Dying too soon young black men suicide & gun violence-View Presentation

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My name is Dr. Roger Mitchell. I am not a psychiatrist. I actually walked in this morning and I saw a friend of mine and he almost dropped his coffee to see a forensic pathologist  at a psychiatry conference. But I'm excited to be here and excited to have a conversation today. As you can see and you saw earlier,  we're having this conversation about dying too soon, young black men, suicide, and gun violence. And we're trying to cover the gamut.  And we're going to jump right in and so we really want you to participate, share your experiences, your stories, your solutions to this big problem of violence in community.  Really no matter where it exists. And so the format is that we're going to present about 15 minutes each and then we'll go into a discussion  about our work individually and collectively. And we hope that during that period of time, really during that 45 minutes, that you're willing  to share your work, your solutions, your thoughts about violence that's so pervasive in community. So our objectives is that you should be able  to explain death in custody, particularly suicide mortality, understand the impact of firearm violence on communities, understand how public health approaches have worked  in other areas of public safety, and will know how to understand laws and reporting mechanisms and expectations in your practice. And so we hope that we'll meet those objectives.  My name is Dr. Roger Mitchell, Jr. I am a forensic pathologist and professor of pathology at the Howard University College of Medicine.  I am the chief medical officer of ambulatory care. Yes, I'm a forensic pathologist giving a talk in psychiatry and I am in charge of quality and safety in ambulatory care.  I do not stay in my lane at all. I'm a medical director of the Center of Excellence on Trauma and Violence Prevention, so I have a particular expertise  in gun violence from my time as the chief medical examiner for several states in the country. I was the chief in New Jersey for two years and the chief  of chief medical examiner for Washington, D.C. for seven years. I ended there as deputy mayor for public safety and justice, so we'll have a robust conversation.  And then I direct a group of international forensic pathologists globally, providing technical assistance to them. And we'll talk a little bit about the book  that I've just written on death and custody later on in our conversation. I have no financial disclosures to report and no bias.  We're in New York and I don't know how many people are from New York that are in this room or were around in 1999. Twenty-five years ago in February of 1999,  Amadou Diallo was on his way home from working. He was in the vestibule of his home and he fit the description. He was reaching for his wallet when they asked him for his ID  and he was shot at 41 times. He was hit 19. He had entrance wounds in the soles of his feet. He was laying on his back when he was killed.  I had just left the FBI as a forensic scientist to go to medical school at New Jersey Med just across the river and was studying violence as a public health issue,  or at least I wanted to. And then Amadou Diallo got killed and I said, well, if gun violence is a public health issue, then so is the gun violence that's perpetuated  by law enforcement. And so started working on this since then. I'm going to give you some breakdown of what a medical examiner does before I get into some  of the work that's happening, that happened by the Office of the Inspector General for the Bureau of Prisons. So the medical examiner is not just your grandfather's morgue.  We provide support to families as well as law enforcement and medical community, our partners that are at local levels and federal levels.  We do cause and manner of death as well as autopsy reports. Fatality review is a big part of what we provide support for as well as morbidity and mortality conferences.  Death and cut, I'm sorry, forensic medicine, obviously we can't ask our patients their history. So we rely heavily on the history of providers like you,  if appropriate, as well as family providers, ICU, emergency department, as well as law enforcement, and families. We center the victim in understanding that.  And all of it is for the purposes of establishing cause and manner of death. So my prescription pad is the death certificate, where we establish cause and manner of death.  And quite frankly, for all jurisdictions, most jurisdictions in this country, if you're not a forensic pathologist, then you cannot sign a death certificate that is not natural.  There's a lot of nots in that. So let me put it in the affirmative. You can only sign a death certificate that is natural if you are outside the medical examiner and coroner system.  So that squarely puts homicide, suicides, natural homicide, suicides, accidents, and undetermined within the purview of the medical examiner and coroner. Does that make sense?  So that's how I show up in this space as the certifier of death of suicides. As a function of my practice, my job is to determine whether or not someone committed suicide or not.  And that is part of cause and manner of death. And so you might say, well, all of the above, how did you come to this space? Well, I believe, and I think it's proven,  that mortality is the tip of the pyramid. It is the top, the capstone. If we understand and surveil why people die, then we can get an idea of why people  are living with that burden of disease or injury. It gives you a snapshot. And if we can properly capture death data, mortality data, then we can understand morbidity.  And not just that from a standpoint of knowing it, but you need to do systems analysis. And that's where fatality review comes in and understanding how fatalities link back.  And then in my ambulatory care role, I understand the access to care and prevention and scheduled and non-scheduled office visits  and how that plays into care delivery, quality safety, as well as mortality. You've seen this before, I'm sure. Any lecture I give, I want to make sure  that equity is centered in that lecture. And so I want everyone to get an apple. You might want everybody to get a crate. You might look at this and say, I'm  so mad at that short guy that he gets more crates than the tall guy. Well, I'm 5' 8", so I like the fact that the short guy gets more crates than everybody else.  Because everybody gets an apple. And that's what equity is about. In a day of precision medicine where there's a molecular marker for tumors  and we identify chemotherapy to get that molecular marker under control, then why can't we look at medicine and health delivery and public health the same way?  But you may not like, again, the fact that he got more crates. So let's talk about what we get that's different. So any time we approach gun violence,  any time we approach suicide prevention, we approach it through a lens of equity, understanding that we center the patient, we center that patient and what that patient needs  that may be different than the patient that's next to them. I got reviewed, my book got reviewed in Harvard Press and it talked about this new thing that I was emerging upon,  a possible new concept of death equity studies. I like this so much, I make sure it's a part of my lecture everywhere I go. So what is death in custody  and what are the phases of custody?  The phases of custody are pre-custody, pre-arrest, in-custody arrest, transport, incarceration or jail and in prison. And this is the federal definition.  So that means that anybody's being chased by law enforcement, either in a vehicle or running, will be considered in custody for the purposes  of understanding cause and manner of death. Not all in-custody deaths are homicides, right? Hence why we're talking about suicides in the carceral system.  Not all of them, they can be any of the manners. There's five manners of death, homicide, suicide, accident, natural and undetermined.  And they can span those manners no matter what phase  or what position an individual finds themselves in the continuum of in-custody. And we center public health and research as a function of that.  I was part of a group of national forensic pathologists that establish how you investigate, define  and examine deaths in custody. We also promulgated that definition there. One of my philosophies is that prisons and jails are large hospitals with safety concerns.  And it's not until we realize that there's someone that's always suffering from a disease or injury, whether it be a mental health disease or whether it be a physical disease,  nonetheless, we can treat it differently. I was part of a group that Rand pulled together at the Department of Justice in 2017 called Caring for Those in Custody  when I was the chief medical examiner of DC. And what we basically found is that there's a need for uniformity, there's a little bit of a delay here,  sorry about that, there's a need for uniformity in how we treat and review and conduct multidisciplinary participation. I wanted to highlight this,  the light blue are natural diseases is what we found, mortality rates. You can see the light blue, those are illnesses and disease and then you can see the pop out,  that red are suicides. And so suicides, although a distant second in prisons  is a close second in jails when it comes to manners of death.  And so in the, I know this is pretty difficult to read, but this is available online, you can go online and get the PDF. But what we identified during that study was  is that there needed to be evidence-based strategies for suicide prevention, there needed to be dynamic versus static processes, there needed to be suicide risk assessments  that were uniform and reliable, we needed mental health providers that were sufficient within the system  and there's often a decrease amount. We also suggested that restrictive housing, back in 2017 and even before, we found that restrictive housing was a suicide risk.  I won't go through every single one of these, but interventions in response to inmates identified a risk of suicide after viewed as punitive by inmates,  double bunking may be proactive, and so there also is ergonomic and actual physical prevention  that can be suicides. Some of the old jails do not have breakaway grates, right?  And so you can put your rip sheet and hang yourself in an environment that doesn't have the breakaway grates. So those things need to be changed.  And we'll have time for questions in a moment.  Also, tier three systems are required to periodically evaluate suicide risk in these facilities  and that wasn't happening back in 2017. And so the Office of Justice Programs recently in 2019  said there's nearly a fifth of state and federal prisons and a 10th of local jails had at least one suicide in 2019. And that would have also been considered under-reported.  And so the rest of the time that I have with you, the next about seven minutes that I have, is that we're gonna talk a little bit about this report. This report, for those of you  that are in the carceral space, does anybody provide care in the carceral space?  No, but we have one.  For those of you that do, and even if you find this interesting, make sure that you take a look at this report. There were 12 observations and recommendations.  We're dealing with just the one, that suicide represents a significant risk area for the Bureau of Prisons, which the BOP can help mitigate through compliance  with existing policies. And you'll see that there is a robust safety net that is built into the Bureau of Prisons policies that functionally our prisons are just not following.  And we'll talk a little bit about that in a moment. So every death requires an incident report. It requires notification within 24 hours. It requires a multi-level mortality review,  an external consultant review, and a death certificate. So this must happen in every single death within the Bureau of Prisons. Not every one of these happens.  So that's the first thing to note. And that's for every death. And this report excludes natural diseases. This report is just for suicides, homicides, accidents, and undetermined.  And you can see the blue are the lion's share across this functionally six-year, seven-year study.  And suicides are the most non-natural death in our Bureau of Prisons from 2014 to 2021. And those total in the study was 187 out of those deaths.  