With reports of discrimination and hate crimes on the rise, psychiatrists and other mental health professionals say they feel compelled to retool their practices as “safe spaces,” where they can better attend to the needs of traumatized patients.
This is the main conclusion of a report from psychiatrists at NYU School of Medicine and the University of California San Francisco, published online in The American Journal of Psychiatry on October 2.
After the 2016 presidential election, the article notes, many mental health professionals reported an increase in distress among patients—especially immigrants, and religious and sexual minorities. Some missed appointments because of concerns about safety.
“As mental health professionals, we often focus narrowly on patients as individuals,” says Helena B. Hansen, MD, PhD, an assistant professor in NYU Langone’s Department of Psychiatry and lead author on the report. “But to understand patients as survivors of discrimination and hate crimes, we also need to understand how their environment contributes to fear and anxiety.”
For the report, Hansen and her team collected patient stories from psychiatrists from across the country the year after the election.
Highlighted in the report is the principal need for mental health professionals to ensure in their patients a sense of security and an understanding that they are going to get the care and support they need. For instance, Hansen says, some immigrants who missed appointments say they feared being detained at the clinic by federal immigration officials.
“Placing posters in several languages to indicate that staff will not report immigration status to authorities is an important step,” she says. “Clinic staff also need to share this information directly with their patients.”
Hansen and her colleagues also say that mental health professionals, rather than dictating the nature of problems to patients, should exercise “cultural humility.” This involves listening first, enabling patients to describe their concerns, and reaching a shared decision on treatment. By taking a more collaborative approach, Hansen says, mental health professionals develop rapport that supports therapy.
The authors also suggest that mental health professionals do their utmost to avoid “re-traumatizing” patients. For instance, Hansen says, addiction patients who have relapsed or mental health patients who have not followed their treatment plan should not be threatened with removal from a program, as it may be taken as punishment. Instead, she recommends peer support. By receiving “trauma-informed care,” as she refers to it, patients are more likely to feel they are in a safe place.
Because survivors of hate crimes and discrimination have many needs, Hansen says, mental health professionals should also cultivate relationships with local religious groups, housing services, and other social support networks. Building trust between these community organizations, she says, fosters better coordination of care around each patient.
“The challenge for mental health professionals is to see themselves as active members of their patients’ larger environment,” says Hansen. “To help traumatized patients, it’s also important that policy makers, educators, and community leaders become aware that what they say can have detrimental effects on people’s mental health.”
Toward that end, researchers have created a toolkit for mental health professionals that offers practical ways to establish a safe space for patients. The toolkit will be available in November from the American Psychiatric Association.
In addition to Hansen, other study authors include Nicholas S. Riano, MAS; Christina Mangurian, MD, MAS, of the University of California, San Francisco; and Travis Meadows, MD, at Mount Sinai Icahn School of Medicine.
Funding support for Hansen was provided by the National Institute on Drug Abuse Career Development Award grant K01DA032674 and a Robert Wood Johnson Foundation Health Policy Investigator Award.