Maria Bryan: Hello everyone. Today, we're joined by Dr. Neeru Bakshi, a board-certified psychiatrist who champions anti-racist mental healthcare. She's a committed advocate for mental health equity, working to center women of color in decision making roles to create lasting systemic change.
And I'm so thrilled to have Neeru here with us because I started off my career in public health as a health educator and working at a few really large public health organizations in New York City and with a lot of immigrant communities. So welcome to the show. This is such an important conversation and I'm thrilled that you're here to have this conversation.
Neeru Bakshi: I am so glad to be here with you as well, Maria. I really appreciate the invitation and this is something I'm so incredibly passionate about and any opportunity to talk about it, I say, yes.
Maria Bryan: Let's start with your story and your journey. What brought you to focusing on anti-racist and equitable mental health care?
Neeru Bakshi: It's an interesting journey. So I guess maybe to start a bit further back when I was in psychiatry residency training, and after medical school, I had to take an additional four years to specialize in psychiatry and be trained in that field, and I would see things that I was kind of like, huh. That's interesting. Hmm. Why is it that way? And I've always been somebody who wants to understand the why behind things. But oftentimes I would encounter a lack of answers or answers lacking significant depth of understanding. And so that then really led me to do my own reading and understanding and then pushing.
Particularly when I was in the eating disorder treatment field specifically, and not in general psychiatry, but when I was in that field specifically, I would see these things happening where it just didn't make sense. But I had the potential to push back a little bit more than I could when I was a psychiatry resident, because as a psychiatry resident, you're at the bottom of this hierarchy, which in and of itself is problematic.
But when I was in this position of leadership, I would push back and I would say, well, why, why don't we take patients who only have Medicaid? Why is it that we're only seeing this group of folks who have private insurance? Or why is it that we have meal plans, which is the food that we provide for patients? Why is it that these meal plans are based in this more like western typical standard of what foods are to be eaten and why is it that we don't have the capacity to actually understand culturally what's going on for somebody in their home because that's where they're returning. And so if we're treating them and feeding them in a way that does not help them be set up to return to their home? Are we actually providing good treatment?
So for me, this journey has been one that's been building over probably 20 years to the point that I decided to push myself into this space and understand the history a bit better, understand why the systems are that they are, and then recognize my part in being complicit with those systems, but then also how I can push against those systems.
Maria Bryan: Can you maybe share some specific aha moments you've had on this journey?
Neeru Bakshi: One particular moment I recall was listening to this author by the name of Ika Tol who now goes by Ika Maltra and having her talk about her journey. So she wrote this book called Inclusion on Purpose. She also co-authored an article in the Harvard Business Review talking about women and imposter syndrome and sort of like, can we just cut this out please?
And so when I started reading her work, I just was thinking to myself, my gosh, okay, here's somebody who has a similar ethnic background to myself being South Asian and who's talking about these things because we as South Asian women do, we don't talk about these things. We don't ask a lot of questions stereotypically, however, here she was asking these really important questions.
And so as I devoured her book, Inclusion on Purpose, I really saw the value of equity and inclusion, which I do have to say I started to hate that word inclusion. But I started seeing the value of having diverse perspectives in the spaces where decisions are made and when I think historically, back upon my training, medical school, you know, these places where decisions were made for me, because I was in a position of training, I wasn't given power. There was this overwhelming belief that what was normal, what was the standard, was something that I wasn't, and that standard existed for hundreds and hundreds of years.
But what we've done by having a certain standard that excludes people like myself and others, is that we then don't allow for appropriate and evidence-based treatment. So when we think about psychiatry, we try to do things in an evidence-based way, but when you look at the actual research articles, they often don't include a diversity of people. It includes sort of one demographic, and then that demographic is then used as the norm.
But when you have people who are doing the research, when you have people in leadership, when you have people who are doing the training programs not being diverse, then that norm, quote unquote, is accepted. There isn't pushback. So if you were to include women and women of color in leadership positions, it automatically infuses this alternative perspective to some degree. And by doing that, then we're actually caring for the communities that we see, because the communities that we see are not just from one demographic.
