Psychiatrist Dr. Dionne Hart speaks out about huge gaps in mental health services among communities of color

When Dr. Dionne Hart was considering medical school, her high school adviser suggested she choose something more "suitable." Fortunately, she ignored the advice. Hart, who was "always curious about brain disorders," is among a tiny group of Black women psychiatrists. An adjunct assistant professor at the Mayo Clinic School of Medicine and Science, she is also the first and only Black woman to be elected to the Minnesota Medical Association's board of trustees. Hart spoke recently on a panel of women psychiatrists sponsored by NAMI Minnesota. She expands below on mental health challenges for a Black community reeling from COVID-19 and the killing of George Floyd.

Q: Even when you had a medical school acceptance letter, people tried to discourage you. Why was that?

A: I had my first child at 17 and welcomed my other two children during my second and third years of college. I married at 18 and I left an abusive relationship at 20. I think some people were genuinely scared and worried that I would be disappointed. When I think of my experience in medical school, it was as if I was standing inside a tornado. Everything was still. From my viewpoint, I could not fully appreciate all of the changes and chaos happening around me because I was so focused on my goals. My denial protected me from being overwhelmed by the challenges I faced.

Q: You must have channeled your deeply proud father, too. You have a lovely story about him.

A: My father was born in 1920. He never spoke about medical school dreams as his own, but rather dreams he had for me. After his older brother died in World War II, he was expected to help the family financially. After he passed away at 79, I found a dissection kit that he kept in a drawer. It's now in my home office.

Q: The American Psychiatric Association (APA) reports that only 2% of psychiatrists are Black. How do we increase those numbers?

A: I initiated a Minnesota Medical Association (MMA) sponsored screening of the Black Men in While Coats film and a discussion of the project (blackmeninwhitecoats.org) with organizers and multiple Black male leaders in medicine. Role models are absent. STEM careers are not encouraged. I was a top student in my class at a private Catholic college prep school but I was never encouraged to go to medical school or even asked about my career goals. I remember my counselor discouraging me from applying to the University of Chicago and then suggesting that I apply to "more suitable" schools.

Q: I think psychiatry has always suffered a bit in terms of respect and understanding. Do you see skepticism in the Black community?

A: It remains true. In the media, psychiatrists are often portrayed as pill pushers having inappropriate relationships with patients, and "head shrinkers." In the Black community, we do not even exist. I recently lost a relative to suicide and it was difficult for many to say the word or even discuss the necessity of mental health treatment. Growing up, there were many excuses and reasons not to seek mental health treatment, such as God does not give you anything you cannot handle; suffering makes you stronger. And, therapy is for white people. When Black patients mention their worries about getting mental health treatment, I remind them that just because you go to therapy doesn't mean you cannot still pray. Prayer has no side effects. I feel medication and science, in general, are often the way God answers our prayers for healing.

Q: I imagine many patients are delighted when you walk into the room.

A: Many times at Hennepin Healthcare, older Black patients will mention how proud they are that I am a doctor. Often, Black women will be relieved that there are issues they do not have to explain or fear that I will judge them.

Q: Conversely, do you think some people won't see you because you're female, or Black?

A: I'm on staff at multiple sites and it is sadly too common for both white and Black patients to refuse to speak with me because of my race. It is not just my professional pedigree that is questioned, but even my identity as a Black American woman. I regularly encounter patients who have had very little exposure to Black people. The first few minutes is not related to their issues, but personal questions about my life. A very common question is, "Where are you from?" My answer: "Chicago." Then, "No, where did you live before Chicago?" My response: "My mother's womb, which is also located in Chicago." Minorities regularly develop funny comebacks or other strategies to defuse these uncomfortable situations and cope with racism and microaggressions.

Q: That judging must feel exhausting.

A: Malcolm X once said, "The most disrespected person in America is the Black woman. The most unprotected person in America is the Black woman. The most neglected person in America is the Black woman." Sadly, it's still true, particularly over the past four years when Black women felt targeted by the former president.

Q: This must be why you advocate to get more women of color into professional leadership roles.

A: One of my mentors, child psychiatrist Dr. Patrice Harris, was the first Black woman to serve as American Medical Association president. She said that at the start of every meeting you should look around the table and think about who is missing. We are a diverse society with different needs and experience. It is important that women are in leadership roles and C-suites to make certain that policies and decisions fit the needs of all patients.

Q: COVID-19 has revealed huge gaps in mental health services among communities of color. Can you say more about "the minority tax?"

A: These are the extra responsibilities placed on minority faculty to achieve diversity or address issues related to minorities. During the past year, I have been asked to volunteer more often, and I was very busy before the pandemic. But the issues of social justice, the disparities in the morbidity of COVID-19, and access to the COVID-19 vaccine are important to me. The tax has, at the very least, doubled in the last year.

Q: We must acknowledge George Floyd's killing, which left you traumatized personally but more focused professionally. Please say more.

A: For weeks after the murder of George Floyd, I could not sleep. I worried about my sons in particular. My family home is a block from our neighborhood police station. I grew up seeing police officers as protectors and now my heart races when I hear sirens. I am incredibly frustrated because the majority of police officers are dedicated public officials, yet they remain silent when these senseless crimes occur. There is a necessary spotlight on police brutality and Black people, but it is a fact that 1 in 5 people shot and killed by police have a mental illness.

Q: What are possible solutions?

A: Specialized mental health units should respond to mental health calls. We would never hand a weapon to someone in a mental health crisis, so why introduce an armed individual into a mental health crisis? Police officers have been tasked with performing too many duties that are a mismatch to their expertise and training. It is a disservice to these public servants and the public. I have used my small platform for change, not in defunding, but in reform. I have hope because I won't accept the alternative.

Q: How has the community shown resiliency?

A: Through campaigns to support Black businesses and the allyship of men and women who recognize systemic racism. I am extremely proud of the Minnesota Association of African American Physicians who, early in the pandemic, volunteered to distribute masks and educate communities and, more recently, advocated for vaccine access equity.

About Dr. Dionne Hart

A former social worker, psychiatrist Hart was named in 2020 one of the state's 100 most influential health care leaders by Minnesota Physician. about this series

About the series

Throughout the year, Inspired will engage in regular conversations with a variety of Minnesotans on the topics of race and equity.