The Traumatizing Impact of Racism in Canadians of Colour

Racial discrimination in healthcare services among Black individuals in Canada as a major threat for public health: its association with COVID-19 vaccine mistrust and uptake, conspiracy beliefs, depression, anxiety, stress, and community resilience

OBJECTIVES

To examine the prevalence of major racial discrimination (MRD) in healthcare services and its association with COVID-19 vaccine mistrust and uptake, conspiracy theories, COVID-19-related stressors, community resilience, anxiety, depression, and stress symptoms.

STUDY DESIGN

The study used a population-based cross-sectional design.

METHODS

Data from the BlackVax dataset on COVID-19 vaccination in Black individuals in Canada was analyzed (n = 2002, 51.66% women). Logistic regression analyses were performed to examine the association between MRD and independent variables.

RESULTS

32.55% of participants declared having experienced MRD in healthcare services. Participants with MRD were less vaccinated against COVID-19, presented higher scores of vaccine mistrust, conspiracy beliefs, COVID-19 related stressors, depression, anxiety, and stress, and had lower scores of community resilience. They were more likely to experience depression (AOR = 2.13, P < 0.001), anxiety (AOR = 2.00, P < 0.001), and stress symptoms (AOR = 2.15, P < 0.001). Participants who experienced MRD were more likely to be unvaccinated (AOR = 1.35, P = 0.009).

CONCLUSIONS

Racial discrimination experienced by Black individuals in health services is a major public health concern and threat to population health in Canada. Federal, provincial, and municipal public health agencies should adapt their programs, strategies, tools, and campaigns to address the mistrust created by racial discrimination.

Landscapes of inequities, structural racism, and disease during the COVID-19 pandemic: Experiences of immigrant and racialized populations in Canada

The COVID-19 pandemic has disproportionately affected immigrant and racialized communities globally and revealed another public health crisis - structural racism. While structural racism is known to foster discrimination via mutually reinforcing systems, the unevenness of COVID-19 infections, hospitalizations, and deaths across societies has precipitated attention to the impacts of structural racism. Research highlights the inequitable burden of COVID-19 among immigrant and racialized groups; however, little is known about the synergistic impacts of structural racism and COVID-19 on the health and wellbeing of these groups. Fewer studies examine how structural racism and COVID-19 intersect within neighbourhoods to co-produce landscapes of disease exposure and management. This article examines the pathways through which structural racism shapes access, use, and control of environmental resources among immigrant and racialized individuals in the neighbourhoods of the Peel Region and how they converged to shape health and disease dynamics during the height of Canada's COVID-19 pandemic. Findings from in-depth interviews reveal that mutually reinforcing inequitable systems created environments for COVID-19 to reinscribe disparities in access, use, and control of key resources needed to manage health and disease, and created new forms of disparities and landscapes of inequality for immigrants and racialized individuals. We close with a discussion on the impacts for policy and practice.

Assessing Support for Policy Actions With Co-Benefits for Climate Change and Physical Activity in Canada

BACKGROUND

Calls to action addressing the interconnections between physical (in)activity and the climate crisis are increasing. The current study aimed to investigate public support for policy actions that potentially have co-benefits for physical activity promotion and climate change mitigation.

METHODS

In 2023, a survey through the Angus Reid Forum was completed by 2507 adults living in Canada. Binary logistic regressions were conducted. Separate models were created to reflect support or opposition to the 8 included policy items. Several covariates were included in the models including age, gender, political orientation, physical activity levels, income, urbanicity climate anxiety, and attitudes surrounding physical activity and climate change. The data were weighted to reflect the gender, age, and regional composition of the country.

RESULTS

Most individuals living in Canada strongly or moderately supported all actions (ranging from 71% to 85%). Meeting the physical activity guidelines, higher self-reported income, and scoring high on personal experience of climate change were associated with higher odds of supporting the policy actions related to climate actions.

CONCLUSIONS

Most adults living in Canada support policies that align with the recommended policy actions related to physical activity and climate change. National campaigns enhancing awareness and understanding of the bidirectional relationship between physical activity and climate change are warranted, and these should consider the consistent demographic differences (eg, gender, age, and political orientation) seen in public support for physical activity-related policies.