So the reasons identified for suicide risk  for those individuals that were at higher risk of committing suicide were sex offender status, lack of family support, mental health issues coming into the Bureau of Prisons,  the death of a loved one would incite a suicide,  sentence length, recent admission to the BOP, pending transfer to a different institution, and deportation status. Deficiencies that were found in suicide  were staff completion of inmate assessments. Greater than 50% of the suicides were single-cell confinement. Failure to communicate risk and coordinate care  when identified, so when a suicide risk was identified, they didn't escalate it, they didn't share it. Greater than a third of rounds were not performed properly  that led to these risks. Individuals that were on suicide watch weren't getting their rounding. And then mock suicide drills were not occurring.  And so this is the Bureau of Prisons policy. You can see this. These MHCLs are the level of risk, right? And so a level one is low risk, and a level four is the highest risk  on that initial assessment. What they found in the individuals that committed suicide, they were found to be a lower risk, the lowest risk.  And in actuality, they probably had a lower risk because of improper classification, not because they came in at a lower risk. And so that's important to point out.  Also, this is single-celled suicides. You can see the majority of them.  You're going to have single-cell or suicide in restrictive housing. And there's some overlap between the confinement and single housing. So I have a quick case.  I do autopsy for Colin Kaepernick's Autopsy Initiative. He does free autopsies for anyone who dies in the carceral system.  And he provides that support to families all over the country. And so we recently had a young man,  and he was sentenced to 25 years after pleading guilty to armed robbery. At the time of his death, he was told to have been placed  in disciplinary segregation and a secured unit separate.  And he hanged himself. And then just lastly, if you get a chance, check out a shameless plug of the book, Death in Custody,  how America ignores the truth and what we can do about it. We identify that there is not, even though the Bureau of Prisons, this report was able to capture death in custody.  The reality of it is, is that we have no consistent way of documenting anyone who's dying in custody in this country.  Harvard called it one of the best public health books of 2023. We have a podcast that goes along with it called Official Ignorance. I'll leave this up for a little bit  so you can check out the QR code for Official Ignorance, of the Death in Custody podcast. You can get it on any of your podcast locations.  It was nominated for NAACP Image Award. We didn't win, we lost to Wakanda Forever.  Ta-Nehisi Coates narrated Wakanda Forever. So you wanna listen to Ta-Nehisi Coates or you wanna listen to Dr. Mitchell, I don't know. And then recently, a PBS Frontline special  just came out this past week, where I'm on that talking about police use of force. So I'm the Speaker of the House of the National Medical Association.  We think that we should include a checkbox on the U.S. Standard Death Certificate, and that is the public health approach  to be able to gather this data surrounding death in custody. So if you want an action item for death in custody or suicide risk within the practice,  within death in custody, please go to your legislature and tell them that you wanna talk about death in custody and that you want a public health method to capture the data.  And so we need to track it through the Centers for Disease Control. I wanna thank you for your time. We'll be able to take questions.  Our speakers will, we will all introduce ourselves like I did, and then we'll have some significant time at the end to have a discussion about suicide  in the carceral state, as well as gun violence. So thank you so much. And we'll be on to our next speaker. Our next speaker is Dr. Lawrence Malik,  and he'll be talking about gun violence. Thank you.  I'm Lawrence Malik, or Larry Malik, as people call me. I'm a psychiatrist over at UC San Diego. I oversee our community psychiatry track and do a lot of education.  I'm working kind of in crisis centers or urgent care downtown and other kind of more public funded and community-based settings.  I have no financial disclosures, but I do need to disclose I am not an expert on public health or gun violence necessarily.  I was asked to take part in this by Altha Stewart, and for those who know Altha Stewart, you don't say no to Altha Stewart, so here I am.  Okay. And part of the reason I'm here is I'm the chair for the Mental Health Services Conference,  the APA's other meeting that occurs in the fall and is focused on kind of public health services and other health initiatives.  And that's where this conversation started with Curtis, Altha, and myself about gun violence. We continued it last year and hope to continue it again in Baltimore.  And shameless plug, I encourage you all to attend the meeting in Baltimore. It's a great place to kind of to tackle subjects just like this, among others.  So we'll kind of do a little background, I know we've got 15 minutes, I'll set myself short today.  But we'll try to sort of cover things, kind of an overview and we can follow up with questions later on.  The current state in the U.S., you know, there's 49,000 people in 2021 died by a firearm injury in this country. And double that rate actually are injured with nonfatal shootings.  And this is the highest homicide rate we know during the COVID and the pandemic that the homicide rate did increase.  We know that actually in 2020, gun violence has now passed motor vehicle accidents as the number one killer in children.  You know, this includes school shootings, but as we are talking about today, you know, both in the carceral system and in the streets and in our communities, young black males  are disproportionately affected by this gun violence and these homicides. The nonfatal injuries, I do want to kind of bring up, because we do focus on homicides,  but the impact of these injuries are devastating, right? The deaths, of course, you know, get the headlines and we track those, but the impact on the  families, the witnesses, the people who have to respond and, you know, and everyone else,  not to mention the victims and survivors themselves of the gun violence, all have to carry this  with them in varying ways, whether that's full PTSD or long-term injuries and the like. And this has a major impact on communities.  I was going to play a video and I'm hoping it doesn't come up now, because I guess you were short on time, but Rhonda McClain was, was that, all right, all right, okay.  I'm standing on the corner of Chew and Sharpe where 22 years ago I got shot in the head when I was 10.  Standing here today, I feel like I'm blessed but on the other side I'm also angry because...  I do encourage you, I mean, if we can figure it out, we'll play the video for y'all, but so Rhonda McClain actually spoke at this meeting last year, I believe, in San Francisco,  and is somebody who survived a shot, I think, when he was age six or seven, when he was leaving a convenience store. And, you know, has had to live with the ramifications of that,  and has gotten involved as an advocate and a leader in the field, and has a part of the Philadelphia Center for Gun Violence Reporting, you know, which has taken an active role  in community outreach and tracking things and pushing for the research and the data, which we will talk about, but which we don't have in a lot of areas.  And I know our focus today is on suicide and, you know, kind of day-to-day gun violence, and so not necessarily mass shootings, which get a lot of headlines, as you see,  but, you know, and we know have increased, but they only account for about 2% of the deaths in this country due to gun violence.  They do have a large impact on mental health in communities in which they occur. You know, we know that youth antidepressant use  and suicide risk go up in the communities surrounding where mass shootings occur in schools and otherwise. And so, again, you know, they have an impact,  even if they don't account for a large portion of the gun violence or the gun deaths in the U.S.  And, you know, the one difference we have in mass shootings  and firearm violence in general in this country is necessarily mental health, but access to firearms, which we lead the world in, fortunately or unfortunately.  And, you know, I think the, you know, while SMI and mental health often gets thrown around as an attribution to why, you know, mass shootings occur,  we know that's not typically the case. In fact, it's a very small percentage of mass shootings are due to serious mental illness and schizophrenia and those things,  but due to unplanned retaliatory substance use and those kind of other risk factors that we know about, which again, and we know that also with suicide,  mental health is a risk factor, right?  And of deaths in this country, 60% of all firearm deaths are due to suicide by firearms.  And so we know that we have to sort of  take a mental health approach to the suicide component. And, you know, the mass shootings component, I think, you know, while again, the mental health is thrown out there,  that isn't the driver. There's an access and there's other public health approaches we can think about for those shootings in addition to the suicide risks.  The other thing I wanna talk about with kind of with gun violence is the impact to the communities, right? And so we know that disparately, you know,  this occurs to black young men and occurs in communities of color.  38% of all homicides in 2020 were black youth  while they only account for about 2% of the nation. So they're grossly overrepresented in that sphere. And same goes for other  historically minoritized communities.  And, you know, and study after study or survey, you know, show that, you know, Latinx, black, Hispanic populations are more likely to know somebody or have been victims  or had someone they know killed by firearm and gun violence.  And, you know, and this circling around in the community, you know, on a day-to-day basis has an impact as we talked about on the individuals, their families, the people they know,  the schools they attend, you know, everything around them. But also the actual financial costs to the communities. And, you know, these undersourced neighborhoods,  you know, have an epidemic of gun violence or, you know, higher rates, and then property taxes go down.  Businesses leave the community, which further drives and continues the cycle of further violence and poverty  and violence in those neighborhoods.  And another, you know, example of disparate costs  that we're seeing here and the huge cost to, you know, the taxpayers and the country at large, but, you know, estimate over $500 billion  is the impact of this gun violence in the US.  And, you know, as we talked about, you know, this impact kind of spreads out wide, right? We know that there's an economic impact, there's a wellbeing, it impacts education, health,  there's, you know, increased risk of hypertension  and other cardiac and other, you know, mortality and morbidity that happen in neighborhoods of high stress and high gun violence.  And kind of, you know, again, reiterating these things, you know, being around gun violence is almost kind of needs to be considered  an ACE sort of criteria when we go through there. And so there's a push to add that as another kind of chronic condition indicator  in the ACE studies and these checklists that we go through, even if you're not directly a victim or have violence perpetrated against you.  So this kind of comes back to, and I know we're four minutes left,  you know, kind of this back to this need for this to deal with this public health crisis, right? You know, various organizations from the AMA to the CDC  and the like have all kind of proclaimed this to be a public health emergency, a public health crisis, a problem that needs sort of an approach in that way.  You know, we have a long history in this country of doing some of these, you know, very well thought out and effective interventions, things like childproof caps on medications,  seatbelts, car safety, tobacco restrictions, and you know, the list goes on, of ways that we can intervene and take an approach that can save lives and reduce suffering.  