MindPath’s Medical Director Emeritus, Dr. James Smith speaks with Charlotte therapist Daja Mayner and Raleigh physician assistant Kerry Mackey about mental health in Black communities during COVID-19.

Online Telehealth Care: https://www.mindpath.com/telehealth/
Kerry Mackey’s bio: https://www.mindpath.com/staff/kerry-mackey-pa-c/
Daja Mayner’s bio: https://www.mindpath.com/staff/daja-mayner-msw-lcsw/

Transcript of conversation:
Alright, good evening everyone. My name is Dr. James Smith. I am the medical director of Mindpath Health. I’ve been with the practice now roughly 16 years and I can say without a hesitation it’s been a thrill and an honor to be part of MindPath. Today we’re talking about COVID-19 and its impact on the mental health of minority groups. Clearly, we know that many minorities work in fields where they are considered critical. Whether that’s housekeeping, in a hospital, nursing services, bus drivers, subway workers- [these are] critical jobs for maintaining the infrastructure of the average community. Unfortunately, because of that, we are also exposed to COVID-19 at a greater rate. And so this evening what we’re going to be talking about is the impact that it has on us from an emotional standpoint, and we’re going to talk a little bit about how we can overcome some of these social determinants of health and build resilience in each of us so that we can get through this pandemic and continue to live our lives on life’s terms. Mr. Mackey?

All right. So, my name is Kerry Mackey, I’m proud to introduce myself as one of the advanced practice providers with MindPath Care (a leader in psychiatric and mental health community in North Carolina). I practice out of the Bush Street office in Raleigh, North Carolina and I see children and adults, diagnose and treat, and maintain and stabilize a variety of mental health conditions including, but not limited to, depression, anxiety, some adjustment disorders, ADHD, and mood disorders. I’m a native of the Bahamas originally and now a permanent citizen of the USA, but more importantly and proudly, I’m a member of the Black community. It’s my pleasure to serve on this panel today where my colleagues and I, as Dr. Smith alluded to earlier, will highlight some of the challenges that we as minorities face in our community with regards to both physical and mental health. One of the things that I’ve expounded upon in my practice is that individuals in the patient population are very diverse. I want to address a glaring recurrent theme that I usually encounter, however, upon interacting with members from a diverse and from the minority community. Frequently I hear individuals bring up remarks such as, “I should have come here a long time ago,” I hear people say “Wow I can’t believe what a difference this has made,” with others I hear people say “Others in my family deal with similar situations to this but they would never come here, for I could never talk to my mom, dad, my siblings about this- they would think I’m crazy.” One of the hardest things I’ve had to hear is “I don’t know what’s wrong with me. Why am I having these thoughts? My people aren’t supposed to think like this.” And so further on in the conversation, after Daja kind of introduces herself, I’ll kind of expound upon this stuff a little bit more, and so I’m going to turn the floor over to Daja so she can kind of introduce herself.

Thank you, Dr. Smith and Kerry, for a wonderful setting of the stage. As they mentioned my name is Daja Mayner. I am a psychotherapist based out of the Charlotte office. I’ve actually been with MindPath for about four months now however my background of about three years is in field-based services, providing sort of in-home family therapy in rural North Carolina communities. With MindPath right now I’m focusing primarily on serving adults, with some adolescents, you know treating anxiety, depression, or trauma experience. In today’s talk specifically, as my colleagues have alluded to, we’ll talk about those risk factors around this collective experience of trauma as it relates to COVID and talk about how COVID’s experience is really amplifying or magnifying. People in the communities of color, their already sort of pervasive relationship with trauma and we will actually, sort of later on the conversation as they discussed, talk about what building resiliency can look like and sort of being able to create a different reality, a different experience with psychiatric care.

You said my favorite word of “resilience,” and this is what all of us need to get through. Kerry would you be kind enough to tell our audience, when a patient comes to you how do they feel about say going on meds?

