Triply Diagnosed While Black During the COVID-19 Pandemic

1 Being Triply Diagnosed While Black During the COVID-19 Pandemic Jacqueline D. Phillips, LCSW Disclosures "This program is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $3,845,677 with zero percentage financed with nongovernmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS or the U.S. Government." 2 Today's Objectives: To explore the impact of COVID-19 on the Black community while facing the challenges of dealing with mental illness, substance use disorder, and as a person living with HIV. View mental illness through a cultural lens. Various treatment options will be addressed. 3 Quote: " Just because we carry it well, it does not mean that it is not heavy."~~ Source Unknown~~ 4 Public Health: Racism is declared a public health crisis New York City in the Fall of 2021. 5 Quote: " American history shows a trend of medical and structural racism imparted on communities of color from the AIDS crisis to the ongoing COVID-19 Pandemic." 6 TriplyQuadruple Challenged Mental Illness/ Injury: Depression, Anxiety, Post Traumatic Stress (PTSD) and Race Based Traumatic Stress ( RBTS). Impacts mood, behavior, and thoughts. Substance Use Disorder- self medicating with various substances and behaviors such as gambling. Mild, moderate, severe. Person Living with HIV-person living with the human immunodeficiency viruses that affects the immune system. People are living longer and healthier lives due to treatment. Black Person Living in America-persons from black enslaved ancestors and can also include Black people from the Caribbean and the African Continent. Being in black skin can have daily challenges because of the structure of America. 7 Black Americans and Mental Health Challenges African Americans utilize mental health services at about half the rate of white Americans. According to the CDC, Black Americans are twice as likely to die from COVID-19 compared with White Americans. Black Americans are hit disproportionately by job losses, food insecurity and homelessness as a result of pandemic. CDC study during June of 2020, found that Black respondents had considered suicide in the past 30 days more commonly than white and Asian respondents. Racial injustices have amplified the stress. Some of the answers are in the Black community. When clinical treatment is supplemented with social support, the likelihood of successful outcomes is greater. 8 More Stats on Black Mental Health: African Americans are less likely to have access to services that include prescription medications, have lower rates of acquiring outpatient services, but higher rates for inpatient services. ( This may be related to access, utilization, trust, and the providers response.) In comparison to whites with the same symptoms, Black people are more frequently diagnosed with schizophrenia and less frequently with mood disorders. Black people with mental health conditions particularly schizophrenia, bipolar disorders, and other psychoses are more likely to be incarcerated than people of other races. Black illicit drug use is slightly higher than national average ( 12.4% vs 10.2%) and alcohol use is slightly lower (44.2% vs 52.7%). Their rate of opioid overdose (6.6%) is less than half of that for non-Hispanic whites (13.9%) 9 Mental Health First " I say put mental health first because if you don't then you're not going to enjoy your sport and you're not going to succeed as much as you want to."~~Simone Biles~~ Cerebral Mental Health APP 10 Factors to consider in Mental Illness. Biological/chemical-the body and the mind Genetic- family Psychological- personality and outlook on life Environmental-trauma and life situations 11 Trauma as a Diagnosis and InjuryRace Based Trauma Racial trauma or race-based traumatic stress (RBTS), refers to the mental and emotional injury caused by racial encounters with racial bias and ethnic discrimination. RBTS is not a clinical definition of a disorder, but it is a mental injury. Experiences of race-based discrimination can have detrimental psychological impact on individuals and their communities. RBTS is similar to the symptoms of Post Traumatic Stress Disorder (PTSD) and can resemble depression. There may be anger, recurring thoughts of the events, physical reactions such as chest pains, insomnia, hypervigilance, low self esteem and distancing self from the trauma. 12 Healing Racial Trauma PTSD can be caused by a single event, but racial trauma is ongoing, pervasive, and generationally transmitted. Racial trauma has cognitive, emotional, and somatic consequences. Exposure to stressors can lead to long term increases in stress hormones in the body and can exacerbate anxiety and depression. Stressors are associated with negative health outcomes such as high blood pressure and risk of cardiovascular events. Black pain' is often invalidated so people stop talking. Talking and storytelling is part of the healing process. The Collective Care Center in Kentucky provides psychotherapy for people who have suffered from racial trauma. 13 Contrast and Comparison of PTSD and RBTS Death/ witness Injury/ witness Avoidance Feelings of doom Anger Depression Death/ witness Injury/ witness Avoidance Feelings of doom Anger Depression 14 Black Children and COVID-19 At least 170,000 American children have lost a parent or caregiver because of COVID-19. In the U.S. alone the number of people who have lost a close relative, whether a child, sibling, spouse, parent, or grandparent to COVID-19 is about 6.5 million. Racial disparities are stark. Hispanic and Black children are almost twice as likely as White children to lose a caregiver because of the pandemic. In general, approximately 10% of American children live with grandparents and that percentage is higher for Black children. Children who lose a parent are at higher risk for mental health problems. Every child does not get the opportunity to express their emotions. Black children are frequently penalized in school for reaction to death, such as crying, distraction, and fatigue. 