Dr. Chintoh: It's a bit disheartening, I think, to see, and also
Dr. Chintoh: not unexpected when you think about the ways that things
Dr. Chintoh: like unconscious bias and racism impact individuals. So I see it.
Dr. Chintoh: I see it in our emergency departments, I see it
Dr. Chintoh: on our wards. I see the young Black men or women.
Dr. Chintoh: The behaviours are automatically assumed to be psychosis. We are
Dr. Chintoh: more heavy handed with the medications that we use to
Dr. Chintoh: sedate and prevent these behaviours from becoming an issue. We
Dr. Chintoh: are more heavy handed when we put them in spaces
Dr. Chintoh: to protect other people because there is this assumption that
Dr. Chintoh: they are going to be more violent because they have
Dr. Chintoh: these illnesses and we don't take the time to explore
Dr. Chintoh: the ways in which their presentation could be or be
Dr. Chintoh: due to things other than schizophrenia.
Faydra Aldridge: So during the pandemic, the inequitable treatment of racialized people
Faydra Aldridge: was highlighted. But how does race affect a person's ability
Faydra Aldridge: to receive proper treatment? As we've heard through our discussions
Faydra Aldridge: with experts, people living with schizophrenia and with family members,
Faydra Aldridge: discrimination and in some cases, clinician bias can play a
Faydra Aldridge: role into how a person is treated within the mental
Faydra Aldridge: health system. Multiple studies illustrate that systemic racism affects mental
Faydra Aldridge: health care for racialized Canadians. For example, some research shows
Faydra Aldridge: that Black people in Canada wait twice as long as
Faydra Aldridge: other Canadians to access mental health services. Research also shows
Faydra Aldridge: that racialized people in Canada are less likely to voluntarily
Faydra Aldridge: access mental health services and are more likely to enter care.
Faydra Aldridge: For a hospital emergency department or through the criminal justice system.
Faydra Aldridge: Race and serious mental illness is a massive topic and
Faydra Aldridge: it's not something we're going to be able to cover
Faydra Aldridge: in one episode. But at least we are going to
Faydra Aldridge: start having this conversation and to help guide us through
Faydra Aldridge: this very difficult and thought provoking conversation. Is Dr. Amy Gajaria. Dr.
Faydra Aldridge: Gajaria is a clinician and psychiatrist in Toronto. She's also
Faydra Aldridge: an assistant professor and the associate director of Equity, Diversity
Faydra Aldridge: and Inclusion for the Department of Psychiatry at the University
Faydra Aldridge: of Toronto. Dr. Gajaria, thank you for joining us today
Faydra Aldridge: and welcome to the podcast.
Dr. Gajaria: Thank you so much and happy to be here.
Faydra Aldridge: Okay, big topic. Now, some clinicians and academics have said
Faydra Aldridge: that racism is a mental health issue because racism causes
Faydra Aldridge: trauma and that trauma can contribute to having a mental illness.
Faydra Aldridge: So what do you think is the connection between racism
Faydra Aldridge: and mental illness?
Dr. Gajaria: Thank you. That's a big question and I really appreciate
Dr. Gajaria: you asking it. This is a complicated question. It's a
Dr. Gajaria: question that's been asked over many years, the relationship between
Dr. Gajaria: culture and mental illness, the relationship between culture and mental health, race,
Dr. Gajaria: mental health, ethnicity, mental health. And now we're asking the
Dr. Gajaria: question racism and mental health. I think they're linked in
Dr. Gajaria: a number of ways. Questions of access, questions of treatment
Dr. Gajaria: experience and questions of treatment, outcome based on racism within
Dr. Gajaria: the medical system, and then the racism that people experience
Dr. Gajaria: outside of the medical system. We also have talked about
Dr. Gajaria: racism as a form of chronic stress and as a
Dr. Gajaria: form of trauma that exists for people throughout their lives.
Dr. Gajaria: And all forms of trauma and stress can increase risk
Dr. Gajaria: of the development of mental health concerns. The more stress,
Dr. Gajaria: the more adversity experience, the higher risk it is that
Dr. Gajaria: you might have difficulties with your mental health or develop a mental illness .
