August 11, 2020
July is National Minority Health Awareness Month. It was designated as such by the U.S. House of Representatives in 2008 to raise awareness of mental illness and to improve access to mental health services and treatments for racial and ethnic minority populations.
Dr. Martha Crowther is a practicing psychologist at University Medical Center, which is operated by The University of Alabama College of Community Health Sciences. She is also professor and associate dean for Research and Health Policy at CCHS.
In addition, Crowther oversees the behavioral health component of The University of Alabama Faculty Staff Wellness Clinic, a partnership of UA and CCHS to provide physical and behavioral health services to the University’s faculty and staff.
She recently sat down with Dr. Richard Friend, dean of the College, to talk about Minority Mental Health Awareness Month and the UA Faculty Staff Wellness Clinic.
Friend: One of the many concerns related to Covid-19 is the effect on people’s mental health. July is Minority Mental Health Awareness Month. What is the history of Minority Mental Health Awareness Month and why is it important?
Crowther: Minority Mental Health Awareness Month was established in 2008 to bring attention not only to mental health issues but to how mental health issues may impact minorities. The name has actually been changed to BIPOC – Black, Indigenous People, and People of Color. That’s a new term. The month was established to talk about issues like racism, which might impact minority populations differently. Minority populations could be people of color, but we can also talk about the LGBTQIA+ community and how they may feel that they are treated differently once they reveal their sexual orientation.
Friend: Why is Minority Mental Health Awareness Month, or BIPOC, important now with Covid-19?
Crowther: Particularly early on in the pandemic, there was a lot of talk about how Covid-19 was impacting minority communities differently, particularly African American communities. It’s important to think about that, and to figure out how to approach testing and to make sure tests are available in rural and/or minority communities. I’m thrilled that our College has reached out and responded to a lot of rural communities and has been able to provide testing. It’s important to make people feel comfortable about getting tested and, if people test positive, to help them deal with that and to lower their anxiety if that’s a piece of the problem.
Friend: What opportunities exist to help improve disparities with Covid-19 in the mental health space?
Crowther: As health-care providers, we need to make sure we’re engaging with diverse populations in a warm and respectful manner. There’s a term called intersectionality. A health-care provider, or anyone working with an underrepresented group, needs to allow people to tell their story and to figure out who that person is and how many intersections they have. For example, we know that Covid-19 is impacting minority populations and older adults differently. So, if you see an older minority, be aware of that, that they may be feeling anxious based on what they’re seeing in the news, and be able to engage with them in a different manner. Don’t make assumptions, just allow people to tell their story. As a health care provider, be thoughtful that this person may have some additional anxieties about how the virus may impact them and has impacted people in their community.
Friend: In addition to the Covid-19 pandemic, we’re also seeing a keen awareness by the public about racism. What effects does racism and racial trauma have on mental health and mental health awareness and care?
Crowther: It’s really making sure minorities feel comfortable coming into any health-care setting – mental or physical health care settings. We want to engage with them in a respectful manner. A lot of underserved populations feel on edge, they’re tense. Maybe their appointment started five minutes late and they might feel like that’s because they’re a minority or from an underprivileged group. So, just making sure we say, “We’re sorry we’re running behind.” It’s about health care providers providing basic information, making sure our population is informed about what’s going on, and then for that underserved population to make sure they communicate, to say, “Why is my appointment running behind?” as opposed to making assumptions that it’s because of racism. In our training as health care providers, we learn to let our patients tell their stories. We learn to ask them who they are. When I got tested for Covid-19, I was asked my age, my gender, my race. You may look at me and make assumptions about who I am but asking is really important. I think that will go a long way in helping minorities and persons from under-represented groups feel that we aren’t making assumptions about them, and I think that will then help to lower some of the racial tensions.
Friend: With many diseases, there is the potential of stigma. We’ve seen stigma associated with HIV. How does stigma play into the Covid-19 pandemic and how does that affect minority populations, perhaps making them feel marginalized?
Crowther: It’s because the virus seems to have a different course with minority populations. I think they’re feeling that everyone thinks there’s something about the disease associated with being a minority. As health care providers, all we can do is provide the best care, and that can lower that anxiety. I think we have to provide as accurate information as we can, and if a person feels marginalized again, to encourage them to talk with someone like myself or another mental health professional to help them maybe think differently and maybe reframe their experience related to feeling marginalized. We have to help normalize that experience and help people deal with that.
Friend: What are some of the things that the University has done to help with the mental health of employees in regard to Covid-19 and other issues?
Crowther: I’m excited to talk about the UA Faculty Staff Wellness Clinic and its focus on behavioral health needs for campus. It’s incredibly exciting for us as a College, and also for the University and our faculty, staff and their families. The name includes Wellness on purpose. We can address issues like depression or anxiety, which are really big for people right now. People are feeling anxious about returning to work. They’re feeling anxious that they’re staying at home. We see a lot of faculty, particularly working moms and dads, who hare having a hard time figuring out how to balance working from home and what to do if their children are not returning to school. How do parents manage that? Some parents don’t want their children back at school at all. The UA Faculty Staff Wellness Clinic and its behavioral health component will be able to address those issues. We can care for faculty, staff and their spouses and children who may be having a difficult time. We’ve had an increase in the last several weeks of children experiencing a hard time as they’ve been home longer, unable to engage with their friends in the way they’re accustomed to and now a return to school will look different. We’re there to help families figure these things out and how to talk to their children about those issues – how to help children cope with those issues.
Friend: Are appointments available? How do faculty and staff schedule appointments, and are in-person visits available?
Crowther: We have done most things via telehealth out of an abundance of safety for our campus community, as well as our providers, but in-person appointments are available. They can call us (205-348-1471) or they can send an email (UMCBheavioralHealth@ua.edu). We’re checking both every day, twice a day at a minimum, to make sure we don’t miss anyone who wants to communicate with us.
Friend: How many mental health professionals are working in the clinic? And what kind of services are offered?
Crowther: We currently have two psychologists, two psychiatrists and a psychiatric nurse practitioner. We will likely have a social worker who will help out a few days a week in the near future. We have a full range of services. We provide services for depression, anxiety, if children need to be tested for ADHD (attention deficit hyperactivity disorder) and ADD (attention deficit disorder). What I’m really excited about that we offer, which is different from some behavioral health clinics, are a yoga class, stress management courses and courses on nutrition and diabetes management. We really are trying to be a more holistic clinic. Nurses and dietitians will be a part of our efforts to make sure we are addressing the whole person. As faculty and staff, I strongly encourage you to come see us because we will try to meet your mental health needs and your physical health needs. We will talk about walking and exercise and how important that is for your physical health, as well as for lowering your depression. We partner with physicians within our College (which operates University Medical Center) and can make referrals as appropriate if people need other services. That works bi-directionally so we’ll get referrals from our physicians. We’re there to offer a broad range of services and to be as helpful as possible.
Friend: We know there are not enough mental health providers, not just in our community but throughout the nation, and that mental health issues have been amplified by the Covid-19 pandemic. What do you think about telemedicine? How is it working, and do you see a role for that in the future?
Crowther: Telemedicine has worked incredibly well. It’s allowed us, as mental health providers, to really stay in contact with our patients. We’ve done phone therapy, and we’ve done zoom therapy and it’s really worked very well. Some of those are traditional 50-minute sessions, but for other sessions, they may be 20 or 30 minutes but be more often just to check in with someone to make sure they’re doing ok. At this point, most people thought the virus would be dissipating and that we would be returning to normal by August. So, what we’ve seen as mental health providers, is people initially feeling anxious, then starting to feel better, but as the (virus) rates are going in the wrong direction starting to feel incredibly anxious again. It’s been really important for us to be able to touch base with people to keep their anxiety levels at a reasonable amount. I don’t think we would have been able to do that as successfully without telemedicine. I hope it stays around.
Friend: What kind of services will be offered for children of faculty and staff at the UA Faculty Staff Wellness Clinic, particularly in regard to behavioral health?
Crowther: What comes up most for children is testing. We will be able to provide testing for ADD and ADHD. We can social distance and do that testing in person. There are also new methods to do that testing remotely if needed. Learning disabilities is something else that comes up, and we can make sure children are tested for learning disabilities. There’s been an increase in our country, not just locally, with children, particularly as they approach middle school, to have an increase in exposure to bullying, and we’re seeing an increase in anxiety and we can address those issues. For adults, I mentioned anxiety and depression. We can also, as someone gets older and are worried about their own memory issues, we can do cognitive testing. We can run the gamut of psychological testing, but we can also provide therapy as needed. One thing I have not said but that is really important is that some people won’t seek out mental health or behavioral health services because of fear of confidentiality, particularly since this a service being offered on campus. We make sure that everything is done confidentially. If we’re doing tele-mental health, we make sure we’re using Zoom that is HIPAA compliant and that everything is as safe as possible. We do not provide any more information that’s needed in anyone’s record or chart. We have a firewall so that no one can see our mental health notes, not even the person’s physical health provider, unless the person provides permission for that. I really want our campus community to understand that we take this very seriously and we respect their confidentiality.
Friend: One of my goals as dean is to create more collaboration across campus. I think our ability to tap expertise across campus is really going to be enhanced by the UA Faculty Staff Wellness Clinic. We’ve got a group on campus that does a lot of work in geriatrics, as you do. What other collaborative opportunities across campus are going to be available?
Crowther: We will partner with the School of Social Work. We will also partner with the College of Education to provide disability services as appropriate. One partner that I think is incredibly important is WellBAMA. We are about a mind body wellness approach, so partnering with WellBAMA will enable us to offer nutrition classes, hypertension classes and yoga classes. We’re not trying to reinvent the wheel but rather we’re partnering with services that already exist.
Friend: Where is the UA Faculty Staff Wellness Clinic behavioral health component located?
Crowther: It’s located in the Northeast Medical Building. It’s on the back side of the building with a separate entrance to help promote privacy and confidentiality.
Friend: What kind of opportunities do you see for the University to enhance services to faculty and staff, as well as enhance productivity and financial savings?
Crowther: There’s something called presenteeism – when people are present at work but really kind of checked out and not being productive. We can decrease rates of presenteeism, as well as decrease rates of absenteeism, and decrease rates of people taking off for mental or physical health problems. They can come to us and we can help them cope better with some issues they maybe don’t want to talk about with their supervisors. I think we can help lower some of (the University’s) insurance costs by encouraging faculty and staff to visit the UA Faculty and Staff Wellness Clinic if needed. We can partner with UA Athletics and other colleges on campus to provide stress management groups. I’m hoping we can be creative with our University community to provide the services that are needed.
