Minority Members Ask APA to Focus More on Their Concerns

Whether the issue is recruiting new members, APA committee appointments, the content of residency curricula, or the need for legislative advocacy, APA’s minority psychiatrists are calling on the Association to assign their unique concerns a higher and far more visible place on the Association’s agenda.

The process of stepping up APA’s efforts in this area began in September at APA’s fall component meetings, when Edward Hanin, M.D., chair of the Council on National Affairs, convened a special meeting of psychiatrists who are members of minority or underrepresented groups or interested in minority-related issues. His charge to these participants was to develop and set priorities for a list of issues they believe APA must address to respond to concerns of minority psychiatrists and patients.

This initiative is an area high on the roster of APA President-elect Rodrigo Muñoz, M.D., who noted in a later interview with Psychiatric News that, as has already happened in Los Angeles, early in the next century the U.S. may have no majority group. APA will certainly be part of this trend, so addressing cultural diversity and other minority issues as they affect both psychiatrists and the patients they treat cannot be an afterthought or looked at separately from the issues to which APA gives highest priority.

Using a low-tech system of flip charts and Post-It Notes, the participants at the brainstorming session came up with 22 issues that have a significant impact on minority psychiatrists and their patients. The meeting was chaired by James Krajeski, M.D., past chair of the Assembly Committee of Representatives of Minority/Underrepresented Groups. Krajeski is also a member of APA’s Task Force on Strategic Planning, which is exploring ways to make the Association more responsive to members and more effective in achieving its goals.

After the list was developed, Krajeski had each participant assign a priority ranking to the items so he could convey to Muñoz and Hanin which ones the group thought deserved the most emphasis and should be addressed with the greatest urgency.

The need to ensure that cultural diversity is reflected in education, training, and the certification process, as well as in the composition of the faculty that teaches future psychiatrists, led the list of concerns by a wide margin.

Following this issue on the priority list was a call for APA to increase its legislative advocacy on issues of concerns to minorities. The participants gave as examples of legislative areas with serious consequences for the mental health of their patients the rollback of affirmative action programs and legislation prohibiting same-sex marriages. They also cited proposals in Congress intended to make it more difficult for international medical graduates to gain work in the U.S. health care system.

Shifting from external to internal concerns, the need for APA to identify ways to increase members’ awareness of minority-related concerns and to include more minority-group members in Association policymaking and leadership roles received as many votes as the legislative advocacy issue.

Next on the list of priorities was taking steps to remedy the dearth of minorities in research. Participants cited the low numbers of minority psychiatrists who choose research careers and the need for all researchers to be aware that whether they are studying psychopharmacology, psychotherapy, or access to care issues, women and minorities have unique responses and concerns. Many researchers have acknowledged this fact, but APA can help ensure that data are relevant to clinical practice, one participant commented.

There was also considerable support for having APA begin to develop practice guidelines reflecting the cultural and ethnic differences that often set minorities apart when it comes to such issues as following treatment regimens, building a relationship of trust with their psychiatrist, or involving family members in a patient’s care.

Other concerns that some of the participants want APA to address include increasing the involvement of minority and women psychiatrists at the district branch level, exploring a certification process that attests to a psychiatrist’s knowledge about treating a culturally diverse patient population, recruiting more minority physicians into psychiatry, and focusing public affairs initiatives on the message that minority psychiatrists and IMG’s bring many positive aspects to patient care.

Stressing the need for APA to involve many more than just its minority and women members in the efforts urged by meeting participants, Jeanne Spurlock, M.D., former director of the APA Office of Minority and National Affairs, pointed out, "Just like mental health issues are everybody’s problem, minority issues are also everybody’s problem; they do not belong just to the minority populations."

Krajeski emphasized that with Muñoz vowing to make minority concerns a major part of his presidential agenda next year and a high level of enthusiasm on the part of members who want the status quo to change, "we have considerable reason to hope that a plan of action will develop in the near future, and we’ll then begin to see the situation change in a positive direction."

The challenge that should not be underestimated, noted Silvia Olarte, M.D., at the close of the meeting, is how to translate the consensus about the future direction of APA’s minority outreach into concrete results. The danger is that, as happened to similar well-meaning efforts in APA’s past, the ideas will remain on paper instead of being translated into action.

Following the meeting, Muñoz commented to Psychiatric News that "the priorities the members identified and ranked at the meeting are things that we can work on." Psychiatrists and other physicians are increasingly exposed to minority group patients, he noted, "and the minorities expect their doctors to understand and be responsive to their unique cultural issues. . . .It saddens me when I learn, on visits to elementary schools with mostly minority students, for example, that I am the first doctor many children have seen."

The September meeting clearly highlighted that "minority psychiatrists want APA to go in directions similar to those cited by members in other APA surveys; namely, that they want a louder voice, better communications with APA leaders, and APA to do more to help them help their patients," Muñoz said.