Dr. Gajaria: And so racism, and particularly structural chronic racism can really
Dr. Gajaria: increase the risk. And that's not just the experiences of
Dr. Gajaria: racism or someone making a comment, but it's also thinking
Dr. Gajaria: about things like structural racism and the idea that people
Dr. Gajaria: that are racialized often have less access to employment, may
Dr. Gajaria: live in places where their housing is less secure, they
Dr. Gajaria: have more financial difficulties, more food insecurity. And so there's
Dr. Gajaria: a direct link in a lot of indirect links as
Dr. Gajaria: well to the social determinants of health.
Faydra Aldridge: Now, you talked about some issues around potentially accessing care
Faydra Aldridge: in Canada's mental health system. Let's get into that a
Faydra Aldridge: little bit more. What can racialized people experience when trying
Faydra Aldridge: to access care?
Dr. Gajaria: The issue of access, I think, is a big one
Dr. Gajaria: and one that makes it hard to tease out other
Dr. Gajaria: questions around diagnoses and outcomes and all of these things.
Dr. Gajaria: What you will see is that racialized people often talk
Dr. Gajaria: about a fear of accessing mental health care, partially due
Dr. Gajaria: to a fear of how they'll be treated. And sometimes
Dr. Gajaria: that comes from what they hear in their community. Sometimes
Dr. Gajaria: that also comes from having negative experiences with the health system.
Dr. Gajaria: And so we see both in literature and in my
Dr. Gajaria: clinical experience, people often saying they didn't like the way
Dr. Gajaria: they were treated. They often felt dismissed. People didn't understand
Dr. Gajaria: what they were saying. They just felt they wanted to
Dr. Gajaria: get rid of me. They didn't want to hear my narrative.
Dr. Gajaria: They didn't want to hear my story. So people have
Dr. Gajaria: negative experiences with the syste, they're less likely to come
Dr. Gajaria: back and they're more likely to tell folks that they know, 'Hey,
Dr. Gajaria: this isn't a great experience. Maybe that's not the way
Dr. Gajaria: to solve your problem.' We also know that wait times
Dr. Gajaria: are longer and there's an issue of people not wanting
Dr. Gajaria: to add discriminations. So having additional identities of being stigmatized
Dr. Gajaria: against so having an identity as a racialized person, we
Dr. Gajaria: also already experience discrimination in society. And then adding in
Dr. Gajaria: other discrimination as being a person with a mental health
Dr. Gajaria: condition and making them more reluctant to access mental health care,
Dr. Gajaria: go through the mental health system. We also know that
Dr. Gajaria: people aren't always sure that they're going to get a
Dr. Gajaria: clinician or have an experience in the system. Someone can
Dr. Gajaria: actually understand their experience. And that, again, makes people really
Dr. Gajaria: reluctant to access care.
Faydra Aldridge: So we all know that there's a difference between having
Faydra Aldridge: a conscious and an unconscious bias. So what do you
Faydra Aldridge: see as being some of those unconscious biases that racialized
Faydra Aldridge: people may experience in the mental health system?
Dr. Gajaria: One of the things that we talk about quite frequently
Dr. Gajaria: is the assumption of dangerousness. And I do think a
Dr. Gajaria: lot of the time this is really unconscious. People live
Dr. Gajaria: in a society where the media represents racialized people, particularly
Dr. Gajaria: Black men, particularly racialized men, as criminals or as dangerous
Dr. Gajaria: or as violent. And that's something we commonly see in
Dr. Gajaria: our media representations. And I think that affects health care providers.
Dr. Gajaria: We are people, we live in that system. We're exposed
Dr. Gajaria: to all of that. And I think that really impacts
Dr. Gajaria: the mental health experiences, especially for young men, especially for
Dr. Gajaria: racialized men and Black men, where your care provider can
Dr. Gajaria: look like they're afraid of you. They can treat you
Dr. Gajaria: with more assumptions that you're going to do something violent.
Dr. Gajaria: They can overuse restraints. They can put people in seclusion.
Dr. Gajaria: More often. They can overuse medications because people have this
Dr. Gajaria: implicit bias about dangerousness and about what it means to
Dr. Gajaria: be that person. But in clinical experience, they often see
Dr. Gajaria: especially racialized young men being dismissed as having conduct problems,
Dr. Gajaria: antisocial personality structures that they're trying to game the system
Dr. Gajaria: or they're lying or they're trying to get out of
Dr. Gajaria: charges, and I see a lot of dismissing of their experiences that I don't think would
Dr. Gajaria: be dismissed if they were in a different body. And
Dr. Gajaria: I think, again, that relates to us living in this
Dr. Gajaria: society that continues to give messages of what it means
Dr. Gajaria: to be certain kinds of people.
