Addressing Health Equity and Racism Through a Hispanic Psychiatry Fellowship

Institutional review board (IRB) approval was waived for this project. Below we describe our initial considerations for the fellowship: choosing a clinic model serving an LEP Hispanic population as a training site; identifying core training themes to fit the needs of the patient population; selecting interested faculty experts; and developing educational goals, objectives, and evaluations.

A year-long training experience for two consecutive fellows was implemented based on the plan (see activities outline in the online supplement). A third fellow is currently in training. The fellows, under the ethnically diverse leadership and staff, have become familiar with serving monolingual Spanish-speaking patients within the established bilingual clinic model. Additionally, the fellows have provided direct clinical services and consultation for public psychiatry mental health settings that previously had only limited access to bilingual psychiatrists. The fellows have engaged in their monthly schedule of individual expert supervision. The evaluations have indicated the experience is feasible and satisfactory and have captured positive outcomes for each core training area.

Within the ≥2 years the fellowship has been operating, several scholarly projects developed, including exploration of culturally sensitive recovery interventions for Hispanics with serious mental illness. An IRB-approved pilot project elicited and identified information regarding the meaning of recovery for Hispanics to transform the Citizenship project (12), an evidence-based recovery intervention for the general population, in a culturally sensitive manner. The results of these projects were presented at the 2020 Society for the Study of Psychiatry and Culture Annual Conference. One fellow’s case review of a person whose symptoms were misinterpreted as cultural beliefs won the John P. Spiegel Memorial Fellowship Award for an original cultural psychiatry article addressing cultural and religious beliefs of a Hispanic woman. A virtual conference was delivered for mental health professionals and community agencies, highlighting care for immigrants and children and a call to action. The fellow’s active participation in recruiting from ethnic minority groups for psychiatry educational programs supported other diversity initiatives.

Structured opportunities to develop educational expertise have included direct teaching and mentorship of other graduate students. The fellows have led the clinic’s curriculum addressing bias, health disparities, recovery-oriented services, interviewing skills, and mental health services for ethnic minority groups. They also have led seminars for medical students working in a primary care student-run free clinic serving minority populations.

Overall, during the first 2 operating years, the Hispanic Psychiatry Fellowship met its established goals and demonstrated feasibility. Implementation was possible because of sufficient political and financial support, resources, and well-matched administrative strategies.

One fellow per year does not provide sufficient data to evaluate outcomes; however, the fellowship experience catalyzed several scholarly projects, with products presented nationally. On completion of the program, the first two fellows applied for and were granted faculty appointments at our academic medical center, thus contributing to diversity in the workforce. Having future fellows disseminate this model to other sites is an additional goal.

The development of a fellowship dedicated to training bilingual Hispanic psychiatrists to securing appropriate services for an LEP Spanish-speaking population is a great beginning; however, it remains a beginning. The lack of recognition regarding the consequences of the scarcity of bilingual mental health professionals was addressed locally through the academic-state affiliation, but many barriers impede starting such programs elsewhere. Those interested in developing a similar program will need to identify which sites and services could become part of a similar model for prospective trainees, secure a support group to identify the service and educational needs, and develop a plan. Alternatively, public psychiatry fellowships can consider creating a specialized mental health services track for serving LEP ethnic minority populations.

Nationally, budgets do not prioritize LEP ethnic minority populations in need of mental health services. Funding our initial budget request was challenging. Many states support mental health services for their populations, including psychiatry training programs, and possess academic-state partnerships. The connections and collaborations with state leaders who understood the unique population needs and who were familiar with the challenges ethnic minority populations face facilitated advocacy and were crucial.

Careful preparation with multiple stakeholders, including academic faculty, organizational leadership, and state officials, was needed to develop an adequate training plan. Core training areas based on the unique needs of the LEP ethnic minority population were identified and served as a curriculum needs assessment. Learning to use existing resources and connect with experts to develop a solid plan are replicable strategies. Our initiative successfully engaged a nationally recognized expert. Recruiting such an expert to a developing training program was feasible and is replicable.

Educational and leadership opportunities for bilingual individuals from racial-ethnic minority groups are limited across health care disciplines. Leaders and advocates can develop educational plans to attract minority populations by using their own faculty or by inviting interested experts from other institutions.

Training in a program that confronts and addresses the social norms that propagate and prolong racist policies is transformative. The creation of such an environment is within the purview of clinician leaders and advocates. Witnessing a community unite to protect the underserved is an important educational experience for trainees.

The Hispanic Psychiatry Fellowship maximizes the impact of bilingual Spanish-English psychiatrists and can disseminate a model that extends to other LEP minority populations, addressing service and workplace scarcity. The experience empowers bilingual psychiatrists to become knowledgeable leaders regarding policy, health disparities, and racism, while developing skills to teach the cultural aspects of ethnic minority diversity, including training others to do the same. Access to virtual patient care and electronic learning modules may help expand and facilitate programming. Further data are needed to assess the outcomes of this program.

The Hispanic Psychiatry Fellowship is a new training model engaging bilingual psychiatrists from a racial-ethnic minority group. The effort is an innovative strategy meant to dismantle racism in education and training. The first 2 years of training activities demonstrated feasibility, ease of implementation, and overall acceptance. Similar programs can be developed by uniting clinicians and educators interested in addressing racism and health equity, thereby maximizing services for minority populations and eventually increasing workforce diversity.

Graduates of such programs can build and expand their careers by teaching as academic psychiatrists and by leading culturally responsive mental health services in nonacademic settings. Most important, they can broaden access to high-quality care for LEP individuals. Additionally, while transforming systems into those capable of offering just and equal care for underserved populations, graduates can recruit the next generation of students, trainees, and ultimately leaders.

The authors thank Selby Jacobs, Robert Rohrbaugh, and David A. Ross for their comments on the manuscript. These views represent the opinions of the authors and not necessarily those of the DMHAS or the State of Connecticut.