Alright. So that’s a big thing Dr. Smith because of all of the stigmas that surround mental health in the African American community. In the African American community, a lot of patients are hesitant for treatment with medication management per say. I tend to notice that some of them are probably a little bit more open to therapy. And so, because I see that, there is a combined synergistic effect with medication and therapy that leads patients to having this robust response and an improvement in their mental health condition, sometimes I kind of like avoid the discussion of medication on the first session. I would get that patient referred to a therapist so that they can begin to develop a therapeutic alliance, and then once that gets established and we kind of warm them up so to speak, then we re-enter the conversation of medication. And then I hit them with statistical facts. I talk to them about the fact that a combined treatment with medication and therapy, psychotherapy specifically, cures about 80% of depressed patients and then they’re a little more open to it. We still have a lot of people that like take a step back from it but I think with statistical data we see that more people are open to the aspects of “I will use medication if it will help me get better.”

Ms. Mayner, would you be kind enough to talk a little bit about- you mentioned earlier the collective trauma, and the impact on our community or visa vie COVID-19. Take it from there.

Absolutely Dr. Smith, Thank you. When I refer to sort of trauma, put simply, it is a deeply distressing or deeply disturbing experience or an experience that questions our sense of safety or sense of security. If you take that definition that simple, I’ll be it, broad definition of trauma, and we apply that to something such as a global pandemic, it’s very clear to see that with so many drastic implications of this disease, it’s sort of having that shock factor in that deeply disturbing way by sort of overwhelming our sense of ability to cope. To sort of answer that second part of your question, in terms of why is this sort of magnified or amplified for communities of color, the reality for so many minorities (we are touching on that social determinant piece of health), we are statistically more exposed to trauma and less likely to receive any treatment (adequate and culturally competent treatment). It’s like your everyday experience is already one that makes you question your sense of safety, and you’re adding this additional unnerving experience of the global pandemic. Folding in that, our mention of how many African Americans are already in roles where they are considered essential, and they are at increased risk. It is, as you all can imagine, a very unsettling experience, and a very traumatizing one. We’ve talked a little bit about the social determinants piece, but Dr. Smith would you please sort of expound upon that concept of the struggles that we have.

We as minority groups live more in urban versus rural environments, and when you’re in a living in a situation where there’s a dense population, there is greater transmission of any disease whether that’s COVID- 19, SARS, or any of the other ones that have afflicted pandemics in the past. Unfortunately, with that being the case, we also have a social situation where many of us have older family members living with us. When I go out and I work my shift at the hospital, I come in contact with a positive COVID person I’ve been working with in housekeeping, and then I go to my second job at a nursing home, again working in housekeeping, and unfortunately I may be COVID-19 positive. So I then spread the illness to my second job, I then bring that illness to my home, well and thankfully we know that for some young adults while they may develop the illness they may not have a severe a reaction to the illness, but grandma has a significant reaction to the illness. So, you’re a hundred percent correct we have an increase in morbidity and mortality because of this, and we’re just stuck because we don’t have the ability to address the social distancing as some can. However, as we talk about this, one of the other things is, when we come into the office, a lot of folks struggle because you’ve got both the medical thing going on and the mental health thing going on- Kerry would you be kind enough to talk about how people will struggle with both the physical ailments and mental ones?

I kind of talk to this about this before in a previous discussion that I had, and I like to always go back to a point that is made that as human beings we are holistic creatures right, and so there are multiple aspects of us as an individual, right. So, we have our physical health, and we have our mental health, and then you know in more than one way we have a spiritual being, or a spiritual health also. All of these things kind of play on top of each other, and so our physical health kind of ties in almost directly to our mental health. If we have physical ailments such as diabetes, hypertension, things that run rampant in the minority communities, whether it’s because of the access to the foods that we tend to eat, or if it’s because of the cultural, you know, the cultural dishes that we make. We already have disadvantages in terms of having higher values or having higher numbers statistically with dealing with diabetes and hypertension, and then we take a look at those things, and those things are systemic and so if our health is in poor condition, then our mental health begins to struggle because now we’re worried about health care. African Americans are 20% more likely, and this is according to the HHS office of minority health, 20% more likely to report serious psychological distress than our peers, adult Whites. One of the things that we came to look at is poverty. Black African Americans living below the poverty line are three times more likely to report serious psychological distress than those living above the poverty line, and with that comes more sadness, and it also comes with more feelings of hopelessness and worthlessness. These are all traits and features that kind of align with depression, as well as some of the things we see with post-traumatic stress disorder and other mood disorders. We really don’t classify it because we kind of stray away from getting diagnosed, because we don’t really seek mental health treatment, and so we have these symptoms of something, and we then really can’t put our fingers on what it is exactly, but because we’re suffering physically, then we also have this implication of where we start to suffer mentally as well. The two are kind of combined in one you know, a lacking physical health also pulls down the mental status and the mental health of an individual also Dr. Smith.