Faydra Aldridge: Thank you for that. We're now going to listen to
Faydra Aldridge: a clip from one of your colleagues, Dr. Chintoh. And
Faydra Aldridge: we had Dr. Chintoh on an earlier episode, and she
Faydra Aldridge: shared this story about the treatment of someone that she
Faydra Aldridge: witnessed early on in her career. Let's take a listen now.
Dr. Chintoh: I have this both horrifying but beautiful story of one
Dr. Chintoh: night when I was a trainee and I was in
Dr. Chintoh: the emergency department and the police brought this young guy
Dr. Chintoh: in in handcuffs. And he was young, still a teenager,
Dr. Chintoh: and he wasn't saying a word. And I was like,
Dr. Chintoh: I don't understand. Why is he in handcuffs? They said,
Dr. Chintoh: 'He's got schizophrenia.' And so finally, it's two in the
Dr. Chintoh: morning and I'm trying to speak. And he's not saying anything.
Dr. Chintoh: And you could just tell he's just done. He's exhausted.
Dr. Chintoh: And finally he says to me, 'Why am I even here?'
Dr. Chintoh: And I said, 'Well, apparently you have schizophrenia and you've
Dr. Chintoh: not been taking your medication.' And he's like, 'What? Who
Dr. Chintoh: said I have schizophrenia?' And he was completely well, he
Dr. Chintoh: had been in handcuffs for hours because he was busy emergency.
Dr. Chintoh: He'd been in handcuffs for hours. And it wasn't even
Dr. Chintoh: a case of mistaken identity. It was just that somebody
Dr. Chintoh: had told the police, pick this guy up, he's likely violent,
Dr. Chintoh: this tiny little young Black kid in handcuffs for hours.
Dr. Chintoh: And it was an uplifting story because I took the
Dr. Chintoh: time to speak to him to get the history and
Dr. Chintoh: to do a bit of digging and realize that none
Dr. Chintoh: of what was being said was actually true. And yet
Dr. Chintoh: he had said it was the third time within two
Dr. Chintoh: months that he had been picked up by police for this.
Dr. Chintoh: And it was, it was devastating.
Faydra Aldridge: Dr. Chintoh's experience echoes the reports that say compared with
Faydra Aldridge: white people with the exact same symptoms that racialized people
Faydra Aldridge: in particular Black people, are more likely to be diagnosed
Faydra Aldridge: with schizophrenia or psychosis and less frequently diagnosed with mood disorders.
Faydra Aldridge: What are your thoughts on this.
Dr. Gajaria: In children adolescence, you will see that mood disorders and
Dr. Gajaria: anxiety disorders are less likely to be diagnosed in Black
Dr. Gajaria: and Hispanic youths compared to what are called externalizing disorders.
Dr. Gajaria: So things like conduct disorder, ADHD, behavioral problems. And I
Dr. Gajaria: think this is a similar phenomena that you're seeing in adults.
Dr. Gajaria: And I think it's because people see the behaviour, just
Dr. Gajaria: like Dr. Chintoh said, they don't see the person. So
Dr. Gajaria: I think what we see from that story, from what
Dr. Gajaria: we see in the data and what I thought about
Dr. Gajaria: why is this happening? And what I've witnessed is that
Dr. Gajaria: I don't think people hear the story. They don't always
Dr. Gajaria: see the humanity. I think particularly with this Black youth,
Dr. Gajaria: there's this idea that for some reason people are not curious.
Dr. Gajaria: They're not interested in why someone is doing what they're doing.
Dr. Gajaria: They're not asking the questions of why are you doing that?
Dr. Gajaria: What happens when we understand your experience and we understand
Dr. Gajaria: where you're coming from? We make an assumption that you
Dr. Gajaria: have a rich internal world. I think that also goes
Dr. Gajaria: back to unconscious biases. If you look back to longstanding
Dr. Gajaria: philosophical literature, talks about this idea that racialized people are
Dr. Gajaria: seen as bodies and not minds, and that we don't
Dr. Gajaria: think about the inaugural racialized people. I think that is
Dr. Gajaria: the process by which this is happening.