Depression and suicidal ideation among Black individuals in Canada: mediating role of traumatic life events and moderating role of racial microaggressions and internalized racism

PURPOSE

Although suicidal ideation (SI) is a serious concern in Canada, its prevalence and related factors among Black individuals are poorly documented. Using data from the Mental Health of Black Communities in Canada project (BeCoMHeal), this study aimed to assess the prevalence of SI in Black individuals aged 15-40 years old in Canada, the mediating role of traumatic life events in the association between depression and SI, and the moderating role of racial microaggressions and internalized racism.

METHODS

Eight hundred and sixty participants aged between 15 and 40 years (Mage =24.96, SD = 6.29) completed the online questionnaire assessing sociodemographic data, depression symptoms, traumatic life events, racial microaggressions, internalized racism, and SI.

RESULTS

Findings showed that 25.7% of the participants reported having experienced SI (26.5% women, 22.7% men, 𝛘2 = 1.08, p = .299). The moderated-mediation model revealed that traumatic life events fully mediated the association between depression and SI (B = 0.12, p = .004; 95% CI, [0.04, 0.20]) and that racial microaggressions (B = - 0.03, p = .042; 95% CI [-0.07, - 0.00]) and internalized racism (B = 0.06, p = .006; 95% CI [0.02, 0.10]) moderated this relationship.

CONCLUSION

These findings underscore the importance of addressing racial microaggressions and internalized racism in therapy contexts among Black individuals to mitigate the potential negative impacts on their mental health. They also emphasize the need to develop effective, culturally sensitive, and racially adapted suicide prevention and intervention programs for Black communities in Canada.

Antiracist training programs for mental health professionals: A scoping review

Racism has been shown to be directly deleterious to the mental health care received by minoritized peoples. In response, some mental health institutions have pledged to provide antiracist mental health care, which includes training mental health care professionals in this approach. This scoping review aimed to synthesize the existing published material on antiracist training programs among mental health care professionals. To identify studies, a comprehensive search strategy was developed and executed by a research librarian in October 2022 across seven databases (APA PsycInfo, Education Source, Embase, ERIC, MEDLINE, CINAHL, and Web of Science). Subject headings and keywords relating to antiracist training as well as to mental health professionals were used and combined. There were 7186 studies generated by the initial search and 377 by the update search, 30 were retained and included. Findings revealed four main antiracist competencies to develop in mental health professionals: importance of understanding the cultural, social, and historical context at the root of the mental health problems; developing awareness of individual biases, self-identity and privilege; recognizing oppressive and racism-sustaining behaviors in mental health care settings; and, employing antiracist competencies in therapy. Professionals who have taken trainings having the main components have developed skills on the interconnectedness between racialized groups' mental health and the cultural, religious, social, historical, economic, and political issues surrounding race, necessary for successful clinical practice and for providing anti-racist mental health care. This scoping review presents a summary of the essential antiracist competencies drawn from the literature which must be applied in a mental health care setting, to improve help seeking behaviors, and reduce distrust in mental health care professionals and settings.

Real world outcomes of distributing Lucira Check-It® COVID self-tests in Ontario, Canada: the GetaKit COVID study

BACKGROUND

In Ontario, Canada we developed and implemented an online screening algorithm for the distribution of HIV self-tests, known as GetaKit. During the COVID pandemic, we adapted the GetaKit algorithm to screen for COVID based on population and infection data and distributed COVID rt-LAMP self-tests (using the Lucira Check-It®) to eligible participants.

METHODS

GetaKit/COVID was a prospective observational study that occurred over a 7-month period from September 2021 to April 2022. All potential participants completed an online registration and risk assessment, including demographic information, COVID symptoms and risk factors, and vaccination status. Bivariate comparisons were performed for three outcomes: results reporting status, vaccination status, and COVID diagnosis status. Data were analysed using Chi-Square for categorial covariates and Independent Samples T-Test and Mann-Whitney U test for continuous covariates. Bivariate logistic regression models were applied to examine associations between the covariates and outcomes.

RESULTS

During the study period, we distributed 6469 COVID self-tests to 4160 eligible participants; 46% identified as Black, Indigenous or a Person of Colour (BIPOC). Nearly 70% of participants reported their COVID self-test results; 304 of which were positive. Overall, 91% also reported being vaccinated against COVID. Statistical analysis found living with five or fewer people, having tested for COVID previously, and being fully vaccinated were positive factors in results reporting. For COVID vaccination, people from large urban centers, who identified their ethnicity as white, and who reported previous COVID testing were more likely to be fully vaccinated. Finally, being identified as a contact of someone who had tested positive for COVID and the presence of COVID-related symptoms were found to be positive factors in diagnosis.

