The Centre for Addiction and Mental Health has released a public strategy to tackle systemic anti-Black racism in the mental health hospital by 2022 — one it hopes will impact patients, staff and mental health care in the city at large.
CAMH’s strategy for Dismantling Anti-Black Racism, released Wednesday, highlights 22 actions the hospital plans to take in the next two years to transform the mental health institution into one that provides equitable care for its Black patients.
It’s an “aggressive timeline,” said Dr. Kwame McKenzie, a world-renowned psychiatrist and co-chair of CAMH’s Fair and Just initiative, but one that is necessary to change the way Black patients, staff and the community at large interact with the mental health care system.
McKenzie said he has been actively engaged in this work since he began his role at CAMH in 2007, and the anti-Black racism strategy has been in the works since 2017. But given the public discourse on racism following the death of George Floyd at the hands of Minneapolis police in 2020, McKenzie said there is urgency to make CAMH’s commitment to dismantling anti-Black racism clear.
“We felt that there was an impetus to be very, very clear about where CAMH is going, and what CAMH is going to do,” McKenzie said.
Mounting data evidence reveals Black patients in Ontario are accessing the mental health care system at higher rates, but with disproportionately negative outcomes. They are more likely to report poor mental health than people who are not Black, due to social factors and experiencing anti-Black racism, yet are more likely to access mental health care in adverse ways like emergency and police services.
At CAMH, recent data reveals Black patients are restrained at a rate that is 44 per cent higher than white patients, and 22 per cent more than patients overall.
“It’s been a persistent issue,” McKenzie said of restraint levels, adding it’s an issue that has been observed in studies for the last 20 years.
McKenzie added inequitable mental health care outcomes are likely not unique to CAMH, but are a snapshot of how Black Canadians are unfairly treated in the mental health care system at large.
Social determinants of health, McKenzie said, are a main contributor to poorer mental health in Black Ontarians: one in four Black Ontarians qualify as low income, compared to 15 per cent of the general population, and Black households are 3.5 times more likely to be food insecure than white households, according to data from Black Health Alliance and Food Share.
Black Canadians are also overrepresented in the justice system, which intersects heavily with the mental health care system, making up 9.5 per cent of the Canadian prison population while accounting for only 2.5 per cent of the overall population, Black Health Alliance data shows.
Other data reveals that while Caribbean immigrants and refugees from East Africa have a higher risk of developing psychosis, Black Ontarians of Caribbean descent face a longer delay in receiving care than people of white, European descent.
While some mental health care methods have proven to be effective for Black Ontarians, like culturally adaptive cognitive behavioural therapy, access to these services is limited. On average, Ontario spends less on mental health per person for Black populations versus white populations.
“You get what you pay for in health,” McKenzie said, adding these compounded systemic issues have contributed to worse mental health outcomes for Black Ontarians.
Recognizing these inequities, McKenzie said CAMH’s anti-Black racism strategy is focused on three parts: patients and families, staff, and the hospital’s operations as a whole.
For patients, McKenzie said CAMH is looking to expand mental health services targeted to the Black population. This includes increasing access to the substance abuse program for African Canadian and Caribbean youth, which has seen double the number of visits last year in comparison to 2016.
CAMH is also looking to provide culturally adapted therapy for Black patients, and has already begun a consulting process on how to reduce its disproportionate restraints practices.
The hospital is also looking to develop a system where Black staff can confidentially report racist incidents in the workplace, and a process in which these incidents can be documented and tracked. All staff will be trained in anti-Black racism and equity.
For the community at large, “CAMH is going to use its voice to try to make sure the system works properly so people can get help,” McKenzie said. This includes working with the non-profit Black Health Alliance and the Ministry of Health to secure funding that will be used to create more accessible mental health care services for Black Ontarians.
Ultimately, McKenzie said CAMH’s anti-Black racism strategy is about publicly admitting to the way the mental health care system continues to unfairly affect the Black population, and using that to build a more equitable system for future patients.
“I’m hoping people will judge us on where we’re going, rather than where we’ve been,” McKenzie said.
Nadine Yousif is a Toronto-based reporter for the Star covering mental health. Her reporting is funded by the Canadian government through its Local Journalism Initiative. Follow her on Twitter: @nadineyousif_
Nadine Yousif, Local Journalism Initiative Reporter, Toronto Star