Faydra Aldridge: So now let's talk about the different mental health conditions
Faydra Aldridge: or mental illnesses and how they differ between races. So
Faydra Aldridge: what are the most common illnesses reported by Black, Indigenous
Faydra Aldridge: and people of color based on your experience?
Dr. Gajaria: Interesting question. A difficult question is a couple of reasons
Dr. Gajaria: why it's difficult to answer. From a Canadian perspective, we
Dr. Gajaria: don't do a good job of collecting race based data.
Dr. Gajaria: People are trying to change that and develop that. That's
Dr. Gajaria: quite hard at a population level to answer that question
Dr. Gajaria: because we haven't been asking that question. I think a
Dr. Gajaria: lot of us will argue that it's less the race
Dr. Gajaria: of a person and more their experiences. So it's more
Dr. Gajaria: about as a person who is Black or Indigenous or Hispanic,
Dr. Gajaria: it's not the fact that you're Black or Indigenous or
Dr. Gajaria: Hispanic that confers any different risk for a mental health condition.
Dr. Gajaria: It's the fact that you experienced differential racism access and
Dr. Gajaria: inability to have opportunities due to systemic racism, not due
Dr. Gajaria: to your actual race or ethnicity. And actually, when you
Dr. Gajaria: do look at some of the data from United States,
Dr. Gajaria: you see a difference in diagnosis. But this is also
Dr. Gajaria: what makes it hard to say what is the true
Dr. Gajaria: difference in prevalence or rates, because research is starting to
Dr. Gajaria: do that. Starting to ask what is the actual diagnosis
Dr. Gajaria: out there there versus like what is the clinician make as
Dr. Gajaria: the diagnosis is really impacted by implicit bias. But I
Dr. Gajaria: would say those two things are less common. Often you'll
Dr. Gajaria: see something like the clinician or the psychiatrist or the
Dr. Gajaria: mental health provider made the diagnosis. But again, you don't
Dr. Gajaria: know if those diagnoses are accurate in racialized people because
Dr. Gajaria: of all of the implicit biases and access and things
Dr. Gajaria: we've talked about. The few studies that try to tease
Dr. Gajaria: this apart either see similar rates or they see higher
Dr. Gajaria: rates in racialized people than we would expect because we
Dr. Gajaria: haven't looked at actually what is the diagnosis, from the clinician .
Faydra Aldridge: What do you think the benefit of having more race
Faydra Aldridge: based data would be?
Dr. Gajaria: Because we don't ask the question of do treatments, access
Dr. Gajaria: to treatment, treatment outcomes, treatment experiences vary on the basis
Dr. Gajaria: of race. We actually can't tell you anything about that information,
Dr. Gajaria: and that matters because we don't actually know if we're
Dr. Gajaria: doing things right. How can you say we know how
Dr. Gajaria: to treat depression? We don't know how to treat depression
Dr. Gajaria: in certain populations because we haven't measured it. We haven't
Dr. Gajaria: actually said CBT for depression in youths work for Black youth.
Dr. Gajaria: Does it work for Indigenous youth? We say we have
Dr. Gajaria: evidence based guidelines and we should follow those guidelines, especially
Dr. Gajaria: in the treatment of different mental illnesses. But we haven't asked,
Dr. Gajaria: do those guidelines actually work for people of color? Do
Dr. Gajaria: they work in the same way differently? And because there
Dr. Gajaria: are so many assumptions out there, because we put whiteness
Dr. Gajaria: and white experience as the norm, people don't think to
Dr. Gajaria: ask those questions because they assume that everything is fine.
Dr. Gajaria: Because if you have a majority white system, you have
Dr. Gajaria: researchers that are majority white, you have health matters that
Dr. Gajaria: are totally majority white. They're not going to see a
Dr. Gajaria: problem with the fact that we don't ask these questions.
Dr. Gajaria: But racial people will tell you, well, how come you
Dr. Gajaria: don't have any? You only have 5% people in your study.
Dr. Gajaria: People will also say we can't recruit Black people to
Dr. Gajaria: our study because Black people are not interested in mental
Dr. Gajaria: health care, which I've heard before. They're not accessing services.