A lot of the proposals that are often put out there, you know, waiting periods, mandatory trainings, we'll talk about some of them and some have some good data,  some have mixed and some have no data,  or little data that we can, that we need more of, right? And I can't do it all justice in the next 15 minutes, but the, kind of want to highlight the discrepancy  and sort of the funding here.  US has spent $10 billion since 1970 on car safety, driver safety and the like, and it's estimated to save, you know, over half a million lives, which is great.  In 2021, the number, the dollar amount that was spent on, by the, that was given to I think the CDC and NIH from federal funding was 25 million split between the two.  There's about 200 million a year spent on research for car safety every year.  And for those who know, or maybe not know, this is all due to what's called the DICI, the DICI rule, the DICI amendment, which said that none of the funds available  for injury prevention and control at the CDC may be used to advocate or promote gun control.  And this was kind of tucked into a bill back in, I think, 96, and kind of is the reason that we have such a disparate level of funding  and research and knowledge around this subject, at least from federal funding anyways.  So kind of run through some of the layers of interventions that we know about, or we sort of intervene with,  and kind of some of the, highlight some of those that seem to be more effective if we can, before we pivot over to Dr. Adams here.  So at the individual level, we're talking about things like counseling, therapy, of course, treating underlying disorders such as depression,  substance use, and kind of direct interventions that way. We know about crisis interventions, education and firearm training, or another sort of more public health approach  to mandatory trainings, or trainings in pediatrician's office about gun safety around kids, and how to use safety locks, and those kind of things for gun safes.  And there's sort of mixed results on that. I think there was, focusing on the education piece,  there was one study, I believe out of Ohio,  I had the citation there, that showed about, there was an intervention in pediatrician's office with suicidal teenagers, or adolescents,  and at the two-year follow-up, only 27% of those encouraged to remove the firearms from the house with those suicidal adolescents in there had done so,  and in fact, 17% of the non-gun-owning folks who received that education purchased a gun in those next two years.  So education alone doesn't seem to be doing the trick. Again, another study in Alaska, where they had education with the free installation of the gun safes in the house,  shorter study at three months, but 86% of those houses were still using the gun safes at that time, and the guns were stored when they did a sort of surprise visit, so to speak.  So maybe, again, more research needed, but these education interventions may have  a place in this spectrum of interventions, but again, maybe not education alone, potentially.  At the community level, we talk about things, community-based interventions, outreach, whether it's violence interventions, education,  there's a few examples of these, I know in Baltimore, there's Safe Streets, there was another program that, I forget the parent organization, but Ceasefire was adopted in Chicago,  and actually, what's that? Cure Violence. Cure Violence, thank you. And there was an intervention in Chicago, but I believe it actually got a one-year contract,  and then was stopped after one year, despite showing, I believe, in two neighborhoods that they were actually implemented in, a decrease in, I believe, 38% of shootings,  and 28% in homicides in those two neighborhoods,  but given the sort of climate and political nature,  that funding was cut and redirected back to criminal justice to increase the presence of law enforcement, which I'll save that for another talk,  or maybe Dr. Adams will talk about at some point, but we can talk about it as a group, but we know that that hasn't proven to be the most effective way to prevent,  and perhaps even perpetuates more violence towards young black, and well, any, lots of people of color, but young black males in particular.  The other sort of intervention, oh, I wanted to say the other thing about community, and that doesn't always get this other upstream  primary prevention, which we always kind of talk about, or it takes a lot more time to bear fruit, is the actual environmental design  and supports that these communities have, right? And we know that if we can intervene and improve education, improve access to parks, and do other kind of, and other resources  that will help neighborhoods that are historically the most kind of poor, and vulnerable, and in need, those also have upstream effects in producing long-term gun violence,  and other homicides, and whatnot.  Coming back to this, the other kind of more institutional levels, public health intervention, so comprehensive background checks, red flags, and emergency protective orders.  You know, and then the other thing that comes up is increasing mental health workforce, right? Is that gonna, if we can increase access  to substance use treatment, crisis interventions, will that also make a difference? You know, the data's kind of mixed, it's early on, but we know there's a couple of studies,  this one at Ohio showed that a 10% increase in behavioral health workforce over the course of, I think, about a decade, actually led to about 1.2% reduction in suicide rates.  So we know that kind of treatment alone, and an increase in the workforce maybe isn't the solution to this firearm violence. And I think there was another state  where that kind of bared fruit as well, but the other part of the time about these extreme risk and red flag laws, which also get mentioned a lot when we think  about common sense gun laws, there's actually better data on these having an impact on reducing suicide and reducing gun violence. You know, both Indiana and Connecticut,  and there's some other states that have done this where they've seen significant or meaningful reduction.  We don't know that's a direct cause, as we say, but it does seem to be associated with that.  And we know that in the states where they have kind of the least amount of firearm law provisions and less restrictions, and say, you know,  they do have higher rates of suicide by firearms. And we know this, I mean, this was a Kaiser Foundation  sort of look back in 2020, and show that the states with the kind of most firearm law provisions, such as Connecticut and California, which we'll talk about,  seem to have been able to reduce both firearm violence, suicide and firearm violence.  I'm talking about California because that's where I'm from. You know, compared to other states, you know, has some of the most restrictive gun violence,  or restrictive gun laws, excuse me. And again, not causation, but it has been correlated with a decrease over the last 30 years, both in suicides and homicides due to firearms.  Lastly, you know, there is, if you didn't see it, JAMA in September 2022 had a whole issue dedicated to firearm violence and covering  kind of various aspects of kind of the research, the lack of research and what, you know, trainings and those kinds of things. And one of the things, you know,  thinking with my academic hand is what else can we be doing, you know, as an educator and other, you know, and as, you know, as an educator and as, you know,  as an educator and as institutions such as this? You know, I think the need for research and the push for funding and finding other ways to get creative funding if we're not able  to access federal funds, I think, are something that we all should be or can be advocating for.  And we know that training and residencies for psychiatrists and for, maybe not pathologists, but perhaps we should add that to the list,  you know, is, you know, psychiatry training programs, you know, grossly say that they are not receiving adequate training on how to talk  about these things, how to kind of intervene, the language to use. There's a, I don't know if I saved it here for us, but yeah, there was another couple articles  within that talking about like doing, how to train, you know, residents about the language. Because if you're not speaking the culture and if you're using things that, you know,  that you're gonna lose your audience if you are trying to speak to a gun owner or to someone who's, you know, been a victim or an advocate for gun ownership,  but if you're trying to talk to them about how to intervene in that moment and what you can and can't do, if you don't know the language, they're gonna write you off.  So.  I will pause there and I think I went over my 15 minutes, but yeah, thank you. Thank you.  I'm at the stage where the best place to put these readers is right here. That way at least I have a chance of knowing where they are because my head usually goes  with me, but not always. My name is Curtis Adams, Jr. I am a psychiatrist at the University of Maryland School of Medicine. I've been there since 1998. That's my email.  I can email you the slides if need be. I'm wearing this red shirt today because today is the day which we are to recognize the missing and murdered indigenous women.  It is an enormous hidden problem in this country, or in this region of the world, United States and Canada.  There are an extraordinary number of indigenous women who are missing, presumed murdered, but there's no recognition, no justice of them.  It's appropriate to talk about that, even though I'm talking about young black and brown men who have been killed and what we can do to try to prevent this, because here we are  in New York where Ralph Ellison's protagonist in his book, The Invisible Man, is to have resided.  There are lots of invisible people, indigenous women among them, but young black and brown  men as well. The origin of my portion of this talk comes from my office. I work in a community mental health clinic 70% of my time.  I also do assertive community treatment with my colleague Jane Richardson over there. We are a group of psychiatrists.  There are three of us, and we actually go do home visits by ourselves. We don't go with staff. We don't have people bringing the young folks and people in.  We actually go to the people's homes, drive ourselves to them. We have gotten to learn quite a bit about the community just by going into people's  homes with our mouths shut and our eyes and ears open and just listening and learning and seeing what's going on.  I'm also in the clinic, and I'm partly here on behalf of the citizens of Baltimore, but specifically Tracy, LaShawn, Cynthia Shawanda, Marsha, Janice, Phyllis, Barbara.  These are all the ladies whose sons that I work with have been killed and come to my office on a very regular basis. In fact, I leave here on May 8th.  I have an appointment with LC on May 9th. We set that, and she was pleased with that time because May 10th is the second anniversary  of both of her sons being shot in East Baltimore on Rose Street where 60 bullets were released  from a young man's gun, and her oldest son was injured, and her youngest son was killed. I've been working with these ladies for years and hearing these stories and hearing and  trying to understand a little bit about it and just working with them just to deal with this, and I'll talk a little bit about that later on.  And then also in 2021, I became aware of only because there's an individual who keeps track of the list of homicides in Baltimore, and there's a street called Gelson Street in a  neighborhood called Edmondson Village where in a six-month span in 2021, a 15-year-old,  a 16-year-old, a 17-year-old, a 19-year-old, and a 20-year-old were killed in a two-block section. And it made me think about a public health approach.  What is, you know, this is almost like that cholera pump in the middle of London. Or when Carl Bell talks about it, he's a famed community psychiatrist, a huge person in our  community who's since passed. But he says, if a person comes in your office with a rat bite, okay, if a second or a third or a fourth, you got to go find out where the rats are.  And so Gelson Street, I'm like, where's the public health approach? I heard it mentioned in the news somewhere, but where is the public health approach to this?  I didn't see it, and that's partly my problem, my fault, definitely partly my fault. So here we are.  And so I had this happen with this information, and there was a talk at the Mental Health Services Conference on 2022, and it was about mass shootings.  