Integrating Diversity, Equity, and Inclusion Into an Academic Department of Psychiatry and Behavioral Sciences

In this 21st century, academic psychiatry departments must prioritize diversity, equity, and inclusion (DEI). Such transformation is in keeping with national calls to implement policies that foster diversity and ensure a culturally competent workforce to provide optimal care for a diverse patient population (1). To empower other departments of psychiatry and behavioral sciences to bolster DEI, this article describes the infrastructure and accomplishments from one such department, discusses DEI-related challenges and strategies to overcome them, and reflects on next steps. Recommendations are proffered for building DEI programs that can be adapted to the broader ecological context in which each department is embedded; our efforts occurred within a school of medicine and a university that valued DEI but did not place it central to their mission—a culturally rich local community on the forefront of social justice in a region that did not prioritize these values consistently.

Infrastructure and Leadership Group

In 2017, the Department of Psychiatry and Behavioral Sciences at our university formed the Diversity and Inclusion Subcommittee (DISC), which includes faculty, trainees, and staff selected by the vice chairs who had previous DEI responsibilities. The committee members represent diversity related to professional degree, primary work site, age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, ability status, primary language, immigrant status, and family socioeconomic status. This committee may be expanded in the future to include other stakeholders, such as patients and community members. Spearheaded by the Vice Chair for Faculty Development with the support and input of the chair and other senior leaders of the psychiatry department, the DISC created a mission, a goals statement including values, and a logo. Its mission statement reads: “The Department . . . welcomes, respects, and embraces differences in age, sex and gender, sexual orientation, gender identity, race, ethnicity, indigenous background, culture, national origin, language, religion, spiritual orientation, ability status, social class, education, veteran status, political persuasion, professional interests, and other cultural and professional dimensions. We celebrate intersectionalities among these cultural and professional dimensions. The DISC endeavors to foster an equitable and inclusive culture in which all members of the department feel respected, valued, and recognized for their unique and collective contributions.”

In keeping with the DISC’s strategic plan, several related work groups were formed. One year after the DISC was established, to enhance the experience of and to empower diverse faculty, the Women’s Faculty Subcommittee (WFS) and the Racial, Ethnic, and Cultural Minority Faculty Subcommittee (RECM) were formed. These two cochaired subcommittees outlined their own missions and goals. The mission of the WFS is to “promote a culture that actively supports the successful professional and personal development of all women faculty in our department through education, advocacy, and mentoring.” The mission of the RECM is to “promote awareness of issues related to race, ethnicity, and culture among the faculty in our department, and provide a source of safety and support, education and other resources.” The following year, the Resident Diversity Committee, was created to advance diversity initiatives within the residency program.

To bolster the departmental DEI portfolio and obtain the personnel to implement the strategic plan, the DEI infrastructure was expanded. In 2019, two assistant Vice Chairs for Diversity and Inclusion were selected by senior leaders of the psychiatry department. They assumed leadership roles vis-à-vis key components of the diversity strategic plan, and their responsibilities evolved based on their interests and expertise and departmental needs. The Vice Chair for Faculty Development’s scope was broadened; she became Vice Chair for Faculty Development, Diversity, Equity, and Inclusion and was allotted a small annual budget. The vice chair, assistant vice chairs, and subcommittees’ cochairs formed a Diversity Leadership Council to learn from one another and to collaborate to expand their impact. Members of this council determine fiscal priorities for the diversity budget.

Accomplishments Related to Strategic Plan Priorities

Prioritized Visibility

To ensure visibility, each subcommittee maintains an Internet presence and advertises events in the monthly departmental newsletter. The subcommittees jointly host an annual event in which faculty mingle and make recommendations for culture transformation. The three subcommittees (DISC, WFS, RECM) jointly created an annual award to recognize a faculty leader who exemplifies the department’s DEI mission. The subcommittees cosponsor departmental initiatives that bring together the arts and sciences from throughout the university to model ways diversity can be interwoven into academic activities; for example, the RECM cofacilitated the conversation about culture change by hosting an event on poetry and psychiatry that featured a Pulitzer Prize winning African American poet. Activities such as these bolster external visibility.

The subcommittees increasingly have been recognized for their efforts. Within the department, people have reported improved interactions, greater inclusion of diverse faculty on committees, and appointment of diverse faculty to lead strategic initiatives. Within the broader community, there are growing requests for Diversity Leadership Council members to engage in medical school and university efforts (e.g., regarding unconscious bias). Such visibility reduces marginalization and increases the impact of faculty committed to diversity.

Conveyed Values

Crucial to the success of the DEI efforts is articulation of the values that guide action. One way in which the values of accepting and celebrating difference have been conveyed is through development and dissemination of departmental emails following the perpetration of hate crimes. Constructed by a DISC subgroup, including someone associated with the targeted group, these emails describe the incident, honor the victims, offer strategies to mitigate the devastating impacts on communities, and convey the unacceptability of the prejudice. These values also are evidenced in efforts to encourage department members to add personal gender pronouns to their e-mail signatures and departmental webpages. Members of the department appreciate these demonstrations of allyship and hope for a more inclusive culture that gives all voices equitable power.

