From Cultural to Structural Competency—Training Psychiatry Residents to Act on Social Determinants of Health and Institutional Racism

Psychiatrists in training launch their careers in a time of inequalities and structural barriers to their patients’ health. Many believe that the uncertain funding and regulation of the US health care system and a frayed social safety net have led to a crisis in mental health care. The United States has fewer mental hospital beds per capita than almost all peer countries, while US suicide rates are at a historic high.¹ Prisons and jails have become the largest provider of “care” of those with severe mental illness. Systemic violence and discrimination based on race, ethnicity, religion, sex, and sexual orientation have increased.² These broader forces not only likely contribute to psychiatric disorders but also make living with these disorders significantly more difficult.³