And it was about Sandy Hook, and that's a terrible situation. But the fact of the matter is, in terms of mass shootings, were there four or more victims,  there had been 12 or 13 in Baltimore between January 1st and October when we had that meeting. And I asked what could be done about this, and they said they really didn't have any  information for me. But these are the much more common shootings, and they also are much more likely to affect black and brown people.  And so this is something to talk about, and then let's try to figure out how we can do something about it, or I, because I don't need any more ladies in this cohort.  I'm really good at working with these ladies, because they've been telling me their stories, and I just listen.  And so a public health approach does actually work, and it exists in certain places, but not necessarily where we look.  And an approach that makes these young people visible, and not just rogues and predators,  and whatever else that people want to label these young black and brown people, particularly when they hit the news at night. It's complex. There are no simple answers.  They're just not. They're just not. But the thing that's exciting to me, and hopeful at least, is that we, as practitioners, most  everybody in here seeing patients, yeah, hopefully, with the skills that we already have in our training and ability, we can be helpful, and I'll show you why in a little bit.  We know some of these practices that I mentioned, but there's some information from the carceral  system that we don't necessarily know, because it's not in our literature that we can benefit from.  So there's a lot of hopelessness regarding this issue, and I want to talk about that openly. We can talk about it afterwards as well.  The thinking is that it's impossible to solve, it's hopeless, and that's our problem. That's not actually the fact.  And so, but I'm going to hope that we can talk about things that do work, and hopefully you can go back right away and start employing some of these things if you're in these places  – Philadelphia, Chicago, St. Louis, Oakland, Los Angeles, you name it, where black and brown young men and even women are dying.  And the world is not going to change today or tomorrow. Our practices can, but the world's not going to change today or tomorrow, and we have to  work within the systems and in the circumstances as they exist, as it is today. Can we stay away from the criminal justice carceral system? No.  Is our ignorance of that system harmful? Yes. We as community psychiatrists, if someone asked me what we do, is that we aim to provide  recovery-oriented, person-centered, systems-based practice. And so, recovery-oriented, person-centered, okay, systems-based.  And so, we are a small part of the health system, a small part, and there are lots of other forces operating.  I tell the residents that 10% of what you will do – I get the PGY3s, third-year residents – 10% of what you will do to help a person has to do with your prescription pad, and  90% is knowing about the community and the systems in the community. And if you want to really help people, learn about the systems in the community.  We need to know about the carceral system for a lot of reasons. One is that – the question was asked, who is working with justice-involved people? One person. That's not true.  That is not true. And what I mean by that is that every member of our community who goes to jail is still a member of our community.  And so, it is incumbent upon us to reach into the jail as best we can. I do it by calling a colleague of mine when I find out that someone is locked up and try  to get them to mental health care and get them noticed. And it can be extremely helpful, extremely helpful.  And so, I'm not in the system, but I'd better be helping my people in the system. I'd better be doing that. They're part of the community.  They're going to come back out, and I hope they come back out in decent shape.  If – one place to start is where I end up starting and I'm learning – and I'm reading articles as of yesterday, so this is an evolving sort of learning and understanding.  This is a book called Bleeding Out. And I came across this book in a sort of serendipitous or a God way. I don't know which one it is.  I'm going to lean on God, actually, preferably, because my daughter goes to University of Maryland College Park.  They send out those little booklets, those newsletters, whatever you call them, efforts to try to get donations partly. I get that.  And I'm just flipping through, and I found this book. And so, Bleeding Out is written by a criminologist, is by his description.  He's at University of Maryland College Park now, as it turns out. And I start reading the book, and I'm like, you've got to be kidding me. Really?  This information is out there, and I didn't know about it? And it gets even worse than that, and I'll tell you in a second.  And I would recommend it to you, partly because it would be better – in many ways, it would  be better than what I'm talking about in terms of what you can do in your position, in your place.  And the reason I say that is that you will read, and then you can see what's possible based in your system, because of where you touch the system currently.  And it is a great primer on criminal – I'm sorry, on gun violence reduction. And it will allow you to start applying immediately, which I'd already started doing, and I'm  adding even more to it. And one of the things that I've discovered in the book is that our mental health language is all over the book, because it's all over gun violence reduction.  The things that work are all over our practices. So for instance, Baltimore has a group violence reduction strategy, instead of a gang violence  reduction strategy, because gang gets you a certain kind of mindset and ideas, and we start to project onto that.  None of us really know about gangs unless you've been in one, and we don't really know about how they operate.  And the other thing, too, is that depending on the city, the corner, the block, the neighborhood, it all varies how this operates. And so it's group violence.  And one of the elements that is extremely helpful in trying to reduce the gun violence is to focus on particular people in particular places doing certain things.  Have any of you heard of people, places, and things before? Of course. Yes. Absolutely. Absolutely. So that's what I mean by this.  There's very many things that are familiar to us, but they're in that section. And so what that means is that there are certain people doing stuff, and the community kind  of knows about it. The police know about it in certain neighborhoods, in certain corners. Not every corner.  And not every corner in southwest Baltimore, not every corner in west Baltimore, not every corner in east Baltimore, but certain corners. And they're doing certain things.  Not every member of a group, clique, gang is a trigger puller. There are some folks who are in the group just because, you know, it's something to  do, and then there's something, and some are dealing drugs, and then some of them are whatever. But it's just certain people, certain places doing certain things  and something we know about.  In Bleeding Out,  and I'm going by memory, but there's a section that describes the fact that there is no effective gun violence reduction without cognitive behavioral therapy.  Raise your hand if you've heard of cognitive behavioral therapy. I have.  I didn't know it was involved in that. I had no idea. I had no clue.  And so now here's where my ridiculousness comes in. So I'm reading and it's describing a program that's going on in Baltimore City and it's a program called ROCA.  Stands for rock in Spanish.  It's originated in Boston, Massachusetts and it's around in other places and they are an agency that's a contractor for our group violence reduction strategy.  And their mission is to disrupt incarceration, poverty and racism by engaging the young adults, police and systems.  That's us, right? Systems based practitioners. At the center of urban violence and relationship to address trauma. That us again? Yeah, yeah it is. Trauma informed care. Find hope.  Drive change.  And here's how they do it. Part of what they do. So our current team ROCA has 420 young people between the ages of 16 and 24. Primarily young men that they are reaching out to.  And what they do is what's called relentless outreach. So they try to engage and see people who have or at risk of gun violence twice a week.  I'm on an act team in Maryland and our goal is to see people twice a week. I've heard of this before.  Relentless outreach. And we go wherever and we do. And then they go wherever. They go wherever. They go back and back and back. Same thing. And they do what they call rewire CBT.  So they call it, it's cognitive behavioral theory.  And so they have CBT on site. They have these laptops that they take out. I went out with them one day, just one day. And did three outreaches with one young man  and three with one young lady.  And they did the CBT right there.  Right there. And so they do it in the classroom and they over and over and over and over again. Because what they're trying to do  is to help these young folks stop and think before acting. Stop and think before acting. Stop and think about all the provocations that go on.  So for instance, I'll give you an example. In the black community, if you say something about somebody's mother, it's an automatic fight. It has to be.  But what CBT can teach you is to stop and think, is this fight worth it? And what's gonna happen? Are we both gonna die in this fight? Or something similar?  Are we both gonna, or am I gonna? So not using an extreme example, but there's so many things that present themselves to these young people to allow them to stop and think.  To rewire so that they don't automatically respond. And these folks can gain control over their impulses.  Yes.  The other thing too is that they recognize that these young folks who are doing whatever they're doing prior to coming in are learning and moving forward,  but they're at risk of falling back to their previous ways.  The trans-theoretical model of behavior change. Pre-contemplation, contemplation.  We've been here, right? Relapsed, we're here. They're using our stuff.  We should be involved. We can use it, we can start now. Period, end of story.  Now here's the worst part about this Roka thing. I have been doing tours of the community for decades. I take medical students, I take residents and so forth. And all around.  Roka, and I didn't know about it until this book, it's a freaking half mile from my clinic.  But it was a silo away because I didn't know. And that ignorance is not a good thing. But at least I know now, but half mile. I had driven past it and didn't even know it.  Didn't have a clue. Yeah. So the other thing is that group violence reduction  requires police involvement. And the ideal is focused, balanced, and fair policing. Well, Baltimore's police are under a consent decree  for some of their behaviors for decades, years.  All right? But that is not an excuse for us not to try.  Because that's the police we have today. And young people are dying today. So are we gonna fix the police force first and then? No, we don't have time. We don't have time.  We don't have time.  And ideal policing offers incentives and promises.  And I didn't say threats, but promises.  Incentives to go to something like ROCA.  The police do a lot of referrals. They have weekly meetings about this, and they do a lot of referrals to ROCA. And what some people don't know maybe is that  in terms of on the corner's got, police officers know, the community knows, and blah. There's a book called Ghetto Side. It's written in Los Angeles.  And there's a chapter called Everybody Know. So the official solve rate for homicide  may be 30, 40% in certain cities. But in the community, it's 100%, because everybody know. People know who's doing what, and who's done what.  But they're not gonna talk to the justice system about it. Black people have had lots of policing, but not a lot of justice. And so there's a vacuum of safety.  And in that vacuum comes people picking up guns themselves. Everybody knows what's going on.  So the police know.  And so the police are referring these young people, even though we are not in the greatest of shape in terms of the quality of our policing.  