Ms. Mayner, would you be kind enough to talk about – if I’m the essential worker, what you would recommend to me?

I absolutely can and I actually would sort of recommend a couple different things. Speaking directly to Mr. Mackey’s point that there are sort of different aspects of health right? There’s that physical health- that means sort of doing things to get your body moving in a different environment, which can literally just be like standing outside. It doesn’t necessarily have to be things at the gym. Yes, it’s great at the gym, but you know making the decision to tend to that physical health being dependent on the location can really cause problems. It would be looking at- how can I incorporate some physical wellness pieces? That mental health piece, as Kerry was discussing, is really talking about sort of that twofold effective stigma. [People say] “I don’t really want to share this with you because I don’t want you to pathologize me or diagnose me,” but it also reinforces that sense of loneliness and isolation that people feel when dealing with this, right? Finding someone you know that that can be that trusted support- we all sort of need that social support, seeking a health professional is great. Maybe if you’re an essential worker, maybe your insurance isn’t great, or if you’re not really having adequate health insurance, I would advise you to find someone that can be that refuge- you all can support each other in that way. That other piece around things that we can do to protect our mental health that’s not at all determined by another person- a word that comes to mind is sort of the boundaries, right? Sort of the limits that we place around what we ingest, or what we engage in, whether that be information and making sure that you’re getting your information about this from reputable sources, and making sure you know, if you’re the type, if the way that your anxiety works is you know, “I’m hearing something and I hear this one thing in my mind that leads to these other places,” then maybe that means you know [I should] not be engaging in the news every day, but maybe once a week. Just being mindful of how your mood is affected and taking that serious, prioritizing that, because it is all very much connected as Kerry pointed out. Dr. Smith, I think that this this kind of talk is leading us into this idea of resiliency which we sort of pointed out before.

What are your thoughts on that?

Well, resilience- One definition is sort of the understanding, the ability to sort of adapt in really significantly stressful or traumatic situations and this conversation is really about strategies. People can build up that resiliency. Exercise that muscle. I think it’s a necessary part of what we have come to understand right? It’s a necessary part for adapting to trauma. Kerry, can you speak a little bit more about maybe some of the barriers like I mentioned, you know the healthcare piece, can you mention some barriers to that part?

