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The Public Health Crisis of Racism
As communities and institutions across the U.S. - from individual municipalities, to the American Public Health Association, to prominent members of Congress introducing the Anti-Racism in Public Health Act of 2020 - acknowledge racism as the national public health crisis that it is, many healthcare providers are looking to build their skills in providing anti-racist care and addressing the harm that racism has caused for many people seeking services.
This effort is complicated by the fact that it is frequently structural racism, rather than individual racism, that inflicts complex harm on communities of color. Structural racism, which has been succinctly defined by the Aspen Institute as "a system in which public policies, institutional practices, cultural representations, and other norms work in various, often reinforcing ways to perpetuate racial group inequity. ...Structural racism is not something that a few people or institutions choose to practice. Instead it has been a feature of the social, economic, and political systems in which we all exist." So, while individual providers may diligently work to provide excellent care to patients of all races and backgrounds, these same patients are likely experiencing ongoing stressors and trauma from systems that were built on a foundation of racial inequity. These systems impact everything from the sort of healthcare patients can access, where patients are able to live, the diagnoses and care patients receive, and whether patients are experiencing trauma-reactive symptoms that impact their daily lives.
Some providers may feel overwhelmed by the task of incorporating anti-racism in their practice, especially given the enormity of structural racism. However, there are several manageable places from which to start:
- Acknowledge racism. Like many other overwhelming topics (e.g., suicide, self-harm, grief), there can be a fear that acknowledging and naming racism will somehow make it worse. However, much like these other critical issues, it is important to acknowledge that what patients are experiencing is real and to push back against related stigma.
- Keep it patient-centered. Providers are human, and there is sometimes a human impulse to become defensive and want to prove that you are not racist and not part of the problem. However, regardless of an individual provider's feelings about race and/or racism, patients (of all races) are constantly being impacted by structural racism. Listening to the ways that patients are experiencing this impact, without defensiveness, is essential to providing anti-racist care.
- Do your research. There is a large body of research, including the work of Dr. Camara Jones, who spoke at the MBHP Integration Forum on November 18, 2020, that details the effects of racism on health. Find resources from our Integration Forum here.
Reach out for resources. Fortunately, there are a wide variety of resources available to support providers in addressing racial trauma and practicing anti-racism in healthcare. The resources provided here are just a start - organizations such as the AMA and APA also maintain resource libraries to provide support and education to providers doing this important work.
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The risk of developing diabetes in patients who have serious mental illness
(SMI), such as schizophrenia or bipolar disorder, is four times higher than in the general population. 1 This risk increases further when patients with SMI are taking antipsychotic medications.2 Prior to developing diabetes, most patients have early signs such as elevated blood glucose, high triglyceride level, or weight increases that are easier to identify and reverse with periodic screening than after a patient develops diabetes. Children also have an increased risk of medication side effects and adverse effects than most adults, and hence screening periodically can prevent major health-related issues in these children. MBHP has developed a program to encourage screening in children who are taking antipsychotic medications.
MBHP's current screening program involves the following steps:
- Identifying the subset of pediatric Members taking antipsychotic medications who were not screened for lipids and glucose in the past year, as recommended by the American Diabetes Association2
- Notifying prescribers of these medications and the Member's primary care physician of the need for periodic LDL and A1c screening, and ensuring that the Member continues to maintain a healthy weight
- Determining if screening increased during the nine months following the notifications
- Focus 2018; 16:48-53; doi: 10.1176/appi.focus.20160048
- Diabetes Care 2004;42(Suppl. 1):S13-S28 | https://doi.org/10.2337/dc19-S002
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MCSTAP Case Discussion Call-In Hour
The Massachusetts Consultation Service for the Treatment of Addiction and Pain (MCSTAP) provides no-cost, on-demand professional consultation for providers on safe prescribing and managing care for patients with chronic pain, substance use disorder (SUD), or both. MCSTAP also hosts a monthly Case Discussion Call-in Hour on the third Wednesday of the month at noon for clinicians across the Commonwealth. During these sessions, MCSTAP explores recent de-identified cases and key lessons learned.
The Case Discussion Call-in Hour is an opportunity for participants to:
- Hear about real, anonymized cases concerning management of chronic pain and SUD, with key teaching points
- Get input on the treatment of patients with chronic pain and/or SUD
- Discuss current best practices around caring for patients with chronic pain and/or SUD
Do you need support in treating a patient with chronic pain and/or SUD? Get help by calling MCSTAP at 1-833-PAIN-SUD (1-833-724-6783), Monday - Friday, 9 a.m. to 5 p.m.
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Meeting with providers can be stressful for Members, even in the best of
times. With worries around the ongoing COVID-19 health emergency and related issues, the pivot to telehealth can be particularly daunting. Making sure that your patients know what to expect and how to prepare for their telehealth visits can help ease their anxiety and make the visit more productive for everyone. Additionally, it is critical to take proactive steps to ensure equity when it comes to access to telehealth. Assisting Members in accessing technology and helping them to have positive initial experiences with telehealth is important for its ongoing sustainability and durability. Some helpful tips:
- Ensure Members have access to a smartphone or computer as well as reliable internet access. Telehealth visits with audio and visual capability are the highest standard of care and should be emphasized over audio-only communication (which may only briefly be billable during COVID).
- Ask if they have and know how to use their technology and provide a resource for if they do not.
- Make sure the patient downloads any apps your office uses prior to the appointment time.
- Make sure there is a virtual waiting room and the expectation that Members should be ready before the appointment (e.g., set up 10 minutes before).
- Determine need for an interpreter, and make one available at the outset of the visit.
- Create and share contingency plans for when technical issues arise, such as internet connectivity problems.
- Consider creating customized information guides and/or checklists for your office. You can also refer them to the links below:
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Find Behavioral Health Services in Real-Time
When you need to quickly find behavioral health care for a patient, there is a place to get help: the Massachusetts Behavioral Health Access (MABHA) website at www.mabhaccess.com.
How does MABHA work?
MABHA provides up-to-date information about the availability of community-based services for child and adolescent concerns, substance use issues, and mental health needs. It helps you find the care you need for your patients - fast.
MABHA lists openings in three types of services:
Youth and family, including: Applied behavior analysis (ABA), In-home therapy, and Care coordination
Substance use disorder, including: Detox/withdrawal
management, Medication-assisted treatment, and Residential
programs
Mental health, including: Short-term crisis care, Walk-in access, and Outpatient treatment
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Directing Members to Emergency Services Programs (ESPs)
As we continue to weather the challenging times brought on by the COVID-19 pandemic, remember that 24/7/365 behavioral health crisis, intervention, and stabilization services are available to your Members through the statewide behavioral health Emergency Services Program/Mobile Crisis Intervention (ESP/MCI).
ESPs are local, community-based resources that help Members access the supports they need without the stress and inconvenience of going to a hospital ED.
On-site, face-to-face therapeutic responses including short-term, solution-focused counseling
Psychiatric consultation and urgent psychopharmacology
intervention, as needed
Referrals and linkages to all medically necessary behavioral health services and supports
Safety plans developed in collaboration with patients' behavioral
health providers
All ESPs are able to deliver care either telephonically or through telehealth and are a valuable resource in connecting Members to community-based care. Services are available at no cost to individuals with MassHealth (Medicaid), Medicare, or who do not have insurance. Many ESPs also contract with commercial insurance companies.
Consider using your after-hours messaging as an opportunity to direct Members with behavioral health crises to the ESP statewide number at
1-877-382-1609.
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