A second way in which values have been conveyed is by acknowledging and addressing microaggressions. After microaggressions transpired at an event attended by department members, the Diversity Leadership Council and subcommittees hosted a well-attended (>150) forum. Small group discussions were cofacilitated, and individuals not previously involved in DEI conversations participated. Recommendations for culture change that came from the forum are being incorporated into the department’s strategic plan implementation efforts.

A third way in which our values have been conveyed pertains to efforts to ally with, advocate for, and engage in science-informed activities to improve the quality of life for members of the department, the patients served, and the communities with whom we partner (2). The Diversity Leadership Council and other committee members have facilitated diversity dialogues for faculty, staff, and trainees (e.g., psychiatry residents and fellows, psychology interns and postdoctoral residents, basic science postdoctoral fellows) in response to recent racially related social injustices in our nation and have trained others to engage in this process.

Educated Stakeholders

One powerful educational initiative we have implemented is the diversity moment at each DISC meeting, in which members share a story about oppression, discrimination, or marginalization related to their social identities or evolving cultural humility (3). Subcommittee members have found learning through listening to personal experiences to be more poignant and effective than traditional educational activities and more likely to increase trust and engagement.

A second educational initiative implemented has been the securing of annual grand rounds spots to invite experts to speak and expand awareness and sensitivity about DEI. Speakers have given presentations on Muslim mental health, transgender behavioral health, and implicit bias in health care and have provided consultation services to the subcommittees for initiatives.

A third set of initiatives has involved the subcommittees’ facilitation of panel discussions, workshops, journal clubs, and movie groups. These programs have centered on unconscious bias, microaggressions, and microinterventions (4); transgender health care; and leadership competencies that attend to gender and privilege.

A fourth initiative has been to include information in the department newsletter about diversity-related topics. Individuals identified with a particular sociodemographic group have provided background information and shared their personal experiences about cultural observances (e.g., Yom Kippur, Ramadan, Martin Luther King Jr.’s birthday). Recently, weekly updates have been shared about disparities and COVID-19.

Fifth, a diversity consultation service has been created to identify departmental consultants on topics including race, ethnicity, language, disability, religion, sexual orientation, sexual identity, refugees and immigration, and implicit bias. Consultants have provided cultural input related to patient care, education, or research. For example, a faculty member, whose patient identified as Muslim and transgender, received consultation from a resident regarding empowering the patient within their (preferred pronoun) family and religious community.

To foster faculty members’ professional development, department members have partnered with an academic psychiatry department in Ethiopia to implement a global virtual learning collaboration focused on innovative technologies to enhance teaching (5). Topics have included learning management systems, innovative technology-based presentations, technological innovations in psychotherapy supervision, and social media to bolster learning.

To strengthen resident training, the curriculum was revised to expand the diversity focus. Sessions were added on cultural formulation, interface between the cultural identities of the residents and their patients, religion and spirituality, and culturally informed interventions.

Bolstered Recruitment, Retention, and Promotion

To promote DEI in recruiting faculty and trainees, several changes were made. To make training programs more inviting, websites and training materials (e.g., for welcoming international trainees and highlighting pertinent resources) were updated. A DISC member now participates in all recruitment activities to detail the departmental commitment to DEI.

For retention purposes, the DISC and the Resident Diversity Committee developed a diversity contact list that is provided annually to all members of the department. This list features faculty, trainees, and staff who identify with various social identities (6) so people can network with others who share or are familiar with specific social identities and are able to connect them with community resources. Representatives from DISC, RECM, and WFS attend orientations for new faculty to highlight their presence on campus and role as resources. The WFS distributes a resource guide they created to address issues that may be particularly relevant for women. Retention is prioritized via the subcommittees’ emphasis on providing safe places to discuss DEI challenges and offer opportunities to collaborate for positive change. Because institutional culture and climate influence retention (7, 8), safe spaces enable people to gain support from and take action with others with similar goals and values.

To address faculty promotion, RECM and WFS held joint meetings to review promotion guidelines and strategies for career enhancement. WFS has a standing agenda item for sharing successes and offering professional advancement opportunities to provide a forum for practicing self-promotion and securing support for career development. The three faculty subcommittees have a systematic nomination process for departmental, medical school, university, and community awards that has resulted in recognition of more women and minority faculty. To facilitate the promotion of diverse individuals, the DISC, RECM, and WFS provide outlets for supported scholarship and leadership. Faculty and trainees associated with the subcommittees have coauthored publications on DEI (9). Subcommittee participation has led to increased engagement in research; one RECM cochair has become involved in multisite research addressing microaggressions and professional identity formation of underrepresented groups in academic medicine. Subcommittee leadership roles have led to leadership opportunities in the medical school and in regional organizations. For example, one WFS cochair created and chairs a women’s committee for the state psychiatric society. Finally, senior faculty who represent one or more forms of diversity now get together annually to celebrate promotion and leadership accomplishments (e.g., endowed chairs).

Engaged in Community Activities

DISC members have engaged with the community by providing education and service, primarily centered on the refugee and asylum-seeking community (e.g., by volunteering at a local summer camp for refugee and immigrant youth and providing workshops on pertinent topics, such as acculturation); by participating in a summit on community challenges and services needed by refugees and asylum seekers; by partnering with community groups, other university departments, and nonprofit community legal providers to develop a consortium to meet the diverse needs of asylum seekers within the rubric of the “Physicians for Human Rights” virtual training, mentoring, and supervision model; and by collaborating with local organizations to write grants supporting the provision of mental health services.

The DISC also hosted a program for the department and community that centered on the reading by the authors, who are current or former medical school faculty, of a children’s book on racial injustice (10). Following the reading, DISC members specializing in child and/or adolescent psychiatry or psychology interacted with the children and discussed with the adults how to help their children recognize and cope with prejudice and inequity. In a third example of a community activity, subcommittee members lead seminars about DEI for trainees, nonprofit groups, and community members.

Challenges Encountered in Transforming a Departmental Culture

Despite these accomplishments, several challenges have complicated efforts to achieve subcommittee missions and infuse DEI values into departmental systems, practices, and culture. Although our aim is to foster a culture of open dialogue, some individuals have been reluctant to speak; some fear that being vulnerable could be risky and result in retribution, and others are concerned they might offend esteemed colleagues or those in power. Others do not appear to be invested in such conversations, possibly because they do not share or prioritize the DEI values enumerated above. These challenges limit the diversity of perspectives offered.

Even among people committed to advancing DEI, challenges emerge in the discourse which need to be navigated. After 2 years of working to align values, the DISC struggled to issue a statement about a hate crime that was perceived differently by individuals from diverse backgrounds. Instead of glossing over the complexities or avoiding making a statement, the subcommittee built respect and trust by acknowledging the process, seeking commonalities, and issuing a statement about the struggle to reach consensus. As another example, although many DISC members support the use of preferred pronouns to promote inclusion (e.g., “they and them”), this change was challenging for some members, because it departs from historical ways of communicating in certain languages.

One problem encountered across settings pertains to the fact that despite widespread departmental interest in DEI efforts, many people do not engage with the initiatives. For efforts to advance, greater participation is needed by more parties, including leaders. In addition, it is challenging to identify the best actions to take to promote DEI. After the departmental forum that resulted in a list of potential actions, prioritizing action steps has been complicated.

Data are needed to determine the department’s current state and to capture change. Data collection could allow for examination of discrepancies between what people believe they know about an aspect of cultural competence and their actual knowledge regarding a specific aspect (e.g., trans and/or gender diversity) of cultural competence before and after a training session. However, data related to cultural competence often are hard to gather or access, and their reliability may be questionable. Finally, although we are grateful for the funding we have received for activities, the funds have been limited. The impact of the DEI efforts enumerated above would be greater if additional resources were available.

Next Steps

Future efforts will be dedicated to creating and embarking on a strategic action plan that incorporates initiatives designed to be transformative. DEI efforts will be assessed to determine their effectiveness, and stakeholder feedback will inform future activities designed to support culture change (11, 12). Optimally, transparency about assessment findings will stimulate discussion, garner buy-in from more stakeholders, and motivate organizational change. More courageous conversations will be planned to facilitate and empower everyone to speak and hear the voices of all parties. Such communication may include small group discussions, mechanisms for anonymous suggestions, and in-person DEI consultations. Increased activities outside the workplace for faculty from underrepresented backgrounds could promote collegiality and connection and reduce isolation and marginalization (13). Data could be used to advocate for resources (money, staff) to advance the DEI agenda. Supporting colleagues’ engagement in DEI to mitigate against burnout and optimize resilience will be a priority.

Recommendations for Other Academic Departments of Psychiatry

DEI must be integrated within the department’s mission. An infrastructure must be established to foster conversation and strategic plan implementation. Leaders must be trained and encouraged to create a community in which all parties acknowledge their biases and commit to strengthening their DEI competencies; action plans are implemented and evaluated; and structures and systems that perpetuate bias and discrimination are altered.

Conclusions

It is our hope that sharing the initiatives undertaken within our academic department of psychiatry will allow others to build on this example. Promotion of DEI is an ongoing collaborative process to ensure that all department members feel welcome, included, heard, respected, and valued. Our future efforts will assess the outcomes of our strategic plan and the impact of our DEI efforts and will articulate dynamically evolving best practices.