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December 20, 2017

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

Author Affiliations
  • 1Department of Psychiatry, New York University, New York
  • 2Department of Anthropology, New York University, New York
  • 3Nathan Kline Institute for Psychiatric Research, Orangeburg, New York
  • 4Department of Psychiatry, UCLA (University of California, Los Angeles)
  • 5Department of History, UCLA
  • 6Department of Biobehavioral Sciences, UCLA
  • 7Department of Psychiatry, Yale University, New Haven, Connecticut
JAMA Psychiatry. Published online December 20, 2017. doi:10.1001/jamapsychiatry.2017.3894

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

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