Richard Youins has provided the musical soundtrack to four funerals since the novel coronavirus has swept the globe. And the experience has been surreal.
One of those funerals was a friend’s mother who died in her 80s. Something his friend said at that funeral sticks with him: “God had nothing to do with this; this was man.”
Youins said his friend’s mother, prior to falling ill from COVID-19, was a church-going woman who was still able to drive and care for herself. She died in the hospital without her loved ones.
His friend’s words captured how a lot of people feel, Youins said.
“A lot of people feel the government knew about this and didn’t prepare us for it,” he said. “Like a lot of diseases, this hit us hard because of the disparities we already face.”
A global pandemic has amplified historical health disparities for Black and Brown communities, vividly showing the world what a lack of adequate access to preventative health care and treatment for chronic disease can do.
Lack of access can kill.
As the Connecticut Mental Health Center (CMHC) prepares to gradually increase the number of people inside its building, how to do so while acknowledging the disparities and inequality faced by patients and front line workers is part of the discussion.
CMHC experts who use innovative methods to deliver mental health care to underserved communities say that the global pandemic isn’t the time for simply thinking about how to address disparities. It’s time for action.
CMHC attending psychiatrist and assistant professor of psychiatry Carmen Parker, MD, addiction psychiatry fellow Myra Mathis, MD, and social worker Erica Reshard, LCSW, spoke on a panel held earlier this year that covered everything from access to mental health care for minority communities to the long-warranted mistrust of the medical-industrial complex. Offering historical context, Dr. Parker referenced articles on Tuskegee and discussed police brutality as part of a long historical continuum leading to the mistrust that is ever-present today (for copies of those articles, see "Related Links").
Youins, a peer support specialist at CMHC, organized this powerful conversation in honor of Black History Month. That was just three weeks before the global pandemic sent many staff members home to telework and created a sudden, dramatic shift in the agency's service delivery.
But the pandemic has made the information the panelists shared months ago especially relevant during a historic time in America where some counties and cities, including New Haven, are taking the bold step of declaring racism a public health crisis.
Parker said the biggest thing she hopes mental health providers understand as they watch the daily death tolls and transmission rates continue to rise -- slower in Connecticut these days, but still ripping through communities nationwide -- is that the disparity they’re seeing on the news and in academic literature is not just a mental exercise.
Often, learning that Black and Brown people are being disproportionately harmed by disease induces a wave emotions like guilt and sympathy, or just plain feeling bad, Parker said. But she said feeling bad is not the same as taking action.
Part of the action that clinicians can take, Parker said, is first recognizing that what they’re seeing on the news isn’t a remote abstract for their Black patients or colleagues. It’s their real lived experiences.
“It’s that person’s brother, sister, parent, neighbor, or childhood friend dying disproportionately,” she said.
That means when they come in for treatment, providers need to understand that patients might not be able to spontaneously discuss trauma and depression triggered by COVID-19.
They also might not be able to discuss it because of what she called the “culturally adaptive mistrust” that many clients of color feel because of how they’ve been treated in the past, and how they’re presently being treated by the government and medical systems.
During the early days of the pandemic, COVID-19 quickly moved from being a virus that was attacking the elderly to one that was devastating zip codes that had the undeniable characteristic of being home to significant numbers of Black and Brown people.
CMHC social worker Erica Reshard could see the disparities while driving down Dixwell Avenue in New Haven. The street runs through the heart of one of the city’s historically Black communities.
It’s on that street where she’s noticed people either not wearing masks or wearing them improperly. It’s also where she has seen people not practicing proper social distancing. It worries her.
We can’t just say disparities exist. We have to understand why they exist.
Myra Mathis, MD
“I don’t think people are purposefully being defiant,” she said. “I don’t think they realize that their community is one of the hotbeds.”
That might seem hard to fathom as news coverage has been dominated daily by the global pandemic. That is, until protests against police brutality broke out in recent weeks, nearly sweeping the pandemic from the headlines and front pages.
But couple the early fast-changing guidelines from federal and state officials about mask-wearing with early reports that the virus was only impacting the elderly, and Reshard said she wasn’t surprised that misinformation had stubbornly taken hold in vulnerable communities.
And that could be bad in the weeks to come as scientists work feverishly on finding a vaccine, or even a cure for the coronavirus.
Dr. Myra Mathis, who recently graduated from her fellowship in the Yale Psychiatry Department, said she has been heartened at the call for greater collection of a variety of data but would like to see that data used to drive solutions.
“We know the disparities exist,” she said. “But it’s not enough to know the data. We have to be strategic in how we use the data to make changes in systems and public health policies.”
She said that means contextualizing the narratives that oversimplify the causes of chronic disease in Black and Brown communities by reducing it to problems of personal responsibility.
“We have to recognize that disparities are happening within a particular context,” she said. “And we are not adequately addressing the systemic barriers that perpetuate those disparities.
“We can’t just say disparities exist,” she added. “We have to understand why they exist.”
Parker said as people build their knowledge, using culturally appropriate interventions, such as making available chaplain services that are dialed into Black faith-based spirituality and cultural practices, is an action that can be taken.
Though she’s not anticipating a surge in people seeking mental health services, she noted that regardless of race and ethnicity, her CMHC clients with severe forms of mental illness are exhibiting “resilience and inner reserve.”
Parker said that the pandemic has helped some of the families of CMHC patients get more deeply involved in their loved one’s care and learn first hand the value of helping someone stay on their medications. That has allowed for the development of even closer relationships with providers and family members to help people.
She suggested that to win back any trust that might be lost from communities of color during this pandemic, doing what CMHC does best -- delivering “extraordinary care and compassion" -- has to be a top priority.
“I don't see minority communities suddenly utilizing more mental health services than they did before,” she said. “Perhaps that would be because our mistrust is being validated a thousand times over.”
Youins echoed Parker’s sentiment saying that it “adds another brick on the mistrust that lets us know that we don’t matter, we don’t count and that we can be thrown away.”
He said as a person of faith, seeing the disparities play out in real-time, caused him to lose some hope. But he’s been rebuilding his faith by taking action.
That’s included attending -- with respect for distancing guidelines -- some of the recent Black Lives Matter rallies and learning about policing alternatives. Youins serves on the CMHC advisory board and is constantly pushing for new solutions for security for the center.
“COVID really opened our eyes to the disparities,” he said. “These things should have never happened to already vulnerable people.”
CMHC, founded in 1966, is a partnership between the State of Connecticut Department of Mental Health and Addiction Services and the Yale Department of Psychiatry.