Dr. Gajaria: That's true. And yet we have never asked that question
Dr. Gajaria: or asked what makes people not come or what is
Dr. Gajaria: the different experiences through the door for asking those questions?
Dr. Gajaria: We don't actually know anything about our system.
Faydra Aldridge: Now, do you think we're making progress in this area?
Faydra Aldridge: Do you think we are starting to see an uptake
Faydra Aldridge: in having more race based data.
Dr. Gajaria: I'm a little bit of a cynical person, because I'm interested
Dr. Gajaria: in race and racism and equity in social justice, like
Dr. Gajaria: probably since I was ten. And so I've seen cycles
Dr. Gajaria: and I think most of us who've done this work
Dr. Gajaria: have seen cycles. In 2020, everyone wanted to talk about
Dr. Gajaria: race and maybe into 2021. I am hoping that that
Dr. Gajaria: is sustainable. But I had also seen in the past
Dr. Gajaria: where people say 'We've talked enough about racism, we spend
Dr. Gajaria: too much time talking about social justice. We need to
Dr. Gajaria: actually deal with other things. People are tired because of
Dr. Gajaria: the pandemic. We don't need to talk about these things.'
Dr. Gajaria: Which I think the pandemic is a racial health issue
Dr. Gajaria: because it disproportionately affects racialized people. But I've just seen
Dr. Gajaria: this over and over again. I've seen people get really
Dr. Gajaria: committed to something for a moment. And then there's the
Dr. Gajaria: backlash that comes. People want to revert back to what
Dr. Gajaria: they're comfortable with, revert back to the mean . So I see some movement.
Dr. Gajaria: I am concerned about how sustainable it is, and I'm
Dr. Gajaria: hopeful that we are changing from the conversations in a
Dr. Gajaria: meaningful way. We are putting structures into place that will last.
Faydra Aldridge: What about the chronic and persistent mental illnesses? What do
Faydra Aldridge: you see is the connection between mental illness like schizophrenia
Faydra Aldridge: and race?
Dr. Gajaria: I think it's a challenge with a chronic illness is you have a
Dr. Gajaria: lot more interaction with the health system. So if you
Dr. Gajaria: have an illness with episodic, you might have one. It
Dr. Gajaria: might be some of that doesn't bring you into contact
Dr. Gajaria: with the hospital system. You might have a couple of
Dr. Gajaria: interactions and maybe that stress is lower because you're like,
Dr. Gajaria: 'I'm just going to go two or three times. I
Dr. Gajaria: don't have to see someone so often.' But I think
Dr. Gajaria: all the systemic issues that we talk about become even
Dr. Gajaria: more apparent when you're a person who from an early
Dr. Gajaria: age is having constant interactions and contacts with the system.
Dr. Gajaria: And sometimes that's voluntary and quite often it's not if you're a
Dr. Gajaria: racialized person with a chronic and persistent mental illness. And
Dr. Gajaria: so I think there's more and more space for there
Dr. Gajaria: to be negative experiences, for people to feel mistrustful, unheard, to have
Dr. Gajaria: experienced medical trauma as a result of those interactions.
Faydra Aldridge: So how does that unconscious or a conscious racism impact
Faydra Aldridge: people throughout their entire lifespan when dealing with a mental illness?
Dr. Gajaria: You see this so early. I see and I hear
Dr. Gajaria: from patients so early, especially in the school system. And
Dr. Gajaria: you've seen these reports in the news of children being
Dr. Gajaria: handcuffed by police for behavioral issues. I hear from patients
Dr. Gajaria: all the time who probably had learning problems or ADHD.
Dr. Gajaria: They never had access to a psychoeducational assessment. They never
Dr. Gajaria: were identified as a young person with mental health difficulties. They
Dr. Gajaria: were always just sent to the office or expelled or
Dr. Gajaria: suspended or told they were a problem. I've heard that
Dr. Gajaria: story over and over and over again, and you can
Dr. Gajaria: understand that early intervention is key. A lot of time
Dr. Gajaria: for mental health conditions. And if you're in a system
Dr. Gajaria: where you're a young person and you're supposed to be
Dr. Gajaria: identified by the adults in your life, they're supposed to
Dr. Gajaria: care about you and identify the problems you're having. If
Dr. Gajaria: that gets missed for ten years, then of course it's
Dr. Gajaria: going to be more complex. Would be present in their
Dr. Gajaria: twenties with untreated illnesses.