Absolutely, I can. I’d definitely like to kind of go back to some of the earlier components of the conversation that you had- specifically the stigma that she talked about. I talked about that stigma a little bit earlier, but when we kind of talk about mental health problems, one of the major issues with mental health that we face, or that we think about first is depression. That’s like one of the top diagnoses in terms of mental health. We look at depression a lot of times, oftentimes in our community. You know you hear people say “oh it’s a weakness,” per say, or “it’s a condition,” but it really it’s a condition that can affect individuals as a whole- your thoughts and your body’s as I kind of mentioned before and seeking professional help is very necessary. Lately I heard even my family members, people that I know I care about, say “oh you just need to go to church,” maybe, or they will say “you need to go talk to a pastor, just talk to somebody about it,” and it’s good to have that spiritual guidance and stuff but [its just] like a physical ailment. If you had really high blood pressure you’d go and get medications to reduce like your systolic value, similarly if you had a high blood glucose value or a high hemoglobin a1c, you’d get medications and get on a proper diet regimen to kind of reduce that. And so, when we think of mental health, not just depression, but other mental health things, these really have a role and impact on the chemical pathways of the brain. There is disruption in neural hormones and the chemical pathways of the brain. These things too require some form or format of medication at times to help to stabilize an individual, so I just kind of wanted to bring up that point real quick before I made up made a point to talk about some of the issues with access to care. In terms of access of care, I’m a very vocal person about this topic, and so I’d like to highlight, when the Affordable Care Act came about, it closed the gap in uninsured individuals. So, it was about 16 percent of African Americans that no longer had health insurance versus about 11 percent of white Americans that were still uninsured back in 2014. In 2012 when we looked at it, the percentage of people who were unable to get, or delayed in getting medical care, whether this was physical ailments or mental health ailments, prescription medication for it- there was a clear discrepancy. It was about eighteen point seven percent of people that didn’t have health insurance couldn’t get care, as opposed to maybe about eight percent of people that did have health insurance that maybe just couldn’t afford medication or afford the co-pays. In 2011, about fifty four point three percent of adult Black African Americans with a major depressive episode received treatment for it, so only about half of the people that actually came in for depression continued with and received treatment, whether that was even in remission or not, as opposed to about 75 percent of adult white Americans that came and received treatment for their depressive episode. These statistics continue to go on and on. I mean we can call numbers off pretty much all day were some of the gleaming discrepancies exist. One of the things is that we like to, at times, go where we’re comfortable, and so when you look at the American Psychological Association (and the numbers might have changed a little bit now), but there was less than 2% of the  APA’s members that were Black or African American. You could imagine how much access to care there was for somebody that kind of looked like you and had some of the same cultural values and beliefs that we had. We kind of compounded that fact by some Black and African American patients reporting, you know, experiencing either increased racism tunes or microaggression. You know, whether it was treatment from a medication provider or from a therapist that didn’t associate with some of the stigmas that we associated with. I’m going to leave this last point about this in terms of access of care, and I want to hear more from Dr. Smith on this, but when you talk about Black or African Americans today they are over-represented in the jails and the prisons, right? People of color account for about sixty percent of the prison population in the U.S. Black and African Americans also account for about 37 percent of drug arrests while only 14 percent of regular drug users are Black or African American, and so once again a glaring discrepancy. Dr. Smith, can you talk to us a little bit about how the system, the prison system numbers of COVID that are authorized play into the numbers of African Americans that are impacted by COVID- 19?

Well, it’s quite significant in that COVID-19 is coming into the prison system by staff members. These same staff members are working multiple jobs- they may be an off-duty police officer working a second job, they may be an EMT- they are working a critical job outside the prison system [where] they contract or come in contact with CVODI-19, they are COVID positive, they come to work, and because of the closed confines in prison, there’s no way to socially distance oneself when you’re in that lockup, and as we all know that these prison units are greatly overcrowded and they are a perfect petri dish for passing of the disease, and, unfortunately, we’re now seeing deaths I think here in North Carolina. We just had our very sixth or seventh death within our system, and unfortunately, I think this is going to be a situation that will only increase. The other struggle that we have as African Americans, and we learn this from what we call our community health assessment- Every three years here in Wake County, the hospitals, the public health department, and social services (why I know all this I was chairman of the board of Social Services and public health for the last seven years), and so we do this thing called the community health needs assessment. One of the most important things that was said by the people in the community, especially of the minority groups both African American and Latino, was that the caregivers did not have the cultural sensitivity to understand what we were going through and we did not feel as patients that they could feel where we’re coming from. It was a request by many of the individuals that did the surveys to train care providers in cultural diversity so that they can get a feel, and understand us as patients. One thing about the medical world is that you have to be very bright to get into Medical School, but that doesn’t mean you’re the most psychologically minded individual, and so you may not have a contact with folks in a lower socioeconomic populations or cultural situations to know. What’s one of the things I’m so proud about MindPath is that MindPath has had repeated cultural diversity training, whether that’s the gay and lesbian community, whether that’s the African American community, and soon the Latino community, so MindPath Care is going to be on the forefront of being significantly sensitive to the needs of the minority groups. One of the other important pieces, and Ms. Meyer if you don’t mind, can you talk a little bit about when I come home, and I’m stressed, and my family members talk to me what do I say? What do they say to me? They should talk to me a little bit.

