healthcare professionals that African American men
are more likely to be violent and dangerous compared to their Caucasian counterparts,
despite having similar externalizing behaviors.

6. How does this affect our patients?
African American youth are more likely to be diagnosed with
Oppositional Defiant Disorder and ADHD compared to their Caucasian counterparts.
Even when comparing groups with similar externalizing behaviors.
Literature shows caucasian children are more likely to be diagnosed with ADHD alone
whereas African American children were more commonly diagnosed
with ADHD with comorbid ODD or Conduct Disorder.
These diagnoses can be stigmatizing. In addition, they are associated with the
development of personality disorders such as Antisocial Personality Disorder, which
is often characterized by delinquent behavior later in life.

7. Why does this happen?
These disparities often stem from a lack of cultural competence and diversity in the mental
Health fields.
Implicit bias in mental health care providers.
These shortcomings lead to the behaviors of AfricanAmerican children being perceived as
delinquent and dangerous.
Patients are then seen under the lens of a disruptive behavioral
disorder rather than a neurodevelopmental disorder outside of the child’s control.
Implicit bias leads to the disregard of factors that contribute to differences
in clinical presentation, for example, how increased exposure to childhood
adversity impacts the development and display of mental health disorders.

8. Case 1
A psychiatry resident, Dr. A, conducted an
intake interview with a 19-year-old, male
patient, B. with multiple previous ER visits
throughout the years.
The psychiatry resident
noted the patient had been on many
antipsychotic medications
Over the years.
“Nobody cares about me!When I said I’m
just going to leave and end it all they got
upset and told me I had to see somebody. I
was just upset because they weren’t
listening to me. I don’t have schizophrenia
but they’re always talking about it. “
Comments from the patient:

9. Case 1

10. Case 1
Why is this case important?

11. Adverse Childhood Experiences (ACEs)

12. ACEs Continued:

15. How does all of this apply to us as mental health care professionals?

16. Conclusion:

17. References:
▪ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10773604/
▪ https://www.childrenshospitals.org/news/ newsroom/2021/12/sound-the-alarmfor-
kids-raises-awareness#.YmNli9rMKt8. Accessed 16 Jan 2023.