CONCLUSIONS

While most participants who accessed this service were vaccinated against COVID and the majority of diagnoses were identified in participants who had symptoms of, or an exposure to, COVID, our program was able to appropriately link participants to recommended follow-up based on reported risks and results. These findings highlight the utility of online screening algorithms to provide health services, particularly for persons with historical barriers to healthcare access, such as BIPOC or lower-income groups.

Improving Traumatic Stress with Justice-Impacted Women and Women Experiencing Homelessness: A Pilot Study of Narrative Exposure Therapy

OBJECTIVE

We sought to investigate the feasibility, acceptability, and impact of a brief, manualized trauma-focused intervention aimed at improving PTSD symptoms in persons with complex PTSD, Narrative Exposure Therapy (NET).

DESIGN

Using a mixed methods approach, we tested the feasibility, acceptability, and impact of NET in a sample of trauma-affected women in traumatogenic circumstances: justice-impacted women in prison and women experiencing homelessness in a shelter. We quantitatively assessed data using a single sample, pre-/post-intervention design. We qualitatively assessed self-described symptom change and opportunities for intervention adaptation using a content analysis approach.

METHODS

Sixteen trauma-affected participants completed the intervention protocol. NET interventionists included one nurse practitioner, one registered nurse, and one nursing student. All NET participants attended pre-/post-intervention visits and active NET sessions. In-depth interviews were conducted at pre- and post-intervention, alongside a diagnostic battery.

RESULTS

NET was both highly feasible and acceptable among participants. Participants significantly improved on the intervention-specific outcome of PTSD symptoms, as well as somatic symptom burden, with large effect sizes. Participants also improved on subjective self-described symptom change. Participants offered recommendations regarding opportunities to enhance population-specific intervention acceptability.

CONCLUSIONS

Results from this pilot study are consistent with previous evidence demonstrating that NET facilitates improvements in women with traumatic stress. Findings of high feasibility, acceptability, and impact supports the use of NET in JW and WEH. Integrating participant recommendations to optimize acceptability may further support scalability and reach of NET. Replication with a larger sample and within a randomized controlled design is required to definitively determine effectiveness.

We're here too: child health information-seeking experiences and preferences of Red River Métis families - a qualitative study

BACKGROUND

Red River Métis families need access to meaningful and appropriate resources when their children are sick. At the invitation of the Manitoba Métis Federation (MMF) to partner in this research, our aim was to understand Red River Métis parents' experiences and preferences for seeking child health information when their child is acutely ill, to inform the adaptation of existing parent resources.

METHODS

A qualitative descriptive approach underpinned by a participatory paradigm guided this study. Semi-structured interviews were conducted with 19 Red River Métis parents and Elders via Zoom or telephone. An inductive thematic analysis approach was used to explore patterns and themes across the data.

RESULTS

Analysis generated four themes: (1) We're here too; (2) We are not all the same; (3) Finding trustworthy information; and (4) Information needs to be widely available. Red River Métis pride was prominent in the results. Parents provided tangible ways to modify existing parent resources, including adding information on how to access Elders, healers and/or traditional medicines and showing different family structures, transport, living situations, Métis names, and incorporating Métis languages. While most parents reported looking for child health information online, they also stressed the need to provide multiple options, including information sheets, recognizing that parents seek information in different contexts. Parents also emphasized the importance of accessible, safe spaces to find child health information, including local schools, community centres, healthcare organizations and the MMF.

CONCLUSION

There is a lack of child health information created specifically for Red River Métis families. The development of this information can support their information needs and preferences and the ongoing efforts to revitalize Red River Métis culture and language. Study findings will inform the adaptation and dissemination of existing child health resources to ensure they reflect Red River Métis parents' information needs and preferences. This research is a critical step in addressing an identified need for Red River Métis families to have culturally relevant and meaningful child health resources, and in the pursuit of equitable care for all children in Canada.

TRIAL REGISTRATION

N/A.

Experiences of racial microaggression among immigrant and Canadian-born young adults: Effects of double stigma on mental health and service use

BACKGROUND

Significant disparities in utilization of mental health services exist among immigrant and Canadian-born populations. These gaps may be associated with a 'double stigma' - stigma related to being from a racialized background exacerbated by mental health stigma. Immigrant young adults may be particularly susceptible to this phenomenon, given developmental and social transitions from adolescence to adulthood.

