2021 Articles of Import and Impact

Abstract

One of the most important and relevant articles that we published this year in the Journal is a call to action for psychiatry to confront and change the structural racism framework that significantly contributes to mental health care inequities (1). Dr. Ruth Shim from the University of California at Davis begins by reviewing the concepts of race, structural racism, health care inequities, disparities, and social injustice. She draws attention to the different meanings of the terms "disparities" and "inequities" as they relate to health care delivery. By doing so, she advocates for the preferential use of the term inequities, as "inequities" links disparities in the delivery of care to the unjust policies and discrimination that drive these inequities. She also explicitly discusses the history of racism in psychiatry and describes how contemporary structural racism policies (e.g., residential segregation, the war on drugs) affect the social determinants of health that result in our present-day inequities in the delivery of and access to mental health care. This discussion is linked to recommendations aimed at how to take action toward dismantling structural racism in psychiatry and toward policies that facilitate equitable care. She asserts that change must begin at the personal level with the acceptance of one's unintended biases and their consequences as well as education and self-reflection. She further emphasizes that it is critical for psychiatrists and mental health workers to make a commitment not only to advocate for mental health equity but to translate this advocacy into real action that will enable positive change. Importantly, efforts need to be targeted at the societal level to influence current leaders-or elect new leaders-who are committed to undoing and changing the public policies that underpin inequities in health care. As we avowed earlier in the Journal (2), the Deputy Editors and I have made the commitment to use the American Journal of Psychiatry as a means to combat structural racism and health care inequities. We are specifically focused on improving mental health care for individuals of color and more broadly for individuals from underprivileged and discriminated communities. We thank Dr. Shim for moving us forward in this direction, as we enthusiastically continue in our pursuit of this critical goal.