Demond E. Bledsoe, PhD, LPC, is a senior program director with UPMC Western Psychiatric Hospital, where he provides clinical support to inpatient behavioral health units in UPMC hospitals and select outpatient facilities across Pennsylvania. His research and scholarly writings focus on the impact of psychological trauma as well as diversity in behavioral health and clinician training. Dr. Bledsoe has worked in a variety of treatment settings and has served on numerous state and local boards and committees.
What led you to a career in behavioral health?
It was almost by accident. As an undergraduate, a friend connected me to part-time research work at UPMC Western. When the project contract wasn’t renewed, another colleague recommended me for a job at a local residential youth facility. Many of the young people there were dealing with abuse, violence, and broken homes. I knew right away it was the kind of work I wanted to do.
What was it like working as a residential counselor?
At first, I wasn’t prepared for the trauma, behavioral problems, and mental illness. I saw the incredible suffering people endure and the courage they found to try and get better.
Early on, I worked with a young boy who would harm himself. Both he and his sibling had been abused at home. He had to listen, helplessly, as his sibling was hurt. In response, he started hurting himself. It evolved into a regular way of dealing with things whenever he felt upset.
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One day he came to me and said, “I was going to hurt myself, but I want to talk to you instead.” When our meeting finished, he said, “You told me if I came and talked to you, I might not want to hurt myself — and I don’t. I think I’m going to be okay.” That moment crystalized my path. Most of all, it underscored for me the critical need to establish trusting relationships with patients.
What are some of the racial biases people of color encounter when seeking behavioral health care?
When someone seeks any kind of health care, they bring all the experiences that have shaped them — good and bad — in life. We are the sum of our experiences.
When people of color present to an emergency department or outpatient clinic for behavioral health care, they’re entering an environment where personal or community experience tells them they’re less likely to receive quality care. They’ve come to expect that their caregivers are less likely to collaborate with, or be respectful of, them. So, the relationship often begins with worrisome tension.
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One of the most important steps a behavioral health professional can take is to simply ask a client about their experiences with discrimination and oppression. We certainly can’t take away the pain of those experiences. But we can tell that person, “I’m sorry that’s happened to you. I’m going to do everything in my power as a clinician to make sure that that doesn’t happen to you here. And if I ever do something that leads you to feel that way, I want you to tell me.” In doing so we acknowledge the past — and give them permission to tell us when we add to that pain.
Could you share some of your own personal experiences?
I travel wherever UPMC has inpatient behavioral health units, so that takes me across Pennsylvania, southern New York, and western Maryland. From the moment I walk in the door until the time I leave, I rarely see another professional who looks like me.
When I walk onto the floor of a behavioral health unit, I often see a look come across the faces of patients of color. It’s a recognition that I’m one of them — there’s a connection between us.
In the medical field, the title “Dr.” often is reserved only for those individuals with a medical degree. But when I’m in meetings with White professionals who are PhDs like me, they’ll often be recognized as “Dr. Brown” or “Dr. James,” while I’m greeted only by my first name. It’s an example of a subtle — often unintentional — but real microaggression.
What areas would benefit from more behavioral health research?
We know trauma affects the body and the way in which we perceive the world. In recent years, for example, testing and assessments done with veterans enabled us to better understand and help people with posttraumatic stress disorder (PTSD).
But surprisingly, we know very little about the impact of race and poverty on a person’s worldview. In particular, I would like to see more testing and research done around intergenerational trauma in the Black community.
Can you talk about the stigma of mental health/behavioral health in the Black community?
In the Black community, there’s a prevailing attitude that we must take care of ourselves because if we don’t, no one else will. It doesn’t matter if you’re hungry or if the water is cut off. The rule is: what happens in this home stays here. When you walk out the door, you put a smile on your face and everything’s okay. So, when people of color seek out mental health treatment, they’re telling others that everything’s not okay in their home.
As a counselor, the challenge is to help a person of color feel comfortable and engaged with you. Research indicates that in a traditional outpatient counseling setting, therapeutic rapport develops by the third meeting. If you haven’t established it by then, it’s not likely to happen.
In fact, people of color disengage from treatment at a much higher rate than those in the majority population. It’s estimated that more than half don’t return after the first session. One reason is that they often feel as though behavioral health providers do not understand the nuances of their particular challenges because they don’t look like them or have the shared experience of oppression.
