A Safe Space to Speak Above the Silences

Abstract

A few years ago two social scientists attended a faculty development course on cultural awareness that my colleagues and I offered to medical school faculty. Their research, reported in their paper in this collection, ‘‘lifts the hood’’ on the course, as we tried to do with each other in order to allow us, the faculty, to see ourselves and the course through the eyes of others. Their inclusionary approach of engaging all the voices offers an additional feedback loop now as they invite me to share some comments on their paper and on the course. The process of producing this essay evokes many possibilities; not only for the course, but also regarding the inherent value of making space for voice and reflection in the construction of knowledge. Unavoidably, my comments on the previous article are colored by the perspective of a behavioral health clinician, just one lens of many possible others in the broader discussion of health. Currently, in the United States, we are at a crossroads as a result of health care reform (the Affordable Care Act (ACA)) and budget pressures. Racial/ethnic health and health care disparities in the U.S. are well-documented (Smedley et al. 2003). During the past decade, mental health care disparities have persisted for black and Latino youth in a 2-to-1, white-to-minority ratio despite efforts to reduce them, and the gap is growing even wider for Latino children (Cook et al. 2013). This is alarming given that children’s mental illness is predictive of a variety of poor outcomes later in life. Social advocates need to follow these changes carefully and come together in force to insure that the health care system that emerges as a result of current reforms is more responsive to people of all cultures and social classes. I lose hope for this kind of change when I hear comments from well-intentioned colleagues who make statements like ‘‘we are more concerned about the 75 % percent of children,’’ or who state that public insurance patients are money losers