Black Mental Health, Part 2 - Practical Tools

Transcript

Dr. Mazella Fuller:
Cultural competency and I'm all for authentic allyship, but the bottom line, if you don't have equity and inclusion in your organization, you'll be spending lots of money or doing lots of podcasts.

Ellie Pike:
If you remember, from our last episode, our two guests, Dr. Charlynn Small and Dr. Mazella Fuller took us through some of the history and impact of the mental health professions relationship to the black community. That episode helped set the context for today's conversation, sharing advice from a more inclusive and equitable mental health community. While I highly recommend checking out our previous episode. First, you can also listen to today's conversation as a standalone podcast. Our guests today are Dr. Charlynn Small and Dr. Mazella Fuller. They've done many projects together, but have most recently co-edited the book Treating Black Women with Eating Disorders. Dr. Charlynn Small is a licensed clinical psychologist at University of Richmond and on the board for International Association of Eating Disorders Professionals, IAEDP for short. Her doctorate is from Howard University in Washington, DC. Dr. Mazella Fuller received her education from Smith College and the University of Massachusetts Amherst. She now serves as a clinical associate on staff at Duke University counseling and psychological services.

Ellie Pike:
Today's podcast is all about exploring practical tools for becoming more inclusive and equitable and supporting mental health. We'll end on a fantastic explanation of the toll microaggressions take on an individual's mental health and why it is so critical to think through how you and your organization exist in the world. Finally, I think it's also important to note that this advice is not just for mental health professionals. A lot of Dr. Small and Dr. Fuller's insights apply to any organization. Ready to get started? Let's jump right in. You're listening to Mental Note Podcast and I'm Ellie Pike.

Dr. Mazella Fuller:
I got a whole litany of list of things that can be done, hiring practices, right? Community engagement, outreach, kind of what you're doing today, Ellie, with us too. Looking at your in-house staffing and boards, and also listening to, if you have a hundred patients and out of that hundred, you get two black or three black patients or whatever the percentage of. Listen to their families, listen to the diversity of thought. If you're running scholarships, hook up with people like us with IAEDP and our eating disorder professionals. It's like 24 of us. You can see, we'll forward you our website. You could see the contributors to the book, or you can even read their profiles. We're all out here, we're ready to lean in and help.

Dr. Charlynn Small:
We are so ready to lean in. And you said maybe you have the two black persons that go to wherever, but the reality is for that 5.1% of psychologists, for instance, who are black, what that means is a black person who shows up for some kind of therapy or treatment, nine times out of 10 or whatever the correct stat is, they're going to be seen by someone that does not look like them. Okay? So what you need to do is you got to learn something about these people. All of a sudden, a lot people are calling for a recognition of structural racism as a public health emergency. What does this really mean though? For instance, Drexel University epidemiologist, Sharrelle Barber, she views public health more holistically than some, and she considers health status and in different populations. But she says that the charge of public health is really to prevent disease and death.

Dr. Charlynn Small:
And in order to do that, you've got to have some proper analyses and so forth, and that's really not happening. You need to examine why there are these various rates of mortality and morbidity. And she says that racism is a barrier to these analyses. Other entities like APA have offered similar responses to explain the impact, for instance of COVID, and blacks calling for more accurate research among these groups. The National Academies of Sciences have said that racism is the root cause of continued disparities and death and disease between black and white people in the US. So it's got to be, as Mazella said, the key decision-makers, the gatekeepers we've got to do something about this. Empathy is what builds better allies. So we've got to have the hard conversations. There's no two ways about it.

Dr. Charlynn Small:
Cultural competence is not, not acknowledging differences. Okay? It is not taking a colorblind approach to assessment. It's not only the client's background that is important. As practitioners, we've got to be thoughtful about our own cultural values, our unearned advantages, our biases. We've got to focus on improving sensitivity to our own cultures because we can be influenced by conscious and unconscious biases and these things negatively impact the trust and rapport and diagnosis and treatment. And we all know that it is the therapeutic alliance that really drives the success. So we've got to have an increase in self-awareness of our own issues. Cultural competence people think, "I took some three cultural competence courses and got some CEUs last Thursday." That's not enough. It's a dynamic, the developmental process that requires a life long commitment. It's not complex, it's multifaceted.