How has COVID-19 impacted behavioral health among people of color?
Stress does terrible things to the body. It’s quite literally a killer. During COVID, we saw people who were isolating, sitting alone, and having negative thoughts. These experiences were shared by all people, not just people of color. When we have negative thoughts, when we experience some depression or some anxiety, sitting alone with nobody to talk to is like going down a whirlpool.
In the Black community, we also have seen friends and family die of COVID at a much higher rate than the rest of the population. Those numbers support a general mistrust of the medical profession among people of color, given what’s happened in history. So, when it’s announced that vaccines are coming out, instead of offering hope, people say, “Remember Tuskegee.”
And while the very public treatment of people like George Floyd or Breonna Taylor by law enforcement may be surprising to some, it isn’t new to people of color. It’s been happening for generations. The minority community’s relationship with police has always been a source of stress and tension — but it’s definitely heightened during COVID.
These and other factors have caused some people to become paralyzed in moving forward with physical health care or behavioral health care. It’s prompted some to turn to negative coping strategies like drinking, substance abuse, or violence. And it has inspired others to realize that now is the right time to get help.
What are some of the challenges people of color have faced accessing behavioral health services during the pandemic?
During the pandemic, we saw a significant dip among all inpatient admissions. While fewer people were seeking care, those who did were really, really sick.
Our services are only valuable when the people who need them know they are available and have the means to take advantage of them. For people of color, that often means leaving their own community — the one place where they feel safe — to engage in treatment that frightens them. We need to start delivering more services directly into the communities that need them most.
Many behavioral health services switched to telehealth delivery during the pandemic. At first glance, that appears to be a great solution. But telehealth video requires a strong and stable internet connection, which many people simply cannot afford.
And telemedicine involves using up data. People on limited incomes have data limits on devices like prepaid telephones. Engaging in telehealth treatment can take up a significant portion of their monthly minutes.
Telehealth also requires a person to have a private and safe space to engage in sessions. The benefits diminish when a person is distracted or can’t talk about the challenges they are experiencing because another person can hear their conversation.
Are there things happening that give you hope?
Yes, though not enough. Martin Luther King, Jr. talked about the myth of time — the mistaken belief that somehow time alone will make things change. Our patients cannot wait for us to give them the care they need. They need it now.
We all need to acknowledge that it’s not always going to be perfect or pretty. At times, it’s going to be bumpy — and that’s okay.
What else can be done to support behavioral health for people of color?
We can turn to Black community leaders to help bridge the trust gap. Church elders and prominent community business leaders are important allies in breaking down the stigma of receiving behavioral health services. They offer credence to the validity and intentions of the organizations providing those services.
At UPMC McKeesport, its chaplain, Rev. Shawn Kirkland, and its chief nursing officer and vice president for patient care, Dawndra Jones, DNP, who recognized that people of color seek mental health support from their churches. At the same time, pastors are recognizing that they don’t necessarily have the skills to deal with the kinds of problems people are experiencing. Rev. Kirkland and Dr. Jones are doing a great job helping to destigmatize mental health issues and linking pastors to referral sources in their community.
Providing childcare or transportation assistance also can be very helpful in reducing barriers to care. Offering prepaid minutes for sessions and other options can help reduce the financial burden of treatment.
How can leadership help support change?
Leaders need to address diversity and inclusion more overtly. When hiring, we need to ask how we can recruit a more diverse talent pool. When we’re doing a consultation, we need to ask what cultural issues are involved in this case.
It’s important to invite people to change. And we need to continually lobby for change because we can all do better. Our patients deserve better. Our staffs deserve better. Being willing to change increases the quality of care, improves our organization, and enhances our standing. It makes us all better.
My manager and I were talking about a diversity issue and she said to me, “If I ever say something that is wrong or offensive, please tell me. It won’t hurt my feelings. I don’t always know, and I want to make sure I change if I need to.”
I never had to have that conversation because she has great awareness and is open to feedback. What’s more, her openness allows me to speak my truth and engage in conversations. I say this because we, as leaders, need to have this conversation with our staff members. We need to give them permission to tell us when we make mistakes or say something offensive. Openness and a willingness to change is the path along which change will occur.
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For more information on health disparities, visit UPMC.com/healthdisparities.