Faculty Bibliography

BACKGROUND/UNASSIGNED:Black patients seeking addiction care experience poorer treatment access, retention, and outcomes when compared to White counterparts. Black patients may have elevated group-based medical mistrust, which has been associated with poorer health outcomes and increased experiences of racism across multiple healthcare contexts. The relationship between group-based medical mistrust and expectations for addiction treatment among Black individuals remains untested. METHODS/UNASSIGNED:A total of 143 Black participants were recruited from two addiction treatment centers in Columbus, Ohio. Participants completed the Group Based Medical Mistrust Scale (GBMMS) and answered questions related to expectations of addiction treatment. Descriptive analysis and Spearman's rho correlations were performed to assess for relationships between group-based medical mistrust and expectations of care. RESULTS/UNASSIGNED:Group-based medical mistrust in Black patients was associated with self-reported delay in accessing addiction treatment, anticipation of racism during addiction treatment, non-adherence and discrimination-precipitated relapse. However, non-adherence to treatment was least strongly correlated with group-based medical mistrust demonstrating an opportunity for engagement. CONCLUSION/UNASSIGNED:Group-based medical mistrust is associated with Black patients' care expectations when seeking addiction treatment. Use of the GBMMS within addiction medicine to address themes of mistrust in patients, and potential biases in providers, may improve treatment access and outcomes.

The COVID-19 pandemic has created an unprecedented natural experiment in drug policy, treatment delivery, and harm reduction strategies by exposing wide variation in public health infrastructures and social safety nets around the world. Using qualitative data including ethnographic methods, questionnaires, and semi-structured interviews with people who use drugs (PWUD) and Delphi-method with experts from field sites spanning 13 different countries, this paper compares national responses to substance use during the first wave of the COVID-19 pandemic. Field data was collected by the Substance Use x COVID-19 (SU x COVID) Data Collaborative, an international network of social scientists, public health scientists, and community health practitioners convened to identify and contextualise health service delivery models and social protections that influence the health and wellbeing of PWUD during COVID-19. Findings suggest that countries with stronger social welfare systems pre-COVID introduced durable interventions targeting structural drivers of health. Countries with fragmented social service infrastructures implemented temporary initiatives for PWUD led by non-governmental organisations. The paper summarises the most successful early pandemic responses seen across countries and ends by calling for greater systemic investments in social protections for PWUD, diversion away from criminal-legal systems toward health interventions, and integrated harm reduction, treatment and recovery supports for PWUD.

Community mental healthcare around the world has been strained as people need more help and experience more barriers to access due to COVID-19. The rapid shift to telehealth services necessitated by the pandemic has made these difficulties even more pronounced. While this transition presented challenges for nearly every healthcare system, it has proven especially difficult for low resource settings such as community health centers. This article is a critical observational study of the care transformation of a state-funded safety net psychiatric system responding to the clinical needs of patients during the COVID-19 pandemic. By discussing the challenges, opportunities, and creative solutions for staff and patients, the article highlights the new importance of technology and adaptability in clinical care and outlines clear recommendations to ensure vulnerable populations do not fall into the "digital divide."

The scarcity of bilingual psychiatrists, as well as appropriate mental health services for populations with limited English proficiency, has led to inequitable health outcomes. A fellowship program was developed, which draws from a clinical model staffed by bilingual (Spanish-English) professionals from racial-ethnic minority groups, to address access to care and the structural determinants of health. This new Hispanic Psychiatry Fellowship focuses on health inequality and racism in policy and leadership, clinical care for Spanish-speaking patients, cultural psychiatry, recovery, forensics, substance use, and education. This column describes the program's development, first 2 years of implementation, and feasibility indicators for use in creating similar programs.

As psychedelic-assisted therapy research and clinical trials continue to grow, there is a positive outlook on the future, but also concerns about who will benefit. Most research shows that there is an obvious deficit of racial and ethnically minoritized populations, defined within the article, enrolling in studies. The objectives of this paper are (1) to provide a history of psychedelics and its resurgence over the last two decades; (2) to present an understanding of the racialization of psychedelics in the treatment of psychiatric disorders; (3) to showcase the current inequity of psychedelic medicine; and (4) to operationalize an antiracism framework for racial equity to decolonize psychedelic research, or remove the historically pervasive White power dynamic in hopes of shifting power back to the originating indigenous cultures. The psychedelic movement is in a rare place to optimize inclusion and this article aims to demonstrate how. [Psychiatr Ann. 2022;52(12):494-499.].

Reports from uncontrolled trials and surveys suggest that there are disparities in substance-use outcomes for minoritised racial and ethnic populations, yet few of these disparities have emerged from randomised clinical trials (RCTs). We conducted a systematic review of RCTs published in English of Black or Latinx adults with any non-nicotine substance use disorder that reported rates of treatment initiation, engagement, or substance-use outcome by race or ethnicity. Study quality was assessed by the Joanna Briggs Institute appraisal tool and a Yale internally validated quality assessment. Of the 5204 studies, 50 RCTs met the inclusion criteria, all done in the USA, 24 compared treatment initiation, engagement, or outcome across races or ethnicities and 26 compared these same factors within a race. Few RCTs have reported outcomes specifically for Black or Latinx populations, with nine reporting significant differences by race or ethnicity. Significant differences were found in all studies that evaluated the baseline differences in social determinants. This Review explains the need for optimisation of RCTs to inform the design, delivery, and dissemination of treatment to historically excluded communities.

OBJECTIVE:The COVID-19 pandemic is a traumatic stressor resulting in anxiety, depression, post-traumatic stress, and burnout among healthcare workers. We describe an intervention to support the health workforce and summarize results from its 40-week implementation in a large, tri-state health system during the COVID-19 pandemic. METHOD:We conducted 121 virtual and interactive Stress and Resilience Town Halls attended by 3555 healthcare workers. Town hall participants generated 1627 stressors and resilience strategies that we coded and analyzed using rigorous qualitative methods (Kappa = 0.85). RESULTS:We identify six types of stressors and eight types of resilience strategies reported by healthcare workers, how these changed over time, and how town halls were responsive to emerging health workforce needs. We show that town halls dedicated to groups working together yielded 84% higher mean attendance and more sharing of stressors and resilience strategies than those offered generally across the health system, and that specific stressors and strategies are reported consistently while others vary markedly over time. CONCLUSIONS:The virtual and interactive Stress and Resilience Town Hall is an accessible, scalable, and sustainable intervention to build mutual support, wellness, and resilience among healthcare workers and within hospitals and health systems responding to emerging crises, pandemics, and disasters.