AIMS

To investigate the joint effects of racial microaggression and mental health stigma on mental health and service use among first-generation immigrant and Canadian-born university students.

METHOD

We conducted an online cross-sectional study among first-generation immigrant and Canadian-born university students (N = 1,280, Mage = 19.10, SD = 1.50).

RESULTS

Despite no differences in anxiety or depression symptoms, first-generation (foreign-born) immigrants were less likely to have received therapy and to have taken medication for mental health issues compared to Canadian-born participants. First-generation immigrants also reported experiencing higher levels of racial microaggression and stigma toward service use. Results suggest the presence of a double stigma, mental health stigma and racial microaggression, each explained significant additional variance in symptoms of anxiety and depression and medication use. No effects of double stigma for therapy use were found - while higher mental health stigma predicted lower use of therapy, racial microaggression did not predict unique variance in therapy use.

CONCLUSIONS

Our findings highlight the joint effects of racial microaggression and stigma toward mental health and service as barriers to help-seeking among immigrant young adults. Mental health intervention and outreach programmes should target overt and covert forms of racial discrimination while incorporating culturally sensitive anti-stigma approaches to help reduce disparities in mental health service use among immigrants in Canada.

The Impact of Language on the Mental Health of Black Quebecers

Quebec's English-speaking Black community finds itself at the intersection of racial and linguistic discrimination, which presents challenges to mental wellness. The present study aims to add necessary detail to the conversations surrounding racism and mental health in Canada while including language as a determinant of health and intersecting element affecting the wellbeing of English-speaking Black Quebecers. We recruited 531 Black adults who are currently living in Quebec to complete a survey on various community-relevant items, including their mental and physical health, their experiences of discrimination, and barriers to accessing mental healthcare. Our analyses revealed that English-speaking participants experience more discrimination across all types and report more barriers to mental healthcare and lower mental health than their French-speaking counterparts. Furthermore, we found that language also had a mediated effect on mental health through discrimination and barriers to mental healthcare. Our study adds to the sparse race-based and intersectional literature about Black people in Canada and substantiates a mechanism by which language affects mental health by exposing Black Quebecers to more discrimination and thus higher barriers to care.

Radicalization from a societal perspective

Studies on radicalization tend to focus on the dynamics of extremist groups and how they exploit grievances of vulnerable individuals. It is imperative, however, to also understand the societal factors that lead to such vulnerabilities and grievances. Our social environment plays a key role in how we view the world and shape our beliefs. By understanding the social dynamics, we can gain insight into the motivations that drive people to extremism. Throughout this paper, we examine the societal factors and processes such as discriminative institutional structures and social norms/practices that can make an individual vulnerable and serve as a driving force for them to join a radical group. To do that, we use the process-oriented psychology of Arnold Mindell and the phenomenology of whiteness of Sara Ahmed as our theoretical framework. These frameworks help us map out the societal dynamics causing individuals to carve social niches out of their current social group and into an extremist group. We use interviews with ex-militants of the radical group, Islamic State of Iraq and Syria, to show how certain societal dynamics, such as social injustice, misuse of power, marginalization and discrimination, served as key factors that led these individuals to identify and sympathize with radical ideology. The aim of this paper is to emphasize that, to develop effective preventative measures against recruitment into extremist groups, it is imperative to have a profound understanding of the social dynamics that make an individual susceptible to radicalization in the first place.

Examining the experiences of Indigenous families seeking health information about caring for sick or injured children: a scoping review

OBJECTIVE

Mapping literature on Indigenous families' experiences seeking child health information and identifying barriers and facilitators to information access.

DESIGN

Scoping review.

DATA SOURCES

We searched Medline, EMBASE, PsycINFO, Scopus and CINAHL for peer-reviewed literature and Google Advanced for grey literature. We screened tables of contents of two Indigenous research journals not consistently indexed in online health databases and used snowball sampling to supplement searches.

ELIGIBILITY CRITERIA

We included full-text, English-language articles, published from 2000 to the time of the search in April 2021, based on: participants (Indigenous families), concept (experiences of families seeking health information) and context (child health).

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers extracted: citation details, study purpose, country of study, publication type, study design, data collection method, Indigenous group, family member participants, home/healthcare setting, child health area, how health information was accessed, and information-seeking barriers and facilitators. Data were examined for patterns and trends, results and implications.

