Introduction
With over 325,000 cases in the United States, the COVID-19 pandemic has been shown to have disproportionately negative effects on communities of color. Black Americans have had the highest mortality rate compared to any other racial group, Asian Americans have faced increased discrimination because the outbreak originated in China, and undocumented immigrants have not received health or economic benefits (e.g., stimulus checks) despite being essential workers and serving in jobs that contribute to government taxes. These collective experiences serve as examples of racial trauma-real or perceived experiences of discrimination that damage physical and mental health through chronic and repeated exposure to stress (French et al., 2020). This article reviews racial trauma in Black, Asian and Latinx communities as a result of COVID-19 and makes recommendations for mental health professionals working with these populations to lessen and help individuals heal from the impact.
Definitions
Individual racism: Implicit and explicit personal beliefs about perceived inferior qualities of people from particular religious/ethnic backgrounds and the actions that stem from those beliefs (e.g., a police officer targeting a Black individual because he/she is perceived as "dangerous" or "criminal").
Cultural racism: Implicit and explicit racism infused into the cultural characteristics of a society and reflected in language, imagery and symbols (e.g., referring to COVID-19 as the "China virus" or "kung flu.").
Structural racism: The ways in which societies foster discrimination through mutually reinforcing inequitable systems. These include laws, policies and practices that overtly or covertly discriminate, disadvantage, neglect or oppress across race or ethnicity. A meta-analysis of 293 studies revealed that racism is significantly associated with poorer mental and physical health (Paradies, Ben, & Denson, et al., 2015). For example, increased exposure to COVID-19 among Black Americans is thought to be attributable to greater representation in service occupations and a greater likelihood of living in inner cities with high population density (Price-Haywood, Burton, Fort, & Seoane, 2020). Financial instability, food insecurity, and lack of access to services such as COVID-19 testing, transportation, affordable medication, safe housing that allows for social distancing, and health care are structural factors which are directly connected with COVID-19 risk.
Examples of COVID-19 and Racial Trauma
Because many essential workers (e.g., transit, childcare, health care, cleaning services, postal workers) are people of color who cannot stay home and/or socially distance, these workers are at increased risk of contracting or dying from COVID-19. Children of these workers may be left home unsupervised, may not have a parent present to assist with online education, are at increased risk for maltreatment, may fear losing a parent to COVID-19 or may actually experience the death of a parent because of increased exposure to the virus. Children of undocumented workers fear their parents getting tested for COVID-19 or seeking public services since they will come to the attention of immigration authorities. Asian American families have endured evictions, unemployment, and discrimination as restaurants, salons and retailers have been shuttered because of the pandemic. This has been most notable in large cities with historic Chinatowns. Children face a cascade of effects from homelessness, food insecurity, loss of community, anti-Asian sentiment and an increase in hate crimes.
How Mental Health Professionals Can Address Racism During COVID-19
TRANSLATIONAL TIPS
(1) Understand the concepts of individual, cultural and structural racism and how these interact synergistically. Mental health professionals should implement systems in their practices that ensure that all children and families know that they will be treated with respect, and that high-quality care will be delivered regardless of background. To do this, it is critical for mental health professionals to examine their own biases.
(2) Strive to create empathic spaces where the potential for healing can emerge through expression of personal narratives that give voice to experiences of oppression, provide opportunity to create meaning regarding their individual and collective experiences of oppression, and empower individuals to envision future possibilities (Ainslie, 2013; French et al., 2020).
(3) Consider the use of scales to better assess experiences of racial trauma such as the following:
(4) Assess hypervigilance, anxiety, or depressive symptoms related to discrimination and racism and assess individual and collective strengths and resources such as resilience, self-agency, spirituality, faith, religious values, social and religious support and community involvement (Trent, Dooley, & Dogue, 2020).
(5) An important protective factor against racial trauma is cultural identity or a positive sense of self related to existing in or belonging to a particular culture or group, especially one that has experienced and overcome past adversities. Deepening cultural understanding through traditions, values, and cultural practices can enhance agency, legitimize experiences of marginalization, and promote resilience particularly during times of extraordinary stress like COVID-19. When providing clinical care, it is important for mental health professionals to be aware of cultural identity with recognition of individual strengths and previous experiences of adversity and resilience.
(6) Racial socialization refers to verbal and nonverbal messaging about the realities of racism and methods of coping and resilience. Research has identified racial socialization as a protective factor in youth exposed to racial trauma. Awareness of the positive impact of racial socialization can assist clinicians in helping children and families decrease isolation and strengthen social support in order to foster a sense of belonging.
(7)
Clinicians should explore resources in trauma-informed, culturally sensitive approaches with children and families exposed to both racial trauma and COVID-19. There are many resources available on this topic such as
https://store.samhsa.gov/sites/default/files/d7/priv/sma14-4849.pdf . Clinicians should approach this work from a place of cultural humility and openness to understanding the experiences of individuals from communities of color. Clinicians should assess for exposure to racial trauma that may have emerged or worsened during the COVID-19 pandemic.
