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Social Justice and Health Equity Curriculum

The Social Justice and Health Equity (SJHE) Curriculum exists within the Yale Department of Psychiatry Residency Program to teach the next generation of psychiatrists how to discern and dismantle mental health inequities within current healthcare systems and personal practice. The curriculum includes four tracks spanning the post-graduate years I-IV and includes didactic, experiential and self-discovery learning. These tracks are committed to the cultivation of transformational learning and are supported by the personal investments of a myriad of residents, fellows and faculty, and most importantly, community leaders and people in recovery. As we strive to develop health equity leaders for tomorrow, it is important to note that the mental health injustices learners will combat today are still very real in both a local and national sense.

The Structural Competency Track

The Structural Competency Track aims to guide trainees in developing an awareness of the extra-clinical structures that impact patients’ lives and health. This awareness creates a context in which trainees can recognize and understand these structures and their impact within patient clinical formulations, ultimately leading to the development of structural interventions to address them. We provide experiences that bring attention to the daily lives of the people who reside in selected New Haven neighborhoods while also thinking critically about the benefits and challenges of living in these neighborhoods. In addition, with the help of the peer advocates and community leaders, the residents explore how neighborhood dynamics influence access and engagement in mental health care. Gaining an appreciation of the social determinants of mental health (such as food insecurity, income inequality, housing, education, interactions with law enforcement, violence/trauma and community resilience) will be the focus of the scheduled sessions.

The Human Experience Track

The Human Experience Track aims to draw upon sociology and anthropology as rich academic traditions that provide a framework for an examination of the human condition, extending beyond a biomedical lens. Focusing on the social sciences and humanities will allow residents to gain a skillset in exploring the subjective and individual experiences of patients, while also valuing the collective experience of varying social groups and cultures. This sociocultural approach will emphasize structures that influence an individual’s understanding of illness, review explanatory models, and highlight pathways to care, while taking into account patient expectations of mental health treatment. These reflections will also provide a foundation for residents to examine their own internal reactions, such as implicit bias, to support a resident’s understanding of patient differences and how this may influence treatment outcomes. Expert discussants are invited to expose residents to concepts such as intersectionality, alterity, conflict theory, functionalism, critical theory, and human rights. Sessions in this track involve an experiential component, as well as discussions of residents' clinical work to help them grapple with complex material, using the introduced theoretical models. The ultimate aim of this track is to empower residents with theoretical principles that can be applied practically to clinical work, to minimize mental health disparities, by understanding the necessary action and systemic change necessary for achieving mental health equity.

The Advocacy Track

The Advocacy Track aims to expose psychiatry residents to various levels of advocacy, teach psychiatry residents the skills needed to be effective physician advocates, and empower trainees to advocate to improve the health and well-being of their patients. This track is informed by the knowledge and experiences from the Structural Competency and the Human Experiences tracks, and is intended to frame advocacy interventions in the context of issues highlighted throughout the Social Justice and Health Equity Curriculum. Through didactic presentations and skill-training experiences, residents will deepen their understanding of the complex systems that influence healthcare and appreciate how advocacy interventions at various levels can have longstanding effects at the population level. Residents are encouraged to develop their own identity as a physician advocate in a way that fits their unique interests and personal values. Special focus will be given to collaborating with community activists and community agencies, impacting state legislation, and educating others through oral and written communication methods.

The History of Psychiatry Track

The History of Psychiatry Track teaches trainees to understand the history of systems and structures in which they live and to cultivate practices and interventions that will promote social justice and health equity. Trainees learn to use history to become leaders who can challenge psychiatry’s complicity in structural oppression, and reflexively critique their own practice. The track examines the history of harm that American psychiatry has inflicted on marginalized communities. Specifically, it explores how psychiatry has reflected and reinforced racism, sexism, ableism, colonialism, homophobia, transphobia, and material inequality in our society. At the same time, the track also provides residents with historical examples of mental health practitioners, in organizations like the Black Panthers and Madres de Plaza de Mayo, who have used psychiatry as a platform to advance social justice in local, national, and international settings. Learning about the successes and failures of activist psychiatrists in the past will help current trainees to imagine new ways of engaging in clinical care, research, and advocacy that enact fewer healthcare disparities today and to become future leaders who will foster greater justice and equity in our profession.

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