What you need to know
Systemic racism affects a wide variety of health outcomes. This includes the mental health of young people in Canada, spanning across access to care, experience of mental health services and outcomes of care. In Canada, there is no best practice framework that unifies research, education and clinical care for racialized youth. Coordinated efforts to collect race-based data are also lacking. In postgraduate medical education, a guide does not exist on how to implement anti-racism teaching and training relevant to child mental health in Canada. A blueprint is needed to improve services for racialized young people in Canada to develop and implement the following:
- A funded and sustainable research agenda responsive to community expertise.
- A Canadian child and adolescent task force focused on strategies in postgraduate education and continuing professional development.
- Clinical parameters that improve access to, and experience of, care for Canadian racialized youth.
Background
Racial discrimination has a negative impact on children and adolescents in Canada. Yet, until recently, research and medical education have rarely put a spotlight on the effects of structural factors and systemic racism on mental health in young racialized Canadians.
Previous research has shown that racism affects self-esteem and self-worth as early as early childhood. Experiences of systemic discrimination experienced in childhood lead to rage and hopelessness, which fosters depression and anxiety and increase the risk of suicide and coping strategies such as substances use. Repeated and persistent exposure to systemic racism is a form of chronic stress that contributes to adverse health outcomes, particularly mental health outcomes, throughout the lifespan.
Research shows systemic racism influences access to and experiences of mental health care. Young Black people in Canada wait twice as long for mental health services, are less likely to access mental health services voluntarily, and are more likely to enter care through a hospital emergency department or through the criminal justice system.
Young Indigenous people in Canada experience particular mental health challenges due to persistent unequal treatment over many years of colonization, cultural genocide and chronic underfunding. This historical legacy has resulted in unequal treatment across various systems, including education, health, infrastructure and the criminal justice system.
What did the researchers do?
The researchers explore the effects of systemic racism and future directions for creating change and addressing race-based discrimination in Canadian child and adolescent mental health. The goal is to ensure clinical settings are re-designed to serve racialized youth and bring an anti-racism framework to education, training and research to child and adolescent mental health.
What did the researchers find?
Effective clinical interventions for racially diverse children and their families must include a commitment to cultural competency that integrates an understanding of the impacts of systemic racism as they apply to models of parenting, assessment of parenting capacity and family therapy.
Engaging diverse youth, their families and communities in effective care delivery can assist in developing youth-friendly care that meets the needs of racialized youth and their families. Improved services for racially diverse young people also includes consideration of design in clinical settings, including:
- ensuring these spaces appear safe and inclusive to the diverse communities they serve
- locating high quality services in the communities in which these young people live
- community outreach
- supporting existing coping strategies, strengths, and resiliencies within communities
- partnering with academic settings.
The researchers suggest honouring the knowledge of young racialized people and their families about their own experiences. They recommend developing methods to measure the effectiveness of care provided to racialized young people and collecting robust race-based data. This will help determine if clinical services include proportional numbers of racialized people, understand the experience of care for racialized minorities, and identify race-based differences in mental health outcomes.
The researchers note that it is crucial to understand the resistances to collecting race-based data, particularly among Indigenous and Black communities as they may experience data collection as a form of surveillance similar police surveillance.
Postgraduate medical educators need to develop an educational strategy for Canadian child and adolescent psychiatry that includes the effect of racial discrimination on children’s mental health. An effective educational model would include faculty development, as well as resident didactic teaching and clinical experiences that include anti-racism and institutional racism. They also suggest building of advocacy skills and using a structural competency approach to ensure an understanding of racism as a systemic and not individual-level determinant of health.
Education should be a combination of both didactic and reflective practice that both acknowledges and names the existence of systemic racism as a determinant of mental health while inviting participants to engage in authentic understanding of racialized peoples within a Canadian sociopolitical and historical context.
Consideration should be given to the development of educational tools that promote continuing professional development on the effects of racism on children’s mental health that all practicing child and adolescent psychiatrists can freely access. Researchers further suggest that the Royal College mandates this as a training requirement for all subspecialty child and adolescent psychiatry residents.
How can this information be used?
Access to care for racialized young people in Canada and the lack of diversity in health care teams remains a challenge. Increasing diversity of providers, particularly Black and Indigenous mental health providers, should be a priority for children’s mental health in Canada, along with the improvement of culturally sensitive care.
Those currently in leadership positions, particularly those who are not members of underserved communities, can act as effective allies by recognizing and elevating the expertise of racialized professionals with leadership positions and/or positions on policy committees. They can also lobby for adequate funding from academic institutions and granting agencies to ensure this topic is given significant priority and receives ongoing support.
About the researchers
Amy Gajaria MD, FRCPC1; Jaswant Guzder MDCM, FRCPC2; Raj Rasasingham MD, FRCPC, DAPN3
- Staff Psychiatrist, Centre for Addiction and Mental Health (CAMH), Assistant Professor, Department of Psychiatry, University of Toronto, Clinician Scientist, Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Toronto, Ontario
- Professor, McGill University Department of Psychiatry, Division of Social and Cultural Psychiatry, Division of Child Psychiatry, Institute of Community and Family Psychiatry, Montreal, Quebec
- Director of Continuing Professional and Practice Development, Department of Psychiatry, University of Toronto, Director of Post-Graduate Education, Psychiatry, Humber River Hospital, Clinical Head, Outpatient Child and Youth, Humber River Hospital, Section Head, Global Psychiatry, Canadian Academy of Child and Adolescent Psychiatry, Toronto, Ontario