By Garsy Presumey-Leblanc, M.S.

Each quarter, we highlight an individual in the field of psychiatry who is a champion for mental health equity – whether through their work in direct care, research, advocacy, or in the community. Our champions are nominated by their APA-member peers to share the tangible ways they incorporate a health equity strategy in their practice and support increasing access to quality of care for diverse populations. To nominate a Mental Health Equity Champion for consideration please reach out to [email protected].

Our Mental Health Equity Champion this quarter is Dr. Dionne Hart!

Dr. Hart is board certified in psychiatry and addiction medicine and licensed in both Illinois and Minnesota. She is also an adjunct assistant professor of psychiatry at Mayo Clinic and medical director of Care from the Heart. In 2014, Dr. Hart was named Minnesota Psychiatrist of the Year. In 2017, Dr. Hart received the National Alliance on Mental Illness Exemplary Psychiatrist Award. She holds local, state and national leadership positions and is a chairperson of the National Medical Association and President of the Minnesota Association of African American Physicians. Dr. Hart was the inaugural chair of the American Medical Association (AMA) Minority Affairs section. She currently serves as an APA delegate to the AMA House of Delegates and the AMA liaison to the National Commission on Correctional Health Care Board of Representatives. In 2020, Minnesota Physician journal named her one of the 100 most influential health care leaders in Minnesota.

Q&A with Dr. Hart

I always wanted to be a physician, but I got married, had kids early, and then divorced. I was just really afraid to apply for medical school. I didn't have the confidence. I was worried about the financial issues. So, I went into social work thinking, “I want to serve people. I want to work with people who are disenfranchised and people who have mental health disorders.” I worked in a community mental health center on the west side of Chicago. That work was really my effort to remain involved in mental health treatment—just to be a part of the team. It was also how I realized being a social worker was rewarding. My daughter's a social worker, so it must be in the genes. But it just wasn't my calling. I think it helped me to stay engaged with the people that I would serve throughout my professional life. It also solidified for me what my true calling was.

I believe it is still in existence. There was the Bobby Wright Community Mental Health Center, and it was one of the community centers that started in the ‘50s/’60s, when there was a push for more treatment in the community. There were a lot of patients who had severe mental illness as well as substance use disorders. There was a methadone clinic not too far away, so some of the patients went to that clinic. It was people who were coping with a lot of social determinants of health, learning how to navigate the social service system to take care of themselves and their families, and addressing their mental health issues.

My job mainly was working with families that were really struggling in regard to safety, abuse or neglect issues. So, I was just trying to help families reconcile and get the skills they needed to reunite or to find alternatives for the families in a wave of support. It was a very interesting center, and it was the first time I had worked full-time with so many Black professionals in a disenfranchised community. I learned a lot and certainly think that the time I spent there was very valuable.

I've always been a patient advocate. I just didn't have the language, didn't have the resources, and didn't know how to ask. I think the heart of it all was there. I was very privileged to be able to train at Mayo Clinic, where bedside advocacy was taught as an essential part of patient care. So, when I had an opportunity to learn how to be more of a public advocate, I felt like I already had a foundation. It's much more of a natural skill to advocate for others versus myself. That to me was very empowering, and there was no other feeling like it. For example, when you saw something, you submitted an idea of how to change that, how to fill a gap, and then you saw your peers accept it, and then it be implemented into action. Once you have that feeling and you're around people who are also advocates, I don't think I’ll ever be able to give that up.

I was thinking about this when I was preparing for one of my sessions at the recent APA Annual Meeting. I remember as a pre-medical student, as a medical student, and then as a resident, we learned these facts about mental health patients in a very normalized way. For example, correctional facilities are the largest mental health provider in the U.S.; black people are over-diagnosed with thought disorders and underdiagnosed with mood disorders; globally, we miss a lot of patients who are experiencing trauma; very few people who are African American or identify as Black get substance use treatment. We talk about these things, and we have accepted them as fact and as normal when there’s nothing normal about that. I think that when residents and medical students are learning about psychiatry, they should learn how to change that.