RESULTS

Among 19 papers (representing 16 research projects) included, nine described family/friends and 19 described healthcare professionals as sources of child health information. Barriers include racism/discrimination during healthcare visits, ineffective communication with healthcare providers and structural barriers (eg, transportation). Facilitators include easy access, improved communication and relationships with healthcare providers, and culturally safe healthcare.

CONCLUSION

Indigenous families perceive they do not have access to necessary child health information, which can lead to insensitive, ineffective and unsafe healthcare. A critical gap exists in understanding Indigenous families' information needs and preferences when making decisions about children's health.

Prevalence of Current PTSD Symptoms Among a Sample of Black Individuals Aged 15 to 40 in Canada: The Major Role of Everyday Racial Discrimination, Racial Microaggresions, and Internalized Racism

OBJECTIVE

Most Black individuals in Canada report having experienced racial discrimination. Although previous studies have shown that there is a strong relationship between racial discrimination and posttraumatic stress disorder (PTSD), no studies in Canada have documented this association among Black individuals. The present study documents (1) the prevalence of PTSD among Black individuals using data from the Black Communities Mental Health project and (2) risk factors associated with PTSD, including racial microaggressions, everyday racial discrimination, and internalized racism.

METHOD

A total of 860 participants (75.6% of women) aged 15 to 40 years old (M = 24.96, SD = 6.29) completed questionnaires assessing PTSD, experience of traumatic events, racial microaggressions, everyday racial discrimination, and internalized racism.

RESULTS

Findings showed that 95.1% of participants reported exposure to at least one traumatic event during their lifetime. In total, 67.11% of participants reported probable PTSD with no significant difference between men and women (68.2% and 67.8%, χ² = 0.132, p = 0.72). Participants born in Canada were more likely to experience significant PTSD symptoms, compared to those born abroad (70.92% and 53.14%, χ² = 19.69, p < 0.001). A multivariable linear regression model of PTSD symptoms was computed using sociodemographic variables and exposure to traumatic events as independent variables, which explained 25.9% of the variance. In addition to these variables, a second model included racial microaggressions, everyday racial microaggressions, and internalized racism, which explained 51.8% of the variance. The model showed that traumatic events (b = 0.6; p = 0.02), racial microaggressions (b = 0.5; p < 0.001), everyday discrimination (b = 0.2; p = 0.03) and internalized racism (b = 0.5; p < 0.001) were positively associated with PTSD symptoms.

CONCLUSIONS

This article highlights the detrimental consequences of racial discrimination against Black people in Canada. Prevention and mental health programs aimed at mitigating its consequences on the lives of Black people and other racialized populations must be implemented.

The weaponization of medicine: Early psychosis in the Black community and the need for racially informed mental healthcare

There is a notable disparity between the observed prevalence of schizophrenia-spectrum disorders in racialized persons in the United States and Canada and White individuals in these same countries, with Black people being diagnosed at higher rates than other groups. The consequences thereof bring a progression of lifelong punitive societal implications, including reduced opportunities, substandard care, increased contact with the legal system, and criminalization. Other psychological conditions do not show such a wide racial gap as a schizophrenia-spectrum disorder diagnosis. New data show that the differences are not likely to be genetic, but rather societal in origin. Using real-life examples, we discuss how overdiagnoses are largely rooted in the racial biases of clinicians and compounded by higher rates of traumatizing stressors among Black people due to racism. The forgotten history of psychosis in psychology is highlighted to help explain disparities in light of the relevant historical context. We demonstrate how misunderstanding race confounds attempts to diagnose and treat schizophrenia-spectrum disorders in Black individuals. A lack of culturally informed clinicians exacerbates problems, and implicit biases prevent Black patients from receiving proper treatment from mainly White mental healthcare professionals, which can be observed as a lack of empathy. Finally, we consider the role of law enforcement as stereotypes combined with psychotic symptoms may put these patients in danger of police violence and premature mortality. Improving treatment outcomes requires an understanding of the role of psychology in perpetuating racism in healthcare and pathological stereotypes. Increased awareness and training can improve the plight of Black people with severe mental health disorders. Essential steps necessary at multiple levels to address these issues are discussed.