Faydra Aldridge: You're listening to Look Again: Mental Illness Re-examined. A podcast
Faydra Aldridge: brought to you by the B.C. Schizophrenia Society and B.C.
Faydra Aldridge: Partner organizations. I'm your host, Faydra Aldridge. This podcast would
Faydra Aldridge: not be possible without the support of the community. From
Faydra Aldridge: the bottom of our hearts, w e want to thank you
Faydra Aldridge: for caring about serious mental illness and everything that's around it. Together,
Faydra Aldridge: we truly can make a difference. Welcome back to Look Again:
Faydra Aldridge: Mental Illness Re-examined. I'm Faydra Aldridge and I've been speaking
Faydra Aldridge: to Dr. Amy Gajaria about how racism can influence the diagnosis,
Faydra Aldridge: treatment and outcome of serious mental illnesses for racialized populations. Now, Dr. Gajaria,
Faydra Aldridge: twice a year, you head to Nunavut to provide psychiatric care to
Faydra Aldridge: underserved communities, the majority of which are Indigenous peoples. Now,
Faydra Aldridge: as a clinician, how do you differentiate between someone who
Faydra Aldridge: is experiencing an incident of racism versus someone who is
Faydra Aldridge: having delusions of experiencing racism due to a mental illness?
Dr. Gajaria: The one thing I say is these two things can coexist.
Dr. Gajaria: So people can both experience psychosis or delusions and be
Dr. Gajaria: experiencing racism at the same time. And frequently we see
Dr. Gajaria: it with Indigenous peoples in different settings just based on
Dr. Gajaria: kind of colonization and systemic factors. It's a difficult thing
Dr. Gajaria: to tease apart. I think what I always tell folks
Dr. Gajaria: is that those two things can both be present. You
Dr. Gajaria: can't just dismiss someone talking about racism as psychosis, and
Dr. Gajaria: that sometimes has led to that over diagnosis of psychotic
Dr. Gajaria: disorders in racialized people for that reason. So something we
Dr. Gajaria: can say about getting to work with people that are
Dr. Gajaria: different than yourselves or have a different lived experience is
Dr. Gajaria: get to know somebody within their context of the history
Dr. Gajaria: of where they live, get to know their community, understand what is normative
Dr. Gajaria: about their experience and what isn't. That requires doing some
Dr. Gajaria: work ahead of time. And the more you do that,
Dr. Gajaria: the more you might understand what's within what lots of
Dr. Gajaria: people experience and what's different. How impaired is someone's behavior. How
Dr. Gajaria: unusual is it compared to their community? And once you've
Dr. Gajaria: built trust, ask other people around them. How is your
Dr. Gajaria: loved ones behaviour different from somebody else's? Is it different, is it
Dr. Gajaria: the same? Do you think there's anything unusual of what
Dr. Gajaria: they're doing or not doing? Often, if there was enough
Dr. Gajaria: trust in the family bringing them to you and saying
Dr. Gajaria: there's something very different here, there's something unusual, they're not themselves.
Dr. Gajaria: So for a lot of people, I know that are white
Dr. Gajaria: they don't understand how much people don't trust the police.
Dr. Gajaria: And I actually don't understand how much white people talk
Dr. Gajaria: about trusting the police. That's a completely different experience for me.
Dr. Gajaria: And so I think it's just a willingness to really
Dr. Gajaria: understand that just because you've had one experience and you've
Dr. Gajaria: lived in one way, it doesn't mean it's everybody's experience.
Faydra Aldridge: And as you touched on, context is obviously extremely important,
Faydra Aldridge: both with what the person is experiencing, but also how
Faydra Aldridge: their community and the people around them respond to them
Faydra Aldridge: and their experiences. What role do you think context can
Faydra Aldridge: play to both the under diagnoses and or the mis
Faydra Aldridge: diagnoses of mental illness for people of color?
Dr. Gajaria: I see people swinging two ways, right? So initially they
Dr. Gajaria: might have said if you talk about police violence, you
Dr. Gajaria: have schizophrenia or you have psychosis. Back in the sixties,
Dr. Gajaria: if you challenge if you're part of the civil rights movement,
Dr. Gajaria: you have schizophrenia. And then now what I see is
Dr. Gajaria: the opposite. If people talk about being followed by the police.