Ellie Pike:
"This lifelong process," says Dr. Small, "Involves two major components, linguistic competency and cultural humility."

Dr. Charlynn Small:
Linguistic competency, basically it's the ability to communicate effectively with different people. Okay? People that may be challenged in different kind of ways. It means being able to provide information, either verbally or written, in some kind of way that you can understand or that you can make the clients understand. It might mean that you have to get an interpreter or do some additional referrals or something.

Dr. Mazella Fuller:
As you were saying, I think Ellie, I want to just go deep down in it because Charlynn's going to give you the explanation. I'm all for culture competency, and I'm all for authentic allyship. But the bottom line, if you don't have equity and inclusion in your organization, you'll be spending lots of money or doing lots of podcasts, and you'll be losing lots of people. And the demographics of this country is changing. And if people feel like you can't relate because the therapy relationship is critical.

Dr. Mazella Fuller:
But this is the generation we are, Ellie. People who are coming in now disease and the millennials, they already have peeped you out, looked at everything and going to to try to see because you can't think about, "Oh, we're doing well today. We get in millions of dollars from clients today." But will your ERC or any of these be 20 years from today? Because 20 years from today, it's going to be very different and cultural competency and linguistics and authentic allyship is critical now for you to get to the next 10 years. And the way this place has changed and the way that's society is changing so fast and evolving, if you're going to survive, you're going to have to evolve with embracing equity and inclusion in your organization. That's the takeaway. I don't need to say another thing. I'm going to sit back and let you all enjoy yourself. But I wanted to make sure I got that in.

Dr. Charlynn Small:
No, you can't sit back because what you just said is it's the essence of all of this. Listen here now, 2014 marked the first time that the US K through 12 population was majority minority. Okay? And some of those young people, they're either in college now or soon will be, or just finished up. Okay? And they're here, they're out here. We have got to learn how to work with some of these people. Cultural humility, okay. That's a big part of this cultural competence thing. Cultural humility is an interactive approach toward understanding the aspects of someone's cultural identity that's most important to them. Okay? It emphasizes seeking answers rather than making assumptions. And the underlying notion is that you have to be comfortable knowing that you don't know everything. Okay? And nobody is insisting that you do, but you got to think about the fact that many of us were trained at institutions that are shaped by Western, European, white American male, Christian, heterosexual ideologies. Okay?

Dr. Charlynn Small:
Robin DiAngelo, she wrote in White Fragility, a book that everybody ought to read it. But she said that she can get through any graduate program, she can go to law school, she can go through any kind of teacher program and not ever have had a substantive discussion on the topic of race. She said, you can be qualified to lead any organization in this country, large or small, and not ever have had a discussion on race. So when these persons end up coming to your facilities and you don't know anything about them, what does that do? That feeds into the distrust that we have, in the medical world and elsewhere.

Dr. Mazella Fuller:
Absolutely. And I think, Ellie, it's important to, like Charlynn is saying, if we want to break that down. So what is your digital footprint, right? So if I'm looking at your organization, first thing I'm going to, because I'm thinking about people who are, I'm going to go with 35 and under, because that's who feed me my advice, give me my knowledge. Right? They don't even call you yet. And if you say, "Okay, we want to just serve 80% of our population going to be whites with resources, so that's kind of what we're going to do," that's fine. Make sure to make it known. But if you're saying, "I want to reach out people 35 or under," before they even call you or look you up, they've looked at your website, they're looking at the diversity of staff.