And defund the police and all that? Yeah, okay. But the thing is, is that the police are there. And I can guarantee you that the average citizen  in these neighborhoods wants the police. They want policing, but they want the police. They don't wanna defund the police. You gotta be kidding me. Not a chance.  That's not what they want. And we're already connected to police anyway. If any of us do involuntary commitments, we're the only folks that have,  our people who are in their most extreme getting put in handcuffs. You're having a heart attack or a stroke in evolution, you're not getting put in handcuffs.  But our folks who are having a mental health crisis are put in handcuffs. So the police are involved. And so we already have contact with the police. So we can't just say,  we're not gonna deal with the police. As I mentioned, sequential intercept before.  And so what we can do. The other thing too is that we can have some influence on the behavior of police.  Just like, for example, our crisis services.  One of the things that we can really do is, if you work at a crisis service or the psych emergency room or something like that, make it very, very easy for police to get in and out.  Because what that incentivizes them to do, in some instances, is to bring people who are perhaps in a mental health state or a criminal state or who knows what.  But if they can get in and out in 30 minutes, because they know they can't get in and out of the jail in 30 minutes, but if they can get in and out, they'll take a chance.  Okay, whatever, you know. We'll just bring them to the psych emergency room because we can keep our guns on our hip. We can go get some water. We come in and go out  and then we can drop the person off and we're done. We're done. And so they don't have to know anything about the whole mental health apparatus. No, there's an incentive there.  And like the rest of us, they respond to incentives and so do we. So we just go ahead and do that.  Just looking at Roka's impact in terms of their year end report for 2023. It says 360 enrolled, because that was the end of 2023, but they're 420. Now, 26,000 outreaches.  They're doing stuff. They're busy in a year. 14,000, 15,000 contacts. And 83% of them engaged in the rewired CBT. This is their reports.  92% retained in employment.  Maybe 5%, 10% when they started and no new incarcerations.  94%. That's a big deal for these folks. Because these are all folks who have been referred by criminal justice, juvenile justice, police, blah, blah, blah.  I don't know what it's doing to homicide in Baltimore. It's been around for a few years, but homicide,  it's getting better in Baltimore.  And so at this stage, this is today, as of May 5th, 2024, there have been 60 homicides in Baltimore already. 60.  A year ago, 90. Two years ago, when I first started talking about this and crying about this, literally crying about this, 116 homicides just by Bay.  This is a city of 590,000 people. It's a small group of people. And that link there is where I follow the homicides. There's a private citizen who does this. The police also do it,  but there's a private citizen who does this. And it's a blessing and a curse. It's good to have the information. The other thing too is that I'm scrolling sometimes  and I'm like, shit.  That's my patient. Damn, no wonder she didn't. Okay. I'm scrolling.  My patient's daughter. What is she doing in that?  I'm finding patients and...  Yeah, yeah, yeah. Yeah.  So what we can do? To front our own nihilism, reframe what we're talking about this.  Some of us who do community work already know about relentless outreach. And so we can do some of that as a part of what we do. And then trying to bring people in.  Connecting to organizations that already do this work. And there are people in your community who probably are doing these kinds of things. And so provide...  And so for instance, for Roka, one of the things that we can provide is trauma-informed mental health care, physicians and therapists. What we can also do is provide support  to the workers who do this work, because this work is hard. The day I went,  the day I went,  one young man had been killed that day. Earlier in the day, there was a conflict where guys had to be separated. This kind of thing.  And there's one of the young ladies I went out with, she said, look, I cannot take him in the community because I don't know who's aiming at him, who's targeting him.  And it reflects one of my patients who said, I can't, I have to have a car, doc. I can't ride the bus. Because I'm out in the corner, I'm invulnerable. He did a homicide years ago  and he's trying to keep himself safe. And has lots of information like, if I wanna get somebody,  like we talked about that relapse thing, right? If I wanna get somebody, all I gotta do is go to their mother's house. They're going back to show up there.  People know that. And they hold that for 20 years and sometimes. So at any rate, we do CBT so we can help people stop and think just like they do it at Rewire  and we get them in our office.  We can do dual diagnosis treatment. Alcohol makes trigger pulling easier.  We can do that.  We can apply the stages of change mindset and keep reaching out to people and keep trying to connect with people no matter what. When people come to our clinics,  they always come, in my clinic anyway, they come in angry because they tried drugs, they tried sex, they tried women, they tried men, they tried all the kinds of things.  And now they come in and see a damn psychiatrist. You gotta be kidding me. Gotta be kidding me.  Yeah, he's black, but does he understand me? Not really. Here we go.  The ladies have helped me a great deal to try to help this come forward because they talk, they teach.  And so you can bring them in as well and let them tell you the story about their child's homicide and part of that is that maybe you can also reach because they have other children  and maybe their other children, you can help get them in the clinic and help them to, or at least through proxy, reach out. And so what I mean by that is that,  so LC, who I see May 9th, her other son was sometimes going back to the neighborhood where he was shot, the street, the very street, like y'all, whatever.  Either you kill me or you don't, he's depressed anyway. And so what she was, she couldn't get him in treatment, but she was sending him texts every day  when he got a job and supporting him. And I'm encouraging her to do that. That's a great thing, you know, because it changes the people he's around,  the places he goes and the things he does. And so he's not my patient, but yes, he is. I'm trying to keep him from being next. And so we can do that with the patients that we see.  As long as we listen and learn what their families are doing and hear what the moms are talking about, and it's usually moms, it just is.  That's just the way it is in my group anyway.  The other thing, too, is that when you ask one lady and then you ask two and then you ask three  and you learn and you listen and you learn, you can take what you learn from one, two, and three  and talk to number four. And there are ladies who are 100% sure that I have not had my child killed.  And so how can I understand you? Well, the reason I can understand is because of what the other ladies have told me.  And I put that out there in front. And I tell them, I said, look, you know, based on what the other ladies have told me,  what they have said, what the women have told me, here's what you're going to be facing.  Three years ago, when it was 300 murders a year, every year, Shawanda's wondering, you know, what's up with the case?  It had been three years. And so the detective, he's not, you know, because there have been a thousand murders  since her child was killed. You think the detective is thinking about her case like she is? Not a chance.  And so that carried that information forward to the next person. I mean, there's just so much to learn  just by listening to these folks and then applying it to the next one and to the next one.  And so I don't have a caseload anymore. I have a cohort. And so I'm the intermediary with these folks back and forth  and things like that. So we are, and some of these ladies don't want to go to group. They don't want to go to the mothers of murdered sons and daughters group.  They don't want to go to the Family Survivors Network. They don't want to go to Roberta's house.  These are all in Baltimore, but they'll come in my office. And so I've got to make a sort of a makeshift group,  even though it's just a, it's an asynchronous group. How about that? Post COVID, there we are.  The other thing you can do is that, like I said, in your community, there's a group violence reduction strategy program,  probably, or there's a police reform strategy. I found that in the D.C. schools, police,  there's a D.C. council is doing a reform program and they mentioned some programs like there's a program called  the Trigger Project. And what the Trigger Project, I don't know how good the program is,  but they have a slide that's called Gunderstand. And what it shows is there's three young people and why they carry a gun.  And so we do harm reduction. We do pre-contemplation. When you have a pre-contemplator and there's no problem,  you have to find out what it is that they like about their substance and why they do it, where they get it from.  You know, is it safer? You know, are you buying in a neighborhood where the fentanyl is in the cocaine or not?  Are you getting beat up when you buy? Are the drug dealers treating you okay? I mean, this kind of thing.  And so because they're not ready to stop, but they're ready to have a, we can have a relationship with them.  We can absolutely have a relationship with them. And so these young people will say, you have to gunderstand us.  There's a reason. I carry the gun because this dude threatened me. And he has a gun and I know he does.  Start. Just please start. Start. Don't desist. For the invisible and the beloved.  Okay. I thought I could get through without crying, but it's just tough. So if you can make your way to the microphones for your comments and we can have the conversation.  You know, it's, I know Thomas app really well and the work surrounding, you brought up some conversation surrounding Listeria.  I think it was that you, cholera. Yeah. Cholera. And, you know, I've talked about TB and direct observed therapy  and how we eradicated TB in this country is we went out into community and said, take this pill. Ah, let me see you swallow it. Ah, okay. You swallowed it. Right.  Direct observed therapy is the type of therapy we need in gun violence prevention.  It is not an ivory tower approach. It is a community based approach that is only going to decrease violence as direct observed therapy.  Yes, ma'am. Just state your name, where you're from and ask your question.  Okay. Claire Cohen, Pittsburgh. I'm a child psychiatrist and I'm going to give a very quick case of patient I recently had because he exemplifies all the questions I want to ask.  So this is a lovely, delightful young 13-year-old boy by the name of JJ and he came into the hospital. He wasn't living actually in Pittsburgh because of gentrification.  All these black people are being moved out into Pittsburgh into suburbs that are resource poor. And his father was killed in some drug-related gun violence a few years ago.  He has a single mother who's working two full-time jobs. So she's not able to supervise him. So he's in the community getting in trouble.  Got picked up by the police because he brought a baseball bat to some corner for defense. And luckily for JJ, when they picked him up, he said he wanted to kill himself.  So that rerouted him to the hospital, not to jail. And luckily for me, he got me as his psychiatrist.  So when he didn't say he was, he did admit he was depressed because he was from his dad dying. But he didn't say he was suicidal or homicidal.  And I was not going to let insurance just make me just kick him out the door with ineffectual therapy because that's not where I am.  So I fought. I did something I didn't want to do as one of my strategies, which got child welfare involved for, quote, neglect because I wanted him,  and luckily they did, to put him in some services. When they asked me what services, I said JJ needs to be in football camp,  which doesn't sound like something a psychiatrist, but JJ likes to play football. So luckily for me, CYS put him in football camp because he didn't really need medicine,  maybe a little bit of an antidepressant, but that wasn't the issue. And he needs some in-home services to keep him busy and out of trouble.  