Bracing to Face Unsettling Times

A look at the confluence of COVID-19 and mental healthcare disparities

As the global pandemic drove every human into a tsunami of restrictions, rules, and anxieties, one thing remained alarmingly consisten: COVID-19 strikes without bias; COVID-19 healthcare is riddled with bias.

While healthcare inequities predate COVID-19 – by centuries – 2020 put a searingly hot spotlight on the topic and presented what the American Psychiatric Association (APA) calls “an unparalleled opportunity to address disparities in healthcare delivery and pursue a meaningful and equitable future for our patients and the field of psychiatry.”

It’s this very “opportunity” that drove the APA’s 2021 virtual meeting theme: Finding Equity Through Advances in Mind & Brain in Unsettled Times.

“We took the last two words – unsettled times – very much to heart, looking at all of the current determinants that impact the patients we treat and the systems of care in which we work,” says Jacqueline Feldman, MD, APA 2021 Annual Meeting Scientific Program Chair. “I think we have a broad collection of sessions that speaks to these unsettled times.” 

And so, with an overarching goal to use the APA 2021 meeting program to advance both knowledge and equity, sessions will cover:

  • Mental health disparities, presented to spur discussion from a multitude of viewpoints.
  • Breakthrough science, offering news in clinical studies, diagnoses, biopsychosocial treatments, and population health.
  • Statutes, regulations, and court decisions that affect mental health practitioners, practices, and patients.
  • Practical solutions, from the individual to an entire system, that may very well help the world face a pandemic of mental illness long after COVID-19 infections subside.

Turning to must-see APA conference sessions, Dr. Feldman offers her top seven.

1. Ketamine for Depression: Is the Hype Holding Up ~ Mechanisms and Evidence Ketamine, a dissociative anesthetic that has been available in the US since 1970, has been developed as a novel antidepressant for treatment-resistant depression. This presentation will review clinical data concerning ketamine effectiveness, hypothesized mechanisms of action, limitations, adverse effects, and controversies.

2. Equity, Ethics, and Future Directions in Telepsychiatry Telepsychiatry – along with the larger world of telemedicine in general – is poised to change mental healthcare post-COVID-19. This presentation will investigate three important ways telepsychiatry can offer great opportunity for psychiatry to expand its importance throughout integrative care and geographical territory.

3. The Self-assessment for Modification of Anti-Racism Tool (SMART) ~ Addressing Structural Racism in Community Mental Health SMART represents a way to facilitate organizational change in community behavioral healthcare. This session will lay out the key components of SMART, describe the development of this organizational tool, illustrate the process for using SMART, and describe future directions for piloting this framework.

4. Climate Crisis and Mental Health ~ What Will You Do? There’s growing concern over the increasing emergence of various forms of anxiety, trauma, and depression associated, at least in part, with concerns about global warming and the future of life on planet Earth. This session investigates how to best support those whose mental health is impacted by climate crisis and how we can stay present in our collective efforts to protect the planet.

5. Cannabis: Clearing the Smoke on Cannabis Use Disorder With more states legalizing cannabis and changing public perception of cannabis, there is considerable confusion around its safety and uses as it relates to psychiatry. An expert panel will explore relevant topics around cannabis, such as clinical implications, cannabis compounds, and risks of addiction.

6. Psychiatry in the Courts: APA Confronts Legal Issues of Concern to the Field The Committee on Judicial Action reviews on-going court cases of importance to psychiatrists and our patients, and then makes recommendations regarding APA participation as amicus curiae (friend of the court). This workshop will review several major issues that the Committee has discussed over the past year and provide their input concerning APA’s role in these cases.

7. Health Policy and LGBTQ Mental Health Mental health disparities plague the LGBTQ community. This is partly due to minority stress and largely impacted by laws and institutions. All told, this can dangerously limit an LGBTQ person’s ability to live their lives fully and openly. This session will look at how legislature, religion, and social practices impact an LGBTQ person’s mental health and their ability to have equal access to mental healthcare providers and procedures.

I think the APA 2021 Meeting sessions are incredibly powerful and incredibly timely,

Dr. Feldman says. It’s a program, she explains, that’s been designed to help mental healthcare communities meet the challenges of the moment together.