Dr. Mazella Fuller:
They're looking at your content because we're talking about liberation psychology now. I think liberation psychology and social work is kind of on the same vein. Right? So they're looking at your staff, they're looking at binary, transgender, religion, all faiths. They're looking at all that. Then if they decide, "Okay, that looks pretty decent. Let me just call up or let me just set up a consultation." Then they're looking at what kind of food are you serving? What kind of wall hangings do you have? What is inclusive? So inclusion is the key, equity is the key if you want to do this. You say, "Well what? Can we?" in a rhetorical sense. What should we do? These are the things you will have to do, or at least think about or wrestle with, or have your staff talk about from different points of views.

Dr. Mazella Fuller:
How do we reach out? And I always say, when you're making all this money, you need consultants. I'm going to self promote in that sense. You need people on that you can have on your Rolodex to help you roll out a 100% hallmark gold standard services that embraces, because all this microaggressions and all this stuff, from what I see in my many years, is all this and stereotypes of what is this and what is that, cultural humility. You can legislate people, but you can't make people be nice. We could talk about, but if people are going to be what they're going to, we see that now with what's going on in the world, right? So 2020 was a clear, perfect vision around a public health crisis, around racism, George Floyd, Breonna Taylor, Jacob Blake, all these people.

Dr. Mazella Fuller:
And we will think the police force or whoever they have to have morality and some humility, but that's not what I see. So I think we see it in people who we trust to lead our country in a democracy. So I think we have to have some real talk about, for what I say is still an equity and inclusion, no one can do any work without having people at the table. That's just not going to happen. You don't have people at the table that you're trying to track or recruit or train or get help with recovery, none of this is going to work unless you have all voices. Ellie, I'm just being straight up and real, right? Because I've been doing this stuff a long time.

Dr. Charlynn Small:
No, but it's absolutely true.

Ellie Pike:
It is. And I think about those college courses or the grad school courses, I took on cultural competency and I don't remember much being about equity or inclusion or understanding fully what that meant. And so I think what I see is this cultural competency and linguistic competency as more of a personal responsibility. But if we want to make systemic change, then we need to bring equity and inclusion to the table, which means all voices need to be at the table. And we had a great podcast episode that I'll actually refer our listeners to, Dr. Seria Chatters talked a lot about equity and inclusion and racism and defining what they all are, as well as educating on microaggressions. So yeah, we have set our listeners up to hear more about that, which is I think really key to take it to the next level, to make cultural change.

Dr. Charlynn Small:
We want to be healthy. In my little independent survey of black men, asking them about a mental health crisis, every one of them said that you have to incorporate mental health concerns into your daily routine. They said, in addition to running and exercising and eating well and so forth, you need to check in with your mental health as well. You need to see a psychologist. You need to join with a group of black men who are concerned about their mental health. You've got to do something. We want to be healthy.

Dr. Mazella Fuller:
And I think you just have to look at, we're all mental health professionals and each discipline has some negative connotation for black people, whether it's social workers, psychologists, psychiatry. But I think we do have to continue to have people lean into their faith as a way, we have to have qualified clinicians like Charlynn and myself. We have to have health coaches because a lot of people are doing coaching now, integrative health coaching. And it's just a whole lot that can be done.

Ellie Pike:
I really appreciate that diverse perspective, that mental health is not just therapy or doesn't come from just therapy, right? There's spiritual practices that can be helpful. Any coping mechanism that can be helpful. And there's so much of that, that just comes from community in itself.

Dr. Charlynn Small:
Absolutely. We have a chapter in our book. The name of it is Food is a Drug, Mental Problem, Spiritual Solution. Okay? It is a community effort, it's a village.

Ellie Pike:
Well, I just so appreciate your perspectives and your incredible knowledge about the history of black mental health and just the cultural competencies of what is my personal responsibility to become culturally competent and linguistically competent and an ally. And really a lot of that has to do with diving in and jumping and being part of a community and not being an outsider, and recognizing and admitting that racism is real and I witness it too. And then I love, not just listening and hearing, but validating that yes, your experience is real because I see it happening. The next piece I really love that you talked about is equity and inclusion. And some of the practical tools to that, that it's more than, well ideally it is hiring diversely.

