COVID-19 has claimed the lives of over 419,000 people in the US and over 2.1 million people worldwide and this number continues to grow. COVID-19 does not discriminate between gender, sexual orientation, citizenship status, or political affiliation. The virus does, however, distinguish between those it disproportionately infects and kills. Racially diverse groups, mainly Black, Hispanic, and Native American populations, are more susceptible to COVID-19 risk factors that, when combined with the virus, are more likely to lead to hospitalisation and death.
These risk factors include obesity, lung conditions, hypertension, diabetes, and chronic kidney diseases. The pandemic has emphasised stark inequities that exist in Black populations such as a lack of access to reliable income necessary for health insurance, medications, caregiving, and education; reliable transportation to testing and vaccination sites; internet and phone access; and access to culturally-sensitive providers. Now that vaccines have been developed, we ought to consider how cultural paranoia, systemic racism, and mistrust of public health systems may dissuade Black communities from receiving vaccines and what steps we can take to make services more accessible and culturally-conscious.
It is not enough for healthcare providers (HCPs) or governmental agencies to simply tell individuals that they should get the vaccine. It is not enough to tell communities to call their doctor or pharmacy and make an appointment to ‘get shots in arms’. If we do this without considering their lack of trust in public health, without considering the language we use to share information, and without being aware of and trying to fix the limitations some face in accessing resources, we are intentionally invalidating and increasing fears linked to the historical mistreatment of their communities.
If we do not take cultural and historical factors into consideration, we are disregarding the long-standing exploitation of Black communities that can be traced back to slavery and the infamous Tuskegee Study. A study that deceived 600 Black men in the US into believing that they were being observed over a course of 40 years in order for public health to better understand untreated syphilis.
Participants were told that some would receive treatment – when in reality none did. These men then went on to infect many women and children in the Black community during the same time that white men were given treatment once it was authorised for use. Consequently, this led to increased levels of distrust that continue to impact the Black community today.
It is not only imperative that Black people have equitable access to resources, but that they are aware that they have access. Also essential is that they receive services from HCPs who are aware of and who intentionally work to treat and heal generational trauma linked to a reluctance of trusting people in positions of authority. Of the characteristics deemed necessary to adeptly work with diverse, underserved, and underrepresented communities – awareness, knowledge, and skills are deemed fundamental to successful outcomes.
As HCPs, we have a responsibility to educate ourselves regarding what disparities exist and how that came to be. We then need to implement and study the effects of culturally-sensitive behavioural skills in our work with clients to create best-practices. My pre- and post-doctoral clinical work entailed providing assessment and treatment to racially diverse individuals in clinical and forensic community mental health systems. A majority of those clients lacked basic resources such as food, clothing, housing, income, education, and social and familial support.
Many tried to obtain resources on their own but found it difficult due to societal stigmas related to mental illness and homelessness. For a few, the colour of their skin and lack of income made it more likely for them to be diverted into the criminal justice system rather than mental or public health systems. A lack of basic resources necessary for survival prevents people from focusing on their health because their most basic needs are not being met. How can they thrive if they can barely survive? This is why I believe that HCPs have an obligation to advocate for the marginalized. We should not accept and assume that the system will eventually understand just how detrimental past oppressive practices have been to the livelihoods of Black communities. We should act.
It is of benefit to clients when they engage in open communication with someone they can trust – in many cases this person is their therapist. When working with clients hesitant of engaging with healthcare systems, it is important to provide a safe environment for them to express their concerns without fear of judgment. Far too often, clients avoid voicing fears due to prior experiences of being dismissed and misunderstood. It is typical – and inappropriate – for Western providers to view themselves as being the expert when we should be viewing the client as being the expert of their experience.
It is our responsibility to listen and compassionately guide them to reduced levels of symptomology and impairment based on their level of need and our educational and clinical training. If it becomes apparent that the client does not have a provider or does not feel comfortable with their provider, we should work with them to find appropriate community providers. I have offered to set up phone calls or live appointments between the client, myself, and the provider so that a multisystemic approach to treatment is formed which increases a sense of community and trust. If transportation is a barrier, I provide bus tokens or ask public resources for assistance. I have even, on occasion, driven clients to appointments because many lack trust in public resources. I encourage clients to identify specific questions which they can easily reference during the meeting – this teaches them self-advocacy and empowerment. It is useful for clients to have hard copies of succinct informational brochures regarding specifics of the treatment, potential side effects, when follow-ups are required, and who to contact if their primary provider is unavailable.
In terms of the COVID-19 vaccine, it might be beneficial for culturally-sensitive agencies to directly outreach to marginalized communities (door-knocking and providing education in their primary language via local radio and television stations). It might be helpful for medical staff to explain how and why the vaccine was formulated at such a rapid pace, how it functions in the body, and to discuss the community-wide benefits derived from every person taking the vaccine – such as how vaccines will allow for the safe re-opening of places of employment and worship, schools, and community programs and events.
HCP’s have a unique opportunity to use our years of education, clinical training, and ability to communicate to highlight and correct the inequitable and unjust policies and practices that continue to exist and which act to the detriment of those who desire or require support.
Merushka Bisetty, PsyD is a psychologist from Santa Barbara, California.