Now, I know that that by itself is not going to be the full answer for JJ because he'll probably get kicked out of football camp, unfortunately, or maybe he won't.  I'll get lucky there. And he's not my patient that I can continue to follow because of where he lives. But someday I think I see him as a kid who's at risk for gun violence  either due to homicide or accident, maybe also suicide, but I think for JJ it's more that. So my questions are, one, we need to fight to change the system.  How do we get more psychiatrists not to just not fight for all of what a kid needs because insurance just wants you to discharge them with bullshit?  I'm sorry, but that's the way it goes. So what's our obligations to fight to change the system? But in the meantime, we're fighting to change the system,  to help other psychiatrists be more creative, like I try to be, and helping little black boys like JJ.  And also, is there a way we can have a better assessment tool that helps brings out why we need to do more than just pop this kid a pill  and send him out of the hospital that can help support us? What other tools are there to help us support us in saying we need to come up with a disposition plan  that really might give a kid like JJ a chance? Thank you.  Is he still in Pittsburgh, or is he outside of Pittsburgh in resource poor area? Yeah, yeah.  Sure, sure. So as many resources regardless that can help him be around.  I mean, the team, the coaches, different people, different things. And then coaches oftentimes recognize that these guys are struggling  and are much less likely to kick him off the team because they know. Because they know. Because that's who they're working with.  And so they're just trying to keep people safe and connected and so forth. And it'd be great if you could still see him.  Because that way you can see him follow through, go through, come, go, lose contact, lose interest.  But there's somebody out there who's worried about him, thinking about him, praying for him. And if there's somebody who can substitute for that.  One of the things is that continuity of care is nice, but continuity provider is so much better. It's so much better, seeing these people for years.  At any rate, I don't have anything. I just want to add, the literature talks about the best violence prevention is surrogate family structures.  So you prescribing football is in line with the literature. And I think that's why it's so important for us to be advocating for additional resources for research.  Research that is translational research at the NIH and the CDC, at academics that show the outcomes when someone has been prescribed by their therapist to football.  And a series of studies of those individuals. I used to coach football. And the point is being made as well is that those boys, including my son was on the team and had a father.  But those boys needed a father. And the star player watched his mother get murdered by his father. And his father was a drug addict. And he was phenomenal.  I mean, this kid could play better than anybody. We buried him three years ago. Right?  The other thing that we built in D.C. that I wrote the legislation for is the violence fatality review committee.  Where we reviewed in a multidisciplinary way with providers, psychiatrists, physicians, social workers, education, law enforcement. We looked at individuals' cases.  And it's still going. We look at individuals' cases. And look at where they come into contact with the system. Whether it's the social services system, the criminal justice system.  And larger policies are generated out of those reviews. Just like infant fatality review, domestic violence fatality review.  Policy is created at the local level, at the D.C. local level. So I would advocate wherever you are for a violence fatality review committee that can generate policy.  And those policies can translate into local Medicaid, Medicare constructs, Medicaid constructs. That will allow for things to be covered locally.  But not necessarily be covered by the federal Medicaid. The only other thing I wanted to add to that.  I mean, just because I think we're talking about, you know, the policies and trying to get more resources. These high-level things which I think are critical.  We've been talking about, you know, for the last hour.  But, you know, I think your individual effort, you know, that time, that humanity, you know, that's something else you can also advocate for, too.  I mean, obviously, you bring that to the table.  But, you know, if you're a clinic or these settings where we're working in, don't give us time to see that person, to be with that person, to hear that person.  You know, we're not going to be able to help them. We're going to be shoving pills or, you know, throwing our hands up. I don't know what resource. I don't have time to look it up.  You guys are good. You know, get out of my office. I can't do anything for you.  But if you can take that time, if you can advocate in your clinic or in your settings for you, for your other providers in your clinic to have that time,  I think that's another thing that we can do today in addition to all these other things. Get a chance to go to a football game. Just show up. Of his. Of his.  Him seeing you in the cheering stand will make a world of difference. Good afternoon. My name is James Lockhart.  I am a PGY3 at George Washington University, up and coming child and adolescent fellow at Children's National. First of all, incredible presentation.  I feel like our work is so intertwined and so involved in what you presented today. I feel like this should have been packed. You know, I grew up in a place in Chicago.  And thank you for keeping the late great Carl Bell name alive. I grew up in a place called Cabrini Green.  Some of my earliest memories in childhood was people begging for their life, getting shot under our window. And so, you know, I lost my brother at age nine.  I lost another very close cousin who was like a brother to me in 2009. And the 21st of May would be his memorial.  You know, as a budding psychiatrist, so often at GW, I do come and encounter with people who have similar backgrounds to me. Because of that, there's a certain connection. Okay?  Unfortunately, the numbers are just not there as far as representation. Okay?  So much so that my first week on the inpatient unit, a nurse mistakenly as a patient, and it was called that a loose patient was on the unit. Okay?  How do we work on recruitment and pipelines for people with backgrounds similar to ours to help at this work? That would be my first one.  The second one is, you know, one of the things that did help me was extracurricular activities. You know, I did carry guns as a child as well.  But there was interventions that happened to me early on to kind of change the trajectory of my life. Okay? Things were expunged from my record.  If it wasn't expunged, you know, I was on the corner like everybody else.  If it was somebody from another community, ooh, that was a goof. All right? For me, they locked me up.  And I had to, you know, go to court, get things expunged to be in the position that I am in now. I'm very thankful.  How do we change and work with the local government to change and bring back those programs that helped me to get here today? So I'll start.  So real quick, I'm on the board and I'm going to recruit you to Young Doctors D.C., the Young Doctors Project. We're in Roanoke. We're also in New York. And we're in D.C.  And we mentor young black males to be physicians, scientists, nurses, whatever they end up being. But right now we have 100% high school graduation rate.  We've been working with our young men for now seven years. And so I think you have to be, I call it the mirror of relevance.  So it's really, unfortunately, we have to be in spaces and places to recruit. No one's going to go recruit young black men off the block to be adolescent psychiatrists but you.  Nobody's going to recruit them to be a forensic pathologist but me. So there's no one else that's going to do that work. We have to do that work.  And so get connected with organizations that are doing that work of recruitment. I think that's extremely, extremely important.  And in a general sense, one of the most important things that you can do is save yourself first and take care of all the needs because you have been through a lot.  And you did not create the system that you see, and it's not up to you as an individual to fix the system.  It's just not possible, and it can result in you burning out,  burning up, and that kind of thing. So, you will do plenty.  Do your part, and then try to get other people to do their part.  They may be willing, they may not be, but I just don't want you to get consumed.  And this is a conversation I have with nearly every black resident.  And in fact, I had this conversation with this one young lady, save yourself first, blah, blah, you know. She's concerned because the inpatient psychiatry is a similar situation.  She's a young black woman, but not so young.  And she's like, why are these white residents treating these people like this?  And I said, save yourself first. In other words, graduate residency, get your certification, blah, blah, blah. Two weeks later, she was dead from domestic violence.  I was like, you've got to be kidding me. You've got to be kidding me.  Yeah. So, save yourself first. My question is a little bit more boring, but I work with Dr. Adams. I'm Jane Richardson, and he knows that I'm incapable  of not asking a question in this sort of scenario. I was thinking about the deaths in incarceration. One thing you, and there's sort of two brief questions.  One thing you mentioned was that there's this form that has to be filled out, but only if it's not a natural cause of death.  And I'm assuming that it's just like the prison guards that are determined.  I have a patient who I knew had gotten arrested while he was psychotic, and he was waiting to go to one of the forensic hospitals, and I got a call that he was  in the emergency room at Maryland, and I didn't know what that was about, and I went over, and he'd gotten frostbite while being in seclusion in the jail.  Which I would say could have been a natural cause of death, but obviously, was because they were, you know, not taking care of him.  So, why don't we just have them do the form on everybody who dies? Thank you.  Hand clap applause for the rhetorical question, right? Because absolutely, right? And that's the pushback, is that they're not capturing all the deaths in the carceral system.  And, you know, frostbite, all those environmental should be classified as an accident, just so everybody knows. That's not a natural death, right?  Hyperthermia and hypothermia, both of them are non-natural deaths. They're considered accidents because they're preventable that way.  But that being said, it's important to have a full assessment of that. And once you understand, there's this thing called the Medicaid Inmate Exclusion Policy.  If you ever heard of it, it is a law in this country that an individual that goes to jail loses their insurance privileges.  You don't have any insurance, right, if you're there longer than 60 days, right?  There's a new amendment, you can get an addendum, you can get it now if you have a psych issue, substance use and abuse issue, if you're 60 days out to when you're released.  But while you're there, you have no true Medicaid, right? The suggestion is that you're going to get the right healthcare because the government is giving it to you.  That being said, those, most of us working in systems have to have an electronic EHR. Jails and prisons do not need an electronic EHR.  And the majority of them do not have an electronic EHR.  And so you, there is no monitoring of those systems. I have an uncle that provided care, incarcerated individual, created great care.  But those measures to ensure that great care is provided is not measurable behind bars.  It does happen to be 12 o'clock, so if you feel you need to leave that, we won't take it personally, but we're going to be here until all questions are answered. Ollie?  Yep. Take your time. All right. One other quick question, and I'm sorry, this is what had me, like, shooting at my hand while you're talking. I'll do a quick answer.  Sorry. You said something about, something like controlled housing or something like that as a risk factor for suicide. I assume that means, like, house arrests? No. No.  