15 Phil Wilson: HIV/AIDS Can Teach Us Something about COVID in the Black Community Phil Wilson, founder of the Black AIDS Institute. African Americans make up 43 % of the new HIV cases and die at the rate of one and half times the rates of white people. In the earliest days of the HIV and AIDS, Black people represented 25% of the new cases in the US, and Black Women represented over 50% of women diagnosed. Black people have always been disproportionately impacted, over-represented in disease, underrepresented in advocacy, underrepresented in resources dedicated to fighting the disease. Need social solutions and not just biomedical ones. Need to look at the context that the patient is in before making judgments about what should be done. The argument to eradicating both diseases have to be structural and have several systemic solutions that address the underlying reasons that communities of color get sick and die from viral pandemics at rates higher than whites. 16 Depression Is One of the Most Frequent Comorbidities of HIV Infection In the general population: 6.7% have major depression. In PWH: Depression is present in 30%-50% of those in HIV care and treatment settings. Depression rates (12%-71%) vary by population, severity threshold, measurement tools, etc. PWH and chronic depressive symptoms have a two times greater risk of dying than PWH who are not depressed. Sherr et. al., Psychology, Health and Medicine, 2011; Remien et . al., AIDS, 2019( Slide courtesy of James Satriano) ( 17 Black People and Depression " I think that many of us suffer from a low- grade depression that has to do with social issues. ~~ Mary Pender Green~~ 18 Anxiety is Another Common Comorbidity of HIV Infection In the general population: 2.1% have generalized anxiety disorder In PWH: 15.8% Anxiety may flare up at certain HIV milestones: HIV testing News of HIV positive status Appearance of first illness symptoms Changes in CD4 count & viral load Onset of AIDS-defining illness Remien RH, Stirratt MJ, Nguyen N, Robbins RN, Pala AN, Mellins CA. Mental health and HIV/AIDS: the need for an integrated response.AIDS. 2019;33(9):1411-1420. ( Slide courtesy of James Satriano) 19 SUD is Another Common Comorbidity of HIV Infection In the US population, 10% of adults have drug use disorder at some point in their lives (NIH) 75% report not receiving any form of treatment (NIH) In PWH, prevalence of substance use disorders ranges from 21%-71% Among PWH drug of choice: 7.3% cocaine/crack 10.3% amphetamine-type substances (ATS) 2.9% illicit opiates 33.1% marijuana 20 Remien, et. al., AIDS, 2019 ( Slide courtesy of James Satriano) 20 Drug Overdoses The recent increase in drug overdose mortality began in 2019 and continued into 2020 prior to the declaration of the COVID-19 emergency but were accelerated during COVID-19. Drug overdose pattern - Decline to 4.1% from 2017 to 2018 Increased to 18.2% Increased to 20% in 2019 Increased to 30% in 2020 These were the largest numbers of drug overdoses for a 12-month period ever recorded. Increases occurred in at least 28 states. Synthetic opioids are the primary driver of the increases in overdose deaths. Cocaine is also connected with the increase. Community response: awareness about increased risk. 21 Providing Care and Treatment Be generous listeners, wise observers, and life- long students. Often our clients are our best teachers. ~Jacquline D. Phillips 22 Culturally Competent Carethe Provider: Have you received training in cultural competence for Black mental health? How do you plan to provide culturally sensitive care? Do you use a different approach in your treatment when working with people from different backgrounds? How do you see cultural backgrounds influencing communication and treatment? Are you willing to integrate the consumer's beliefs, practices, identity, and culture into the treatment plan? 23 BEAM ( Black Emotional and Mental Health) treatment in LAPIS Listen and assess for trauma and distress Affirm their experience Partner to navigate and seek services Initiate self and community care plans Seek out help as needed Is the environment affirming? 24 Treatment Through a Cultural Lens: Therapy for Black Girls Therapy for Black Men Melanin and Mental Health Association of Black Psychologist Ayana Therapy ( Free Therapy Frontline Workers) 25 Treatment through a Cultural Lens: The Confess Project is a nation-wide initiative that trains barbers to be mental health advocates. American Psychological Association recently stated the need to deal with the pandemic of racism. Black community through various channels has started to speak about mental health i.e. sororities, celebrities, and churches. Salvation and Social Justice is a theologically based program that advocates for more community led mental health responses rather than policing and punishment. 26 Treatment Models for Triply Diagnosed Clients: Sequential Treatment - Acute disorder is treated first and after stabilization other disorders are addressed. Sequential treatment has the advantage of providing an increased level of attention to the most acute disorder, but a disadvantage is that patients are often transferred to a different team to address a less acute disorder. Parallel Treatment- Disorders are treated simultaneously, but the treatment setting and providers are different. The providers may have different areas of knowledge and philosophies. Collaboration is important or this can become confusing for patients. Integrated treatment- Treatment is done in one location. It is the same team of clinicians and providers. It is believed that this is more effective than the other treatment models, but it maybe the least available. ttps:// 27 Questions to consider: What has been your experience with the 3 modules of treatment? How has COVID changed treatment? How do community resources be integrated as part of treatment? 28 Thank you: There have been numerous resources made available throughout these slides and I encourage you to visit the sites. Thanks for your dedication. Keep the conversation going. 29