Dr. Gajaria: People might say, Oh, no, no, that's totally normal. No
Dr. Gajaria: one can have psychosis and talk about that. And what's
Dr. Gajaria: really important is you have to be contextual and you
Dr. Gajaria: have to understand someone as a full person. You have
Dr. Gajaria: to be curious. You have to take the time. You
Dr. Gajaria: have to wonder with somebody about what's going on. And
Dr. Gajaria: that sometimes leads you from swinging in one direction or
Dr. Gajaria: the other. And in terms also under diagnosis, sometimes this
Dr. Gajaria: also goes to that conversation or there's an expectation that
Dr. Gajaria: every racialized person has experienced constant oppression in the sense
Dr. Gajaria: that people who are racialized can't be successful, they can't
Dr. Gajaria: be professionals, they can't have money. And so sometimes there
Dr. Gajaria: can be a well-meaning approach to people, particularly Black and
Dr. Gajaria: Indigenous people in Canada. They're very well-meaning, but they just
Dr. Gajaria: assume that they live in poverty. They assume that people
Dr. Gajaria: have come from trauma, that they never had positive family structures.
Dr. Gajaria: And that's also important to challenge that. There's lots of
Dr. Gajaria: healthy families and successful people and resilient folks within these communities.
Dr. Gajaria: And if you overfocus on trauma and all of the
Dr. Gajaria: negatives and actually missed that part, you also miss part
Dr. Gajaria: of the picture.
Faydra Aldridge: So throughout this entire conversation, we've been talking about the
Faydra Aldridge: patients that you care for and the people you work with.
Faydra Aldridge: But now I'd like to talk about you. What has
Faydra Aldridge: been your experience as a mental health care practitioner of color?
Dr. Gajaria: I think it has actually been in some ways similar
Dr. Gajaria: to my patients. So I say that because it is
Dr. Gajaria: incredibly valuable to me to work with racialized patients, to
Dr. Gajaria: be able in my practice to see a majority people
Dr. Gajaria: of color, to work with families from different communities. And
Dr. Gajaria: I'm from Toronto. I work in Toronto to see a
Dr. Gajaria: practice that feels like it reflects the city that I
Dr. Gajaria: live in and that is currently. But in my training
Dr. Gajaria: that wasn't the case and I didn't see people whose
Dr. Gajaria: experiences I could relate to who I felt. I understood
Dr. Gajaria: a lot about how they lived or what their childhoods
Dr. Gajaria: were like, what their neighbourhoods were like or their lived
Dr. Gajaria: experiences like. And I'm just realizing, as I'm saying this,
Dr. Gajaria: that there is such a gift to be able to
Dr. Gajaria: work with people where you have some shared experience. And
Dr. Gajaria: I know that patients say that as well, that for
Dr. Gajaria: them it's such a gift to have a provider that
Dr. Gajaria: they think they can actually talk to or they can
Dr. Gajaria: talk about certain things with. But also I think there's
Dr. Gajaria: the challenge of all the time before that when I
Dr. Gajaria: wasn't doing that, especially in my training and people would
Dr. Gajaria: many times question whether racism exists. This is before 2020, people
Dr. Gajaria: would four or five years ago ask questions like, 'Isn't
Dr. Gajaria: that reverse racism' and just questions that are frustrating. Take
Dr. Gajaria: issue with the fact that I wanted to work with
Dr. Gajaria: underserved folks or people living in certain experiences or racialized people,
Dr. Gajaria: and they ask questions like, 'What is it about you
Dr. Gajaria: that makes you want to do that?' as if it
Dr. Gajaria: was a problem. And I'd say 'We never question the
Dr. Gajaria: idea that people feel comfortable having a mainstream practice unquestioningly
Dr. Gajaria: homogenous in a certain way. Why is it suddenly problematic
Dr. Gajaria: to want to work with people who are not represented
Dr. Gajaria: in the system?' or even just have I shared lived
Dr. Gajaria: experience with So I would say training as a mental
Dr. Gajaria: health provider was extremely difficult as a person of colour.
Dr. Gajaria: I think there's a lot that needs to be changed.
Dr. Gajaria: I was never particularly interested in medical education, but I
Dr. Gajaria: went into it because I had a lot of experiences
Dr. Gajaria: that were negative and I didn't want to see trainees
Dr. Gajaria: have those same experiences and wanted us us to change our culture,
Dr. Gajaria: change our curriculum, change the way we treat trainees that
Dr. Gajaria: are racialized, because there is a lot of racism that
Dr. Gajaria: you experience as a resident and as a medical student
Dr. Gajaria: that you think you're going to be protected from a
Dr. Gajaria: little bit because you have all this power and you
Dr. Gajaria: have a certain position in society and then you realize
Dr. Gajaria: that doesn't necessarily protect you from all those experiences, which again,
Dr. Gajaria: I think reflects what some of my patients are telling me who
Dr. Gajaria: are professionals or lawyers or doctors and yet still are
Dr. Gajaria: having these experiences.
Faydra Aldridge: Thank you for sharing that. What do you think needs
Faydra Aldridge: to change within the system itself, with education, with research,
Faydra Aldridge: with policies to make mental health care across our country
Faydra Aldridge: more equitable?
Dr. Gajaria: I, I would love if we had equitable funding. That
Dr. Gajaria: would be wonderful. A great place to start. Money is great.
Dr. Gajaria: And I always say for people in equity work is when
Dr. Gajaria: you want to see change, ask people where the money
Dr. Gajaria: is and where the power sharing is. I can give
Dr. Gajaria: you a thousand suggestions on what we can actually do
Dr. Gajaria: with what we have. But the ultimate question that I
Dr. Gajaria: always ask is are people who are at the top,
Dr. Gajaria: who always have power, willing to give up some of
Dr. Gajaria: that power? Are they willing to be uncomfortable and to
Dr. Gajaria: be challenged and to sometimes have difficult and uncomfortable feelings?
Dr. Gajaria: And are they willing to fund this? Because if the
Dr. Gajaria: funding is not there, if community services are constantly underfunded,
Dr. Gajaria: if mental health care in Canada is underfunded, if we're
Dr. Gajaria: not funding culturally specific care, if we're not putting people
Dr. Gajaria: in positions of power that can make these changes that
Dr. Gajaria: have had these experiences, that have this expertise, nothing else happens.
Dr. Gajaria: And so often people want you to do it the other way.
Dr. Gajaria: They want you to suggest, 'Give me a plan and
Dr. Gajaria: then I'll see if it's worth funding.' My thing is,
Dr. Gajaria: are you even willing to have a conversation about funding?
Dr. Gajaria: Are you even willing to have a conversation about changing
Dr. Gajaria: structures of power if you're not willing to have that conversation?
Dr. Gajaria: There's nothing that can be done.
Faydra Aldridge: Thank you so much for joining me today. We at
Faydra Aldridge: least got the conversation started and I realized it's a
Faydra Aldridge: huge and very difficult topic and I'm sure I'll be
Faydra Aldridge: connecting with you again. So thank you for your experience
Faydra Aldridge: and for sharing your thoughts with me today. And I
Faydra Aldridge: truly appreciate it.
Dr. Gajaria: Thank you so much. Was really thought provoking. I appreciate
Dr. Gajaria: your time.
Faydra Aldridge: And a huge thank you to you, our audience, for
Faydra Aldridge: joining us for this very difficult episode. Together, we can
Faydra Aldridge: change the narrative around mental illnesses like schizophrenia and start
Faydra Aldridge: to end the many myths and stereotypes that still exist today.
Faydra Aldridge: If you have any questions or any comments, tweet us
Faydra Aldridge: at @BC Schizophrenia and to get our latest episodes, be
Faydra Aldridge: sure to hit follow n Apple Podcasts, Spotify or anywhere you
Faydra Aldridge: listen to podcasts. And to hear more about how schizophrenia
Faydra Aldridge: affects families, we have another podcast for you three moms
Faydra Aldridge: from the East Coast, West Coast and Middle America ost
Faydra Aldridge: a unique podcast about mental illness. Each host has an
Faydra Aldridge: adult son with schizophrenia, and they've written acclaimed books about
Faydra Aldridge: their journeys. They say it like it is with the
Faydra Aldridge: goal of helping families learn more about serious mental illnesses.
Faydra Aldridge: Listen to Schizophrenia: Three Moms in the Trenches wherever you
Faydra Aldridge: get your podcasts. We hope you join us next episode.
Faydra Aldridge: Talk to you soon.
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