It's actually controlled housing within the carceral system. So there's restricted housing within units, and then there's housing that you can kind of move within. I see.  Within the population. That did make me wonder, then, about, like, home arrests.  Is that a risk factor for suicide? And are we counting that as being a death in custody if they're on house arrests?  So probation right now is not being, if individuals are dying while under probation, parole, they are not being counted as a death in custody. Well, they should be. They should be.  Absolutely.  And as far as the house arrest in general, or the risk factor associated with it, I would believe that that isolation, Sandra Bland is a good example.  So Sandra Bland was in isolation right across the hall from women that were, like,  they could hear her moaning and crying.  And they said, why don't you just put her in here with us? And they refused to do it.  So Sandra Bland is a really good example, another really good example of how isolation can breed suicide. Thank you. Yes, sir.  Well, I was about to say good morning. It's not morning anymore. But hi, my name is Wes Smoo.  I'm a PGY3 at Meharry Medical College. I'm going to continue my training at University of Maryland  for child and adolescent psychiatry.  Come on.  I have a, with my colleague who left, I have a, not the same story, but I grew up in South Memphis. Then we moved to Atlanta.  And my uncle is one of the chief of police in Memphis now. He channeled his anger, all of that, into being a police officer.  And he married my aunt, who's also, like, the sheriff of Memphis.  So gun violence is not strange to me.  I'm not foreign to it.  Lost people. I'm now training at Meharry Medical College, which is, like, the unique experience of being on the other side of the fence and seeing my patients.  Being able to do act team with them, move throughout the neighborhood, and all of that stuff. However, it's like a two-sided coin.  How do you, how do you plan to continue an act team in a place that's underfunded now, and we have to do grant funding for things, and it may or may not, because Tennessee is one  of those places that they will snatch stuff when you mention any DI, anything of that nature. Like, how do you continue and push forward and get the funding for act team for things?  And to, and my second question is, like, for mentoring, how do we, you answered it, how do we continue to push sciences and becoming physicians to Black youth?  Not necessarily Black men, but just Black women, Black men in general, just all of them.  How do we continue to push that? Let me say something about the act piece.  If it's possible to make the argument that a certain community treatment is much cheaper than standard care based on act's marketability to, marketability,  to reduce hospitalizations, and so the monthly rate for act is far cheaper than two days in the hospital, and so if you can make the argument with the people who operate  in spreadsheets or count money, you can say, look, you know, we're going to save this system,  X number of dollars by enrolling these people in act services, because they're going to show up somewhere. They're going to show up in the hospitals, jails, and all these places  that are far more expensive, so let us have them on the act side if we possibly can. And perhaps you can make that argument.  One of the challenges is, is that he who pays cares, and so if it's, if it doesn't cost, if it doesn't accrue to their line, they don't care.  So you have to be mindful of that, and then the mentoring. Well, I want to just say it, the same thing.  The world of DEI is not a moral argument.  It's a financial argument.  It's an impact argument, and there's enough literature that talks about the finances and impact of diverse work groups and diverse outcomes and diverse populations.  There are money arguments, so DEI cannot be a moral argument. So stop, if you're doing a DEI moral argument, don't do it anymore.  Get the financial literature. You'll have more than enough weapons to do that. So that's it. You know, nobody does things because it feels good anymore. That's not what we do.  The second thing for mentoring, yeah, be a mentor. I love the, you know, save yourself first, right? I'm glad, he's talking to me right now, right?  But, yeah, man, you just got to get involved and find and create relationships.  Everything is about relationships. Everybody wants to be loved by somebody, and, I mean, the reason why people do anything that they do that is negative  because somewhere they didn't feel loved.  So, you know, if you find love and can give love, then that's really, the human experience is the generation of that love aspect and fulfillness, and that's where we get it from.  So this, and that's why violence, particularly in urban smoldering violence that is based on structural racism and the dismantling of black families,  all it is is about rekindling that love, right? And you can find it as a peer.  Like I mentor people that are older than me, and I just give them love, and these men will change their lives because I show up consistently, right?  As well as the young people that show up consistently.  You know, one brother told me the other day, we were the same age, he said, I don't know if I see you as a mentor or uncle or a father.  I said, a father?  Brother, we're two years apart.  But the reality of it is is that that's what it is, and that's not just, you know, for black people or, you know, that's a human experience needs that, right?  I tell my children they're going to have me until I die.  I will never give up on them.  And they can take that to the bank, that's why they want to be successful,  because they feel that love and support from their mother and I. So as a mentor, that's all we're going to try to do is try to create that love.  The only thing I would disagree about is that they'll take it past that,  beyond the day you die, for sure, that's right. And I can, part of this talk, I channel my mentors and my, I aim to honor my ancestors  and predecessors whenever I open my mouth, because they can't speak anymore, but they can speak through me.  Thank you.  I've trained under, I've worked under a lot of psychiatrists, and I have one.  Good afternoon.  I'll be very quick, y'all.  I am a therapist. I work in Newport News, Virginia, which is a very urban area. I have been directly and directly impacted by gun violence.  My cousin was murdered in Norfolk, Virginia.  November 2020, me and one of my colleagues that are here were actually present during a school shooting in our building. I don't even know how to classify ourselves.  Are we school shooting survivors or witnesses? It's still very difficult to process.  And since then, my colleagues, more than I, have had a steady stream of crisis calls involving gun violence and has been very disheartening to hear,  especially when you consider one of those involved a six-year-old. So it was very important for me to support this presentation.  I would be very interested to hear more about CBT when it relates to gun violence because I find that CBT is very goal-directed and working with irrational thoughts.  But I find that my students' thoughts are not irrational.  A lot of the behaviors we're seeing, they are survival skills, whether we like it or not, the defensiveness. They need these skills to a certain extent.  Personally, I like to use acceptance and commitment therapy, which is a subset of cognitive behavioral therapy.  It focuses on radically accepting our circumstances and focusing on not seeing ourselves  as our emotions and kind of diffusing from them and also establishing values within ourselves.  But again, it is sometimes difficult to know that I'm treating someone that's going back to the same environment, the environment that's making them sick.  So I'm sad that she left because I wanted to sing the praises of the psychiatrist that first spoke about the importance of mentorship  and getting them to see another life versus what they have. The school that I'm at, I just try so much.  I will be honest, I go outside my scope of therapist because I just find that my young black boys, they need so much.  I tell them all the time, when I see y'all in the hallway, I see y'all as kings. I see you as doctors. I see you as lawyers. I see you as engineers.  I see you as more than you see yourself. So I try to make a point to be present in the hallways at the middle school that I work at.  So I don't know if this is much as just me sharing my experience. I don't really have a question.  It's just, you know, still just disheartening that my children are going back to the environments that are making them sick.  And I can teach you how to regulate your emotions, but I can't say anything if, you know, the other young man who's, you know, y'all like the same girl or you stepped on his shoes  and he's reacting in a hostile way, you're peaceful and you're regulating your emotions, but that person might not.  So can you see how survival skills may still be needed for the demographic that I work with?  So thank you for this presentation I just want to share.  Thanks for your comments and your work.  And same as to the other young gentleman, make sure you take care of yourself and save because you don't want to overspend.  It's not, you see it and so it's hard to resist doing something. I get that. I get it. I get it. So just be mindful of that piece of it.  At the same time, by helping, doing the acceptance and commitment therapy, rewire CPT,  any of that is still helpful because you don't know where, when they leave, where they take that. And even in the same environment, they may make a different set of decisions  because they see something now that they didn't see before. And you're injecting and hoping them, helps them to say, okay, there is something better for me  so then I can make this decision. I have, you know, I still, they still have the capacity to choose even in some bad situations.  And they may start making better decisions to preserve themselves, not to obey the law or just to preserve themselves and to see to a better day.  Because a lot of these guys have a foreshortened future because they get surprised that they're 18, 21, 25, 30. I've got patients that are like that.  And so they don't know that there's a longer view. And when you're talking to them about that, helps them to perhaps consider that there's something more to me  other than what happened to every other person in my community.  And it's not every other person too. Most people don't carry guns.  The ones that make the news carry guns, but most people don't.  Anyway, nice work. Thank you. Appreciate you. Thank you. And the only thing I was gonna add, I know we've been talking about taking care of yourselves  and kind of mentorship and our role in that. But I do also, I mean, I think whether it's getting involved in local organizations, figuring out where you can be a mentor,  it's also good to get your own mentors, right? I mean, I think some of us, maybe I'm not as young as I think I am anymore, but entering this field,  and I'm thinking about the residents and other people kind of just getting started here, there's places to get that support. And for me, I met Curtis 10, 15 years ago now  in the Association for Community Psychiatry, not psychiatrist, psychiatry, which is open to folks. And that's where you find, for me, I found resource and support and understanding  on some of these challenging issues and clinical cases and just kind of what do I do, how do I throw my hands up and find a place to channel that energy and to get that support.  So you don't have to join the Association for Community Psychiatry, but I mean, finding that place for yourselves so you can get that support, because the work is hard.  Good afternoon. Thanks for the great talk. My name is Tyson Boudreaux, and I'm here in New York. I'm a child and adolescent and an adult psychiatrist.  I work for the New York State Office of Mental Health. And I wanted to know your thoughts about going beyond the traditional approaches of CBT,  of the Western colonial heteronormative patriarchy lens that we use to treat patients. And think about engaging faith-based organizations and wellness strategies,  which focuses on social prescribing to help young people of color to go beyond suicidal violence or homicidal violence.  Just, I'll mention an example.  Also in Baltimore, and I haven't mentioned it, is an organization called the Holistic Life Foundation.  