Dr. Charlynn Small:
That's right. Absolutely.

Ellie Pike:
But if that's not possible, and an institution has already established bringing on an advisory board to make sure that all voices are included at the table, is there anything from first or second episode that you are like, "Oh man, I forgot to mention something I really wanted to talk about"?

Dr. Charlynn Small:
Well, I don't think we talked enough about how it is that we come to have so many difficulties and issues with our mental health. We named, we said racism, but we didn't talk a whole lot about the microaggressions and the cultural stressors that we deal with on a daily basis, the subtle racism that just doesn't jump right out at you, but it's bare. It's subtle racism, it's a cycle social stressor that can erode health through chronically elevated cardiovascular responses. The moment where someone says something to you and it doesn't feel right. And you say, "Well, no, he wouldn't have insulted me in that way. But on the other hand, it seemed like he was given me a little shot there." And that going back and forward, that raises your blood pressure and it makes us sick.

Dr. Charlynn Small:
The daily things, "You sure are beautiful for a dark skin girl? What do you mean I'm beautiful for dark skin? I'm beautiful, period. What are you talking about?" Those things that we deal with every single solitary day. You're getting in the elevator and you're still getting the clutching of purses and there's the black man standing there with a three-piece suit on. And still people are looking at you as if you're going to do something horrible to me any minute. These are the kind of things that we are dealing with every single day. And in terms of our specialty, Mazella and I, in terms of the whole eating piece, this is what does it to us. We're uncertain. So while we're trying to figure it out, we say, "Well, let me eat this entire cheesecake and drink this two liter soda, and I'll be okay."

Dr. Charlynn Small:
We lean on our comfort foods to make us feel good. That's how we soothe, a lot of us and that's how we end up so overweight. We didn't talk a whole lot about the eating thing, but mainly what we do as black women is we binge eat. Sure, we have some persons struggling, grappling with anorexia, and we certainly have some persons who have bulimia. But by and large, we eat too much and a lot of times we're eating it because we're trying to feel better. We use the food as a coping mechanism.

Dr. Mazella Fuller:
Yeah, it's a coping mechanism. And we tend to be on the higher end, Ellie, of eating right. We're not as anorexic, right? So we might binge because you're eating your stress, you're eating the microaggressions, you're eating again, why are we eating or what's eating us because what's the problem? The system is not really bringing you in wherever that system might be. And I think we alluded to that early in terms of interpersonal relationships, institutional policies, environmental things. So it's a micro level, it's a meso level, right in the middle management or whatever people, and there's some macro level of systemic stuff. And I think, like you said, the takeaway that I agree with Charlynn wholeheartedly, that's really the essence of our book. You really have to have the tough conversations, the hard conversations, the difficult conversations.

Dr. Mazella Fuller:
And so we won't cover all that in this podcast, but there are other opportunities, references we can send that or share. But I would say the take away is we have to keep talking, we have to keep walking and we have to keep acting, right? So we just can't have one without the other. Are you going to walk the talk? Are you going to show me some action? That's what I would say because we can get into these academic conversations. And I'm just saying what my clients would share, what the book, thousands of people we've worked with over the years, people want to see action. We've been talking for 400 years, because it's still is race with black people. It still is because it's an economic issue, right? You don't have home ownership, you have no wealth. Health is wealth in itself. But if I can't have health because I've been locked out, shut out, ignored dehumanized, how in the world can I have access to anything?

Dr. Charlynn Small:
And those are the macro aggressive things that you're talking about there because we did talk about the microaggressions and the meso. And you're exactly right. If we're just locked out of everything, then we feel that, we're not worthy and obviously you're going to have a mental health crisis.

