Promoting equity in forensic psychiatry with an EDIIA framework
Forensic psychiatry is a specialized area of psychiatry that involves evaluating individuals who are involved in legal proceedings, such as criminal trials. In Canada, the criminal justice system continues to confront deep-rooted inequity and unfair treatment of minority groups. In order to achieve the best outcomes for those living with mental illness and create effective and ethical teams, it is deeply important for forensic psychiatrists to take action on equity and not replicate existing patterns of discrimination.
Dr. Sumeeta Chatterjee and her colleagues have created an EDIIA framework that identifies the ways that inequities affect forensic psychiatry and provides strategies for addressing them.
We spoke to Dr. Chatterjee about her work and its’ potential to change forensic psychiatry.
What motivated this initiative? Why is it needed?
The field of forensic psychiatry lies at the interface between medicine and the law. The over-representation of minorities, especially those of Indigenous and Black origin, within the criminal justice system has been a long-recognized phenomenon that has its roots in systemic and structural discrimination. These inequities cascade down into the forensic mental health system.
Like other health care settings, forensic systems are impacted by staffing and structural equity, diversity, and inclusion challenges at all levels. To achieve the best possible health outcomes for patients and to develop workplace environments that attract and retain skilled staff, it is essential that we address EDIIA issues that impact our entire system.
What is an EDIIA framework to advance EDIIA in forensic service?
The EDIIA framework that we adapted from the literature identifies the ways that inequities affect forensic psychiatry by dividing them into six key categories, or domains. Each domain includes action items to address inequity.
The six domains are:
- Organizational Commitment
- Staff and Workforce Competencies
- Service Access and Delivery
- Promoting Responsiveness
- Community Outreach
- Data Collection
CAMH Forensic Mental Health Service - Equity, Diversity, and Inclusion
For example, the Organizational Commitment domain encompasses policy and leadership changes, and includes initiatives such as leadership support for EDIIA initiatives, equity policies in hiring practices, and clear reporting and investigative processes for instances of oppression.
Staff and Workforce Competencies include action items such as implicit and anti-Black racism training and race-based team conversations.
The domain of Data Collection emphasizes the importance of evaluating outcomes and engaging in continuous improvement that is measurement-based.
Many of the initiatives are interconnected and mutually reinforcing.
What is the most important finding/contribution of this initiative, in your opinion?
The need for EDIIA-informed practices and principles is vast and can be a daunting task too. The most important lesson is to not strive for perfect solutions, but rather to be willing to engage in initiatives and innovations one step at a time in an effort to create awareness, facilitate conversation, and to move the dial on these issues that reflect our broader societal values and priorities.
How does this change mental health care or clinical practice in the future?
It is our hope that we will progress to a point where EDIIA is embedded in our health care system, innately informing how we think and what we do.
Any next steps?
No one framework or initiative will ever be sufficient in isolation. We are looking at a societal shift that is complex and, as such, will require long-term projects with data-informed decision-making and, most importantly, leadership support and prioritization to secure personnel and resources dedicated to effect change.
What is the major take home message for the public?
If our society adopts a value system in which all people are equal and deserve the same opportunities and care, then we also have to recognize and address the unconscious and invisible barriers that have stopped this ideal from becoming a reality. Curiosity, openness to questioning our assumptions, willingness to act in accordance with our values, and safe dialogue that facilitates justice, growth, and connection is probably a good place to start.