We've accepted it as something that we must live with. There should be strong efforts to make sure that patients are at the right facility and have access to the right treatment with the right diagnosis. We should be making sure that all those things line up. But we should also be making an effort to increase the number of people who are working at the bedside of patients, who are involved with the justice system—whether that's corrections or law enforcement—to provide some services for people who are in crisis. We should really be a lot more involved in the conversations to change these problems that we have accepted as facts. And I think that if we start to expose people to the idea that they can make those changes and that it will help their patients, then 20 years from now, people aren't learning the same concept and thinking that's just the way it's always been and always going to be.

I became initially involved in organized medicine because I had applied to be a chief resident and wasn't accepted. And part of the reason was because I can be outspoken about some of these issues. I knew my selected colleague was just as outspoken, but it was okay for them because they were educating people. Whereas I was like a soapbox, or it was a sermon. There was negative connotation because as a Black woman, I was speaking out. I wrestled with that and said, “Okay, I want to do this, but this is not where I'm going to develop these leadership skills. What am I going to do?” A friend told me about opportunities at the Minnesota Medical Association and Minnesota Psychiatric Society. I started to get involved.

And then, of course, once you started to get involved, people mentioned other things. Then that's when getting involved in what was then the Minority Affairs Consortium at the AMA came up.

In the past, the AMA didn’t really accept Black physicians. That's the old AMA. I did have a negative experience with one person, who when I walked into the room to meet the Minnesota delegates told me I was in the wrong room. Just looked at me and said you're in the wrong place. But then, somebody literally extended their hand and said, come in. And I was like, okay, well, I am welcome. And I've found so many people who share similar beliefs, systems and personality traits.

I became very involved and was very instrumental. I was in the right place, at the right time, where I was the first person of what became the newly formed minority affairs section, which is doing amazing things now. And it's part of the reason why there's an AMA Center for Health Equity. But I felt like I had to be equally passionate, equally involved in the NMA because the NMA was formed because the AMA was not a safe place for them and not an open place for them.

That's how I became more involved in the NMA. To me, it was intentional. I think that it's so important for minority physicians to be involved in organized medicine. It gives people the opportunity to hear our voice, to understand what our issues are, to be seen and to be heard in a genuine way.

Right now, only 2% of psychiatrists practicing in the U.S., identify as black. When we put all the minority physicians together, we only represent 9% of total physicians. (For comparison, 13.6% of the U.S. population is Black.) There's no way for us to treat all the minority patients, even though there are a lot of studies that say when there's concordance, especially as related to mental health, there's a better outcome. That is related to trust, but we can't do it all. What we need is to really work with other colleagues to make sure that they understand... cultural competence. Micro- and macro-aggressions are often not intentional, people just don't know, they're not exposed.

I think some of it is setting ourselves up to have open dialogue and ask questions, so people don't feel like they're going to be labeled a certain way or “canceled” because you asked the question. I think there's curiosity, right? And I think we really need to embrace that curiosity and teach each other about our cultures, so that people feel more comfortable treating patients from all different backgrounds. We need to make an effort to have conversations to address why things are where they are and to actively work with each other to make changes.

I hope one of the things I'll be remembered for is the school-to-prison pipeline and juvenile justice reform policy at the AMA, that to this day people are still building upon. Then being at the APA now and being involved in so many advocacy efforts related to improving the quality and access to community psychiatry. Almost 10 years ago, I was Minnesota Psychiatrist of the Year, and last month, at the APA Annual Meeting, I received the Assembly Profile of Courage Award. I'm sure those are the things that when my professional career’s over, I will remember.

Well, I think I would just really emphasize the need for psychiatrists to really start talking to and educating our peers about what we do. I think that part of the problem with the scope of practice issues is people don't know what we do. They don't know the complexity of brain science and how we apply that.

Everybody needs to have the best mental health possible and to have access to treatment when there are struggles. Suicide is preventable. Substance use and mental health disorders, anxiety disorders, you name it, there's treatment out there. And I just hope that we do a better job of making people understand the essential part of healthcare.