And so how is it that we could possibly be treating the diversity of people that we see if we don't actually have diverse perspectives? Doing the training, doing the research, doing the educating of the next generation.
Maria Bryan: You know when we talk about, kind of a normative patient coming from a practitioner, you're not feeling well physically or mentally, and then you go and you seek help. And we know, you know, that this isn't always the case. Now more than ever there are certain communities that really fear seeking help. And I've seen your writing on how delayed care seeking can actually cause more traumatic treatment experiences.
Neeru Bakshi: Right.
Maria Bryan: What does that look like or how has that come up in your practice?
Neeru Bakshi: Well, I think to answer that question, there's a couple of parts to it. One is why these different communities don't seek out care and you know, there's this sort of idea of a mistrust of the medical system and that's why. But when we dig just even a little bit past that there is reason for mistrust of the medical system in these minoritized communities.
And when we look at history, we even look at, you know, sort of the father quote, unquote, of psychiatry Dr. Benjamin Rush. He was a slave owner, even though he was an abolitionist. He was somebody who believed that slaves had mental illness because of their desire to run away from plantations. He believed that having darker skin was a form of leprosy in which the only cure was being white. And he also strongly encouraged that during a pandemic at the time that he was alive, that black people were naturally immune to it. So they should then go into white households and help and cure and did not need to take any precautions, which led to untold deaths, right?
So even when we just look at this, you know, father of psychiatry purporting these things. Of course there's gonna be mistrust. Right? And it's not just in psychiatry, it's in ob-gyn, you know, in the development of the cesarean section. That was based off of experimentation on slaves without the use of anesthesia, sort of believing that they didn't experience pain.
Maria Bryan: Right.
Neeru Bakshi: And then we see that to the present day where there is this or there recently, which is unfortunate. But just last year there was sort of pushback on this belief that kidney function tests have to be differentiated by race. There was this belief that kidney function tests had a certain range for black people versus a certain range for everybody else. This is not actually based in science. This was based in this belief of something that wasn't actually true. So when we look at that like mistrust of medicine, there's reason, there's more than reason.
Maria Bryan: Right.
Neeru Bakshi: So that leads to delayed care seeking, I think secondarily. When we don't have practitioners who understand cultural differences or who show a lack of curiosity, then the person seeking out care may not actually receive the care that they're looking for. And I see this, you know, again, kind of coming back to the eating disorder realm, there is this anti-fat bias that exists, right? So diversity of bodies. There is this belief that if you are in a larger body, that there is a moral failing, that you have not been doing enough, that you desire to lose weight, and regardless of the reason that you came in for your visit, you might have a cold, they're gonna speak to you about weight loss.
Maria Bryan: Hmm.
Neeru Bakshi: And again, if your provider isn't caring, why would you wanna seek out care? So what I've seen in that particular example then, are women in larger bodies oftentimes not going in for routine screenings, not going in for pap smears because the table doesn't fit them, or the procedure is uncomfortable, or there's commentary that is made about the difficulty, quote unquote, of the exam, not going in for mammograms routinely because again, commentary that is being made or discomfort that is experienced but not believed.
And so what we then end up seeing are the consequences of that delayed care. And oftentimes, believe it or not, people will say, well it's because you're in a larger body. You're at a higher likelihood of having X, Y, and Z. Not taking into account that this person wasn't receiving appropriate care. You know, and then we think about the incidences of maternal and fetal demise for the black population. So, you know, oftentimes black women in pregnancy are at a higher risk because their pain is not believed, their symptoms are not believed.
You know, famously we saw Serena Williams talk about the difficulties that she had in childbirth with having a blood clot that was not being appropriately diagnosed or treated, the woman could have died. And there are so many black mothers who have died in childbirth as a result of poor care.
