A Culturally Informed Approach to Supporting Suicidal Minoritized Patients

Supporting suicidal minoritized patients begins with the recognition and acknowledgment that racism and discrimination are contributors to psychological distress and suicidality. This requires starting with our own beliefs, attitudes, and biases about minoritized patients. Studies of clinician bias toward racial, ethnic, and sexual minoritized patients have described differences in communication and clinical approach when providers from a majority group interact with minoritized patients. Studies of White physicians’ interactions with Black patients find less time spent with patients, shorter interactions, limited opportunities for patients to ask questions, and documentation reflecting limited engagement (8). Other studies show missed diagnoses, incorrect diagnoses, poor-quality treatment, and failure to engage in follow-up treatment (5, 8–10). Recognizing our own conscious and unconscious biases, using a cultural humility–informed framework, can facilitate understanding the unique stressors, risk and protective factors, vulnerabilities, and supports that increase trust and engagement, improve mental health, and prevent suicide.

Research attests that people of color and Indigenous individuals’ experiences with racism, discrimination, and microaggressions affect their mental and general medical health. Racism, discrimination, implicit bias, and structural inequities have severely affected health care delivery and outcomes, and historical experiences contribute to mistrust of health care providers.

Research confirms that traumatic experiences occur for minoritized individuals at significantly higher rates when compared with majority populations, and this is worsened in the context of intersectionality—individuals identifying as more than one minoritized group. Clinicians regularly assess the impacts of traumatic events but rarely inquire about racial trauma or its impacts on patients. Racial trauma is a form of race-based stress that describes the reactions of people of color and Indigenous individuals to dangerous events and real or perceived experiences of racial discrimination. These could be threats of harm and injury, humiliating and shaming events, and witnessing racial discrimination toward other people of color. It differs from other traumas in that it involves ongoing individual and collective injuries due to exposure and re-exposure to race-based stress, and it may not be recognized as a trauma by the individual experiencing it (11). It is essential that racial trauma be integrated into our trauma-informed assessment and care of minoritized patients (11).

Cultural humility is a lifelong, active approach to optimizing communication and interactions between patients and clinicians whose backgrounds, experiences, and values differ. It is a process along the cultural competence continuum, does not require expertise about groups, and is more feasible for clinicians to utilize. In this context, culture is defined more broadly, considering race, age, ethnicity, gender identity, sexual orientation, disability, or any other identity of individual patients, including those with overlapping oppressed identities. The culturally humble clinician engages in critical self-reflection, nonjudgment, openness, and curiosity. This approach has demonstrated effectiveness in strengthening the therapeutic alliance and improving health outcomes (7).

Ultimately, supporting the minoritized suicidal patient requires that we use the best practices that we have to date for suicide prevention for every individual patient, every time that we see them, recognizing that our risk assessment must include recognition of racism and discrimination as sources of psychological distress and trauma, as determinants of mental health generally and suicidality specifically. As caring clinicians, we are not immune to implicit and explicit biases that affect clinician-patient communication and thus result in unintended harm. A culturally humble approach can help by diminishing biases, promoting empathy, and acknowledging the patient’s experiences and individuality—inspiring hope (12).