You’re coming home, you are stressed out, and that might look like you know being short, like short-tempered, or maybe quick to escalate a situation because you’re already at the brim, you know, your anxiety is already super high since today was a particularly bad day. So, I think it all absolutely boils down to that like attentiveness. First of all, sort of that that grace of like “this is not just a normal regular experience I don’t have to feel this way,” and it’s that sort of understanding of no one lives in a vacuum. You know our lovely examples around what housing can look like for African American communities. No one’s living in a vacuum; you have this emotional experience and that emotional experience is like a domino, and it’s a ripple effect, it sort of starts with that that that perspective of like “this is important, this is not me being crazy here, this is not me just needing to dismiss this, this is me, this is my body and my mind telling me that I can’t just go on as business as usual.” The number one thing I sort of encourage many of my patients to do is take that break. Carve out that moment of refuge when you come home. I know that depending on our roles and responsibilities in our family systems that some people are responsible for that for that caregiving piece, either young children older parents or whatever, older adults, and they’re in their lives. But for many there is sort of an opportunity for just 5 minutes, 7 minutes, 10 minutes of “I just need to decompress,” and you can give yourself that grace, to say like “this is important, then this is necessary for me,” and it sort of ties directly to what Kerry was talking about in terms of accessing care and you know finding competent providers. Competent in terms of your profession, but also culturally competent, closely sensitive providers, and sort of being willing to engage in these conversations around what’s actually going on for you, and hearing that sort of supporting information around how this is actually, not just made up, or something that you can think away or something like that. Kerry, you know we’re having this rich discussion. Do you have anything that you’d like to add to that? Whether it be about those other social factors, or?

Kerry why don’t you say your words, we’re going to start to wrap up so Kerry first and Daja second, and then I’ll follow.

As I alluded to, and I’ll try to keep this short, but I’m very passionate about this. Not just because it involves people that that look like myself, but because I’m passionate about mental health and access to care for all individuals. I definitely think about the African American or another minority population, the implications that COVID-19 have had on us- this isn’t something that has only occurred and will pass over. There will be lasting impacts, long term effects of this. The social structure of the homes, of jobs, of many things revolving around this will change you know in in the days to come, and what really resonates with me is handling it with care. We’ve already been through a lot. By this age, my age specifically, I’m almost 30, most African Americans have been imprisoned one time or more. They’ve had to deal with serious violent crimes that some of our peers may not have had to deal with. There are a lot of traumas, whether it’s social or physical. So many aspects of us have been impacted, and I kind of urge us to treat each other with love and compassion and focus on helping each other to build in these tough economic and tough emotional times. Just to be there for one another and to let people know about the resources in the community that are available for them [is great], because there are things out there and are places that people can go, even when they don’t have the access of care that we kind of mentioned a little earlier. Extending them the olive branch and extending a little kindness will take people a long way.

Ms. Meyer will you be kind enough to give us your words?

Absolutely. Honestly, it’s going to piggyback much off of what Kerry said in terms of orienting ourselves to a sense of community. You know, a collective trauma, such as something like this, is absolutely going to have those implications. So, while you may feel like you are pretty well adjusted, for many, African Americans specifically, it might not even feel like life has changed so much right? You’re still going to work, and you’re still using the modes of transportation, and all those other things like normal, but there’s a sort of a disillusion there of like “since I’m functioning, since I’m doing as the status quo that I’m okay,” and the reality is everyone is going to need support, no matter you know how this thing shakes out for you, no matter what, things you can point out in your life are different. Trauma is sort of that all extensive and all sort of expansive, like a comprehensive experience, and so getting in with community and giving yourself that grace to just feel as you feel would be my parting words. Thank you.

Thank you. Very good. Well, thank you very much for giving your time both Daja and Kerry. At the end of this you are going to see some slides with some resources for those of the uninsured, resources for food pantries, because with the high unemployment ratee, many folks are in need. However, Mindpath Health is at the forefront of harnessing the strengths of individuals, both black and white.  We’re doing our best. We are sharing our faith, our family, and our cultural institutions, because that is a backbone of support of as we deal with this pandemic. Clearly, MindPath works with individuals you’ve heard from, like Daja, to build that resilience, to empower folks, and encourage individuals to stay alive, to get out and smell the roses. I just want to thank everybody that’s listening to this today. I’m hoping we have provided you a little bit of insight on how we can come together and overcome all these difficult times. COVID-19 will pass; however, the new norm, we have no idea what it will look like. We are resilient folks. We’ve made it for many years and will continue to survive. I want to thank you for listening and we wish you the very best.

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