And then when I think specifically about what I've seen, I've seen South Asian women who did not get treatment for their depression because they don't wanna bother anybody. They don't want to speak on it. It's not something that's culturally accepted to really talk about. So they might in turn present with more physical complaints. I'm tired, I'm lacking energy. I'm not able to do what I want to do. Those kinds of things. Then I've seen very specific patients whose depression got to the point where they were then psychotic because they had delayed care for so long.
So then I'm addressing this acute psychosis as opposed to the underlying depression, right? And so I, we see this across the board of the whys and then how it manifests, and then the outcomes.
Maria Bryan: From a leadership perspective. If we're moving towards an equitable mental health care system and space, what should we be doing to increase representation? And to, I don't love the word empower…
Neeru Bakshi: Mm-hmm.
Maria Bryan: ...for those who are already in leadership, what can we be doing to give them more power?
Neeru Bakshi: I think there's a couple of things that we can be doing. One of which I think it starts with the research and I just recently wrote about this, is that there was an article in the American Journal of Psychiatry that came out about binge eating disorder. And I was like, wow, this is, this is great because we don't often see eating disorders talked about in mainstream psychiatry, which is a whole nother issue on its own.
But when I looked at the article, I thought, ah. Okay, so they reported the demographics of the people that they studied, and it was like 90% women, 90% white, 70 something percent had some degree of higher education past high school. And that was the majority of the people that they looked at in this study. And so, and I was thinking to myself like, this does not, this does not make sense.
This is not who we see. The American Psychiatric Association itself falsely claims that black women tend to have more binge eating disorder than other eating disorders. So even if we were to take that nugget to be true, why are we then studying mostly white women?
Maria Bryan: Right, right.
Neeru Bakshi: So I think, fundamentally it starts with the research. It has to include a diversity of people. Our country is a diversity of people, and so if we are not looking at differently abled bodies, if we're not looking at transgender bodies, if we're not looking at folks from various cultural backgrounds, then we're really doing a disservice.
So I think fundamentally it starts with research, and one of the things that I've tried to do is to highlight and champion diverse voices in research.
You know, and so there's a PhD out of San Antonio that I've tried to sort of inflate her work as best as I can. When I've done conference presentations, I often pull on research from a PhD who works with South Asian populations and is South Asian herself so that I can amplify their voices because the people that I'm talking to are primarily white. They're the ones who attend these conferences and these talks, and so I wanna make sure that I'm highlighting these voices and encouraging them to do their own reading about that.
I think secondarily, what we need for those who are in those positions of power to think really critically about what they're doing in their training, what they're doing to educate and what they're doing, to look at the broader picture. Because if we don't, then again, you know, this edict that we have in medicine to do no harm, we are failing if we do not look at those diverse perspectives. We are intentionally or not causing harm. And so we've really gotta look at that.
There were three different psychiatry programs that the residents came together and said, we need to actually learn more about how to provide culturally thoughtful care. And so they proposed changes to their own curricula to then include that as part of their training. And I believe it included UCLA and Yale. And the outcomes were great. They were, they showed improved care across the board. And so truly, when we want to provide good high quality care, we have to have diverse voices.
I remember when I worked at a community hospital and I was elected to be the department chairperson for the Department of Psychiatry. So then that meant I met with all the other department chair people and I would sit in this room with all the other department chair people, the hospital CEO, the head of HR. I'm thinking to myself, wow, it's me, one other Indian person who was a man and one other woman, and out of the other, you know, 20 to 30 people, all white men.
And I thought to myself like, this is, this is strange. This is not representative of those who are practicing medicine. Although to some degree it was, but how is it that we're serving this broad, diverse community in which this hospital is located when this is what we've got in the room. And so if we have those opportunities to elect people or to push people forward, then we have to choose the diversity of the perspective as opposed to what we have considered to be the norm.
And I know politically there's a lot of pushback on this with the current system as it exists. But I think my answer to that is we are choosing folks who are highly qualified. Just because they represent a marginalized population does not decrease the strength of their credentials.
Maria Bryan: When you were talking about research, I was thinking about the early ACE studies and how they were, I think, almost exclusively white women.
Neeru Bakshi: A hundred percent.
Maria Bryan: And how that research, that body of research has informed so much and we really need to be investing in more studies.
Neeru Bakshi: I agree a hundred percent. There's a study group that is focusing on cardiovascular health in South Asians because we know that there's a higher incidence of cardiovascular disease, elevated blood pressure, elevated cholesterol, and it's called the MASALA study, which I love.
Maria Bryan: I see.
Neeru Bakshi: But right, again, like there are these pockets where this kind of work is being done, but the pockets are so small. And so it really is up to us to then amplify and speak on these things and highlight them because they are worthy, you know, just like human life is worthy. And so anything that we can do to help support human life, then we should.
Maria Bryan: Are there other researchers or practitioners that are championing this, that we can amplify right now?
Neeru Bakshi: Most definitely. So last year I did a sort of informal fellowship in anti-racism and mental health care that was led by Dr. Rupi Lega. She is phenomenal. She has published articles, she has her own lived experience that she pulls upon, and I think she is just this wealth of information. And so I highly, highly, highly recommend you taking a look at her work.
I would also wanna highlight Dr. Jessica Isam, who's also a psychiatrist and does a lot of writing on this topic as well. And then Dr. Oi and Uche Blackstock who are twins and just incredible champions of this work as well, who've also done a wide variety of writings. So all four of them are just remarkable.
Maria Bryan: This work can feel heavy and maybe isolating at times. What hope and encouragement do you have for the future of mental health equity?
Neeru Bakshi: I think you're right. It can potentially be something that feels like, okay, I am voluntarily putting this anchor around my neck and I'm going to carry it. However, I think my perspective being somebody who is curious, is that the more that I know, the more that I have the capacity to know what to do next.
And so in the work with Dr. Lega, for example, what she talks about is, okay, now that you understand this part, here's how this reflects in the work that you do. Here's how you can push back against the systems of oppression. Here's how you can change your documentation so that we are accurately looking at the person as opposed to just carrying forward what somebody else has assessed of them.
And you know, oftentimes what we will see, especially for black folks and people of color, is that they are overdiagnosed improperly with certain things when they actually meet the criteria for something else, you know?
Maria Bryan: Hmm.
Neeru Bakshi: So we will see black folks diagnosed with psychotic disorders when in fact they might have a mood disorder, and that's a big difference. Or a black child might be diagnosed with oppositional defiant disorder, not taking into context what's actually happening for that child, but we're assuming, quote unquote, pathology.
And so what I've been actively doing is that if I'm seeing a patient that has been seen by somebody else and there is a diagnosis in the chart such as bipolar diagnosed in a young Hispanic woman who was 13 at the time, I'm thinking to myself, is this actually true? You know, do I want to just believe or can I understand who she is as a person? What was happening for her at that time and where she's at now? And make hopefully a more accurate diagnosis, even if one exists.
And so I think that's where I have the hope is that there are things that we can do to change this narrative, and that is what then emboldens me to do the work that I'm doing because I wanna shout this from the rooftops. I want to have everybody be aware of what has happened and then how we can change from that, how we don't have to keep repeating the same things over and over and over again. We can choose to do it differently. So then I do the education, I do the writings. I talk to medical students and to residents because I want them to understand that you don't have to just accept what you are given as the truth.
Maria Bryan: Neeru, you are not only a practitioner and advocate, you are also a speaker. And I'm just so grateful for your work and what you're doing in the world. How can folks connect with you, learn more from your work, hire you to speak, spread the work, tell us how folks can connect with you further.
Neeru Bakshi: I appreciate that. So I am on LinkedIn, I'm on Instagram, I'm on threads. While I do despise social media, to some degree, it does have its value and its benefit. So if you do wanna connect with me, those are places that you can find me. I try to post as regularly as possible without burning myself out. But these are the things that I talk about when I'm writing and when I'm speaking.
Maria Bryan: Thank you so much for joining us for this really important conversation.
Neeru Bakshi: Thanks.
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