Dr. Mazella Fuller:
Absolutely. And if we start looking at, we know that black and brown people have more suicide gestures than whites. They don't complete it, but they have more. And that's just speaking to the stress and these are starting with teenagers. We're not even talking about adults because I think it's addictions in the black community, right? We are talking about food, but we also know that it's substance use, alcohol is a big one now. And I think even in our white community, opioids is huge, like the crack was in the eighties.

Ellie Pike:
Well, I just so appreciate your perspectives and using your voice to do that because we need more people like you who are willing to have these conversations and help educate and dumb it down too, to what are some practical skills and where do we even start.

Dr. Mazella Fuller:
Every opportunity to have the conversation to advance the human race, Ellie, that's basically. Because when the human race, all people, advance, we all win. So I want to take every opportunity for all of us to win.

Dr. Charlynn Small:
And we appreciate you for providing this platform for being an authentic ally. We appreciate you.

Ellie Pike:
Well, that is my goal. It is certainly my goal. And I want more people to hear your stories and just what you've provided today, the better. And I will most certainly be linking to your book on our website, mentalnotepodcast.com. And anyone who wants some of those practical tools of how talk about racism, but also how to talk about those microaggressions because those are sometimes the harder-

Dr. Charlynn Small:
They're listed for you in the book.

Ellie Pike:
Yeah. I'm going to tell people right now, page 25, go there.

Dr. Charlynn Small:
Go right there.

Ellie Pike:
It is the place where sometimes I think it's hardest to talk about the microaggressions because I know for me, I fear that I'm going to hurt their feelings, I'm going to create another microaggression by saying something wrong. So you've provided me with some really practical tools. Thank you so much.

Ellie Pike:
Thank you so much for being with us on this two-part conversation with Dr. Mazella Fuller and Dr. Charlynn Small. We covered a lot. So don't feel bad if you need to pick these episodes back up, or better yet, if you're a clinician, pick up their book, Treating Black Women with Eating Disorders.

Ellie Pike:
My biggest takeaway from these two episodes is that goodwill is not enough. Cultural competency doesn't happen by just trying to be nice to people who don't look, talk or act like you. It requires input from actual people of color who know how to foster organizational growth and the people giving that input should be paid. On the individual level, it's the same thing, but on a different scale. We can't just like woke Instagram photos and be magically cured of ingrained racist behaviors and thoughts. It requires seeking out the advice of people of color who can share their experience and their input.

Ellie Pike:
It takes sitting down with the list of microaggressions on page 25 of Dr. Small and Fuller's book and thinking through your own behaviors and thoughts. None of this happens overnight, but change is possible and sustainable. And the best news is that it also is life-giving. Our show is sponsored by Eating Recovery Center and Pathlight Mood & Anxiety Center. If you'd like to talk to a trained therapist to see if treatment is right for you, please call them at (877) 411-9578. They also provide a support group for the BIPOC community on Monday evenings. Check it out and join at eatingrecovery.com or pathlightbh.com. You can sign up for our e-newsletter and learn more about the people we interview, at mentalnotepodcast.com. We'd also love it if you leave us a review on iTunes. It helps others find our podcast. Mental Note is produced and hosted by me, Ellie Pike, and directed by Sam Pike. Till next time.

Presented by

Ellie Pike, MA, LPC

Ellie Pike is the Sr. Manager of Alumni/Family/Community Outreach at ERC & Pathlight Behavioral Health Centers. Over the years, she creatively combined her passions for clinical work with…

Presented by

Mazella Fuller, PhD, MSW, LCSW, CEDS

Dr. Fuller is a clinical associate on staff at the Counseling and Psychological Services of Duke University. Dr. Fuller provides clinical services, consultation, and training for social work and…

Presented by

Charlynn Small, PhD

Dr. Small began working at CAPS in 2004 as a post-doctoral intern. She serves as chairperson of the University’s Eating and Body Image Concerns (EBIC) team. She is a frequent speaker at national and…