Teledermatology in remote Indigenous populations: Lessons learned and paths to explore, an experience from Canada (Québec) and Australia

Objective

Recent introduction of a provincially funded and administered teledermatology platform in Quebec presents a major opportunity to improve healthcare delivery to rural Indigenous communities where healthcare is suboptimal. In this study, we assessed approaches, challenges, solutions, and outcomes in implementing teledermatology in rural Indigenous communities of Australia and Canada.

Methods

A narrative review was performed using journal articles and grey literatures to assess challenges encountered in Canadian and Australian teledermatology programs in rural Indigenous communities. We then conducted a focused search to identify solutions and outcomes to these challenges. We identified four main areas of focus for implementing teledermatology: financial, cultural, legal, and provider competency.

Results

Main financial concerns included identifying the cost-to-benefit ratio of teledermatology and financial benefits of the store-and-forward system compared to videoconferencing. Delivery of teledermatology through culturally considerate services is crucial to mend the mistrust felt by Indigenous people toward mainstream health services. From a legal standpoint, patient confidentiality and physician liability must be considered. A uniform teledermatology platform and physician competency in both telemedicine and dermatology are needed to ensure standard of care.

Conclusion

Teledermatology initiatives represent great opportunities to improve healthcare services to rural Indigenous populations.

A scoping review of refugees' employment integration experience and outcomes in Canada

BACKGROUND

Refugees involuntarily arrive to Canada to escape unfavourable conditions in their home country. Employment is an important marker of integration and a foundational determinant of health yet; little is known about the employment integration experiences of refugees as a distinct group of workers in Canada.

OBJECTIVE

This scoping review was completed to explore the employment experience and outcomes of refugees in Canada and to identify gaps in the literature.

METHODS

Three databases were searched for peer-reviewed articles published in English over a 25-year period, 1993 to 2018, for research on refugees and employment in the Canadian context. The research team reviewed all articles, including abstract screening, full text review and data extraction; consensus on inclusion was reached for all articles. Relevant articles were synthesized for overarching themes.

RESULTS

The search strategy identified 2,723 unique articles of which 16 were included in the final sample. There was a mix of quantitative, qualitative and mixed-methods studies which reported on employment rates of refugees, the quality of jobs secured, gendered differences in employment experience and differential impacts of under/unemployment on health and well-being.

CONCLUSION

The findings suggest that refugees in Canada do not secure jobs that are in line with their previous skills and experience leading to downward occupational mobility and poorer health with refugee women experiencing these outcomes more acutely. Research in this area with long-term outcomes and contextualized experiences is needed, as well as studies that include equity considerations such as racialization and gender.

Anxiety-Related Disorders in the Context of Racism

PURPOSE OF REVIEW

The literature on racism and anxiety-related disorders, especially social anxiety, specific phobia, and generalized anxiety disorder, is notably lacking. This report aims to review recent evidence demonstrating the link between racial discrimination and various anxiety-related disorders.

RECENT FINDINGS

Anxiety-related disorders were the most significant mediator for daily discrimination and suicidal thoughts, above both depression and substance use. Further, studies showed that racial discrimination promotes posttraumatic stress and racial trauma among people of color. Systemic racism puts people of color at a higher risk for anxiety disorders than White people. Clinical case examples provide lived evidence of diverse racial and ethnic individuals suffering from anxiety-related disorders, with the development and worsening of symptoms due to racism and microaggressions. There is a prominent need for recent research on anxiety-related disorders and racism. Recommendations for clinicians and future research directions are provided. These actions are required to address bias and mental health inequities and empower people of color.

Getting to the Root of the Problem: Supporting Clients With Lived-Experiences of Systemic Discrimination

For many marginalized people, coping with discrimination is not a temporary condition. Rather it is endemic to living in a discriminatory society and a source of ongoing stress. In this paper, we explore the need to provide people struggling to cope with the skills to tackle not just the personal consequences of discrimination, but also to understand and address the root causes of their pain, and specifically the ones that lie outside of themselves. We propose using the concept of social capital to bring greater awareness among clients, clinicians, and society in general about the need to pair the treatment of personal distress with concurrent practices to understand and tackle larger systemic issues impacting their mental health. People with marginalized identities are often expected to find ways to cope with oppression and then sent back into a broken world, perhaps with stronger coping skills, but often ones which do not address the root cause or source of the pain, which is social injustice. We propose that it is therapeutically important to problematize, pathologize and address the systems and narratives that discriminate and cause people to need to cope, instead of focusing therapeutic interventions only on the internal resources of the person doing the coping.