And started by Uncle Will, based on the book,  who learned mindfulness and yoga practices and taught them to his two nephews and his good friend. And this organization is responsible  for what's called the mindfulness moment, as one example. They were the first in the city of Baltimore to put mindfulness-based practices in Baltimore City schools.  And so there's a school called Robert Coleman Elementary that no longer has detention. They have mindfulness. They start the morning with a mindfulness moment,  and instead of going to detention, they can come to the room. And there are many in the city of Baltimore, many schools that are involved with this,  and they have extended it elsewhere, just as an example. So yes, we're a small part of the system.  And there's so many people out there,  community-based folks who are doing so much work. And I prescribe a lot of that.  Our libraries are quiet, peaceful, and they have social worker in the library and lawyer in the library. In the middle of Curtis Bay, which has almost no resources,  which is in vision site of the bridge that got knocked down in Baltimore, is the Filbert Street Garden. And I have prescribed that to a patient of mine  who's got PTSD, and she loves, she goes, she enjoys. These kinds of, so there are many things that have nothing to do with our system. So we have a lot to learn from the community.  There's a lot of wisdom within the communities of color, and it's epistemic injustice for us to believe the psychiatrists hold all the wisdom and the powers of truth.  There's wisdom within the communities. How can we learn from that and partner with the trusted entities in order to gain the wisdom  and use our resource and our practice to help our people? Because what we're doing now ain't working. We have to be willing to go out in the community first,  listen, and like I said, we do home visits, mouth shut, eyes and ears open, listen and learn, because there are so many people. The same street where those two young men were killed  is the Rose Street Community Center run by a former corrections officer who does social work for his community. There are so many people out there who are doing so many things.  The folks who were in the other cell, Sandra Bland, they were trying to reach out to their sister.  You know, this thing called American psychiatry  is a thing and our thing and how we talk to a certain extent, but we are small and a whole bunch of humility would be extremely helpful because there are so many brilliant people  out there in the community doing so many things, saving lives, and we don't know anything about it. And we are sometimes in the way,  and we're doing some things that are not helpful. I've got at the University of Maryland School of Medicine, we have a department of epidemiology.  We're doing nothing in East Baltimore, West Baltimore, wherever Baltimore, about gun violence, nothing, nothing. We have a shock trauma, which is world famous,  but it's also doing hospital-based violence interruption, which doesn't work. The studies are small. They've been around for 30 years, but it doesn't work.  We just do what we think we know, and we don't know enough, and we just, we're not gonna be, the medical facility is not gonna be humble enough,  so we just work around it and do the best we can, listening to the people that come in the door. There's a book, Murder is No Accident, by Deborah Prothaus-Stith.  Deborah Prothaus-Stith, she's now the dean at Charles Drew College of Medicine, and she came out of Boston. She's really the auntie of violence prevention.  She's my auntie of violence prevention. That's where I learned a lot from her and David Satcher in his work on youth violence prevention,  and both of those rubrics are community-based rubrics. Both of them center. I mean, she, in her work over a decade of work she did in Boston  was to decrease homicides of individuals under the age of 18,  and that was a collaborative, with faith-based groups that are part of it. So to your point, there is no violence prevention without community,  particularly the smoldering urban violence that occurs from the history and work of institutional structural racism. There's a need for community.  And keep on doing what you're doing, being you. Absolutely. Amen. I can't help it. Yes, sir. All right? I have a human stain, and my reputation precedes me. Indeed. Of course, yes.  Indeed, yeah.  I had a patient who was passing away, and the relationship between him and his mom and us,  she didn't see what we had a purpose for it. He was at home at hospice. I was doing telephone, telehealth visit, and I asked, if there's anything we can do, let us know.  She said, what can you do? I told her, I can pray for your son right now. She said, thank you.  And I did, of course.  My name is Marcel Funk, working as a psychiatrist in the Netherlands, and I want to first thank you all for your very impressive talks.  I had two questions. The first is a simple one. Your presentations are not in the app. Is it coming up later on?  If you get my email, I can send you mine.  I finished slides this morning, just to be honest. We'll have to get them to you. Yeah, and there are some other opportunities where they get uploaded after the fact,  and so we'll get them in, sorry. My second remark was for Dr. Adams. You say, more or less, as I get it well, do what you can do, a strong and positive message.  But you say also, don't do what you can't do.  Is that the reason that you leave out the American belief that you must be able to defend yourself with a gun, or not to talk about the NRA, for instance, or other things that I?  Sure, so here's where that goes. So the first time I saw the Serenity Prayer was not as a psychiatrist, but it was in my grandmother's house.  And the Serenity Prayer is probably more important, well, I can't say for other people, but it certainly is important for me, given the kind of work I do.  Because there are a lot of things that I have to accept.  And wisdom is the hardest part, because I don't always know. And so there's some things I can do something about, and there's some things I can do something about.  Now, in terms of guns in the United States, it's in the Constitution, and they aren't going away. And what my main concern is that we cannot let that be an excuse for doing nothing.  Well, you know, when the other side gets rid of guns in this country, then we can do something about it. No, no. Young black and brown people are dying today, tomorrow,  and so we have to do something now, and there are things that we can do. And so what you can do something about, we do something about. Guns, and the other thing, too,  is that there's a lot of different understandings about guns. Fannie Lou Hamer said that they needed to have a Winchester in every corner.  Winchester's a rifle.  Because between me and thee, thee being the Klan or the whomever or whatever,  is nobody, nobody stepping in the breach. And the other part that also reflects, too, is that the history of black people in this country, especially young men, particularly,  is that there's been either policing or no policing, and not a lot of justice. And so there's a huge vacuum for these people who look like my ancestors, because they are,  who have had to figure out something to try to protect themselves in a system that destroys them actively. And so, you know, I'll disarm second. I ain't gonna do it first.  So I'm a registered gun owner, concealed carry weapon owner.  I'm an American.  I'm also a, I lead a group at the National Medical Association that has been very vocal about the stranglehold that the NRA has on our government.  So we just didn't get to it. Good question.  I say that the NRA has met its match with black physicians.  We should have a conversation about the best way to ensure that there's safe handling of weapons in this country. There's environments where there's a rural America.  I mean, to take the guns away from a rural American, it just doesn't make any sense, because there's things that are happening in that rural environment  that doesn't even have to do with people.  And so there's a lot of conversations. The issue with the NRA is that there's a gag order on the conversation.  And that's why you talked about the Dickey Amendment. My colleague talked about that, which has been overturned. The Dickey Amendment was overturned by Trump.  I'm not a pro-Trumper, but it was good policy  because Democratic presidents before him, and it actually happened under Clinton.  So if you know, then you know, then you know, right?  And it's so important. So there's no dichotomy in the advocacy.  And I think you're right. There has to be room to have conversations about common sense gun reform. We don't say gun control, but common sense gun reform,  which is the red flag laws, and having conversations with your patients about how they're handling conflict, and is there a gun in the home, and how is it stored?  Those types of things. Are you trained to use it? How often do you use it? If you're a gun owner and you don't shoot at least once a month, then you're reckless.  Oh, absolutely. The pure presence, the presence of that weapon, and that was the original study that happened  that got the gag order, is that it pointed to the gun as one of the single risk factors for shootings in homes was pointing to the gun.  Pointing to the gun is like pointing to the cigarette  for cancer, right? It's true. Not everybody that smokes gets cancer. Not everybody that has a gun dies. But those that smoke get cancer more than the ones that don't,  and those individuals that get shot or shoot shoot more with a gun. So there's no doubt. The literature's clear on it.  The Constitution is not gonna change.  One last one. One last one. Wow, I sure don't wanna hold anyone from going. Please do. God bless you guys. You guys are all making a difference. I mean that sincerely.  Question was asked, who works in incarcerated settings? Well, yeah, Justin Trevino, I'm from Ohio. I work with our State Department of Mental Health  and Addiction, so we work with our state prisons, jails, everywhere around the state. My comment up here is saying, I would get to know people like that.  I would get to know, I can help with a lot of things in jails and prisons. We work with faith-based organizations all over the place. We're doing some very good work in Ohio  with faith-based organizations.  Young black men, getting them into drug treatment and really making a difference there. You mentioned Medicaid. Our state, states have Medicaid policy.  There's something called an 1115 waiver. California did that. So you don't lose your Medicaid when you go into the jail. They pay for services.  Those decisions get made at state agency levels. And just for folks to get to know, there are psychiatrists who work with the State Department of Mental Health,  Medicaid, public health all over the place. We should use each other. What you guys are saying, just go out there and do things and get to know people.  Sometimes your state government waits on evidence-based this, that, whatever, no.  But you are fantastic, Dr. Adams, getting out there and just doing what you're doing, man. Just get out there and do stuff. But if you inform people that hold those jobs,  I hear all sorts of legislation. I get the opportunity to talk to people about that or they ask the opinion there. So if you get to know those folks in your state,  those are ways I think you can make a system-level difference and begin to push things in the right direction for you. But you guys are fantastic. Thank you for the talk.  I appreciate you. Thank you.

Video Summary

The presentation provided by Dr. Roger Mitchell, Lawrence Malik, and Curtis Adams revolves around the urgent public health issues of gun violence and mental health in Black communities, specifically among young Black men. Dr. Roger Mitchell discusses his role as a forensic pathologist and his efforts to address violence and death in custody. Emphasizing a public health approach, particularly with regard to gun violence that goes beyond traditional methods, he advocates for a combination of community-based interventions, consistent surveillance, and policy reform. The discussions also highlight the psychiatric perspective, illustrating the disproportionate impact of gun violence on communities of color, particularly on young Black males. The speakers underscore the importance of addressing the root causes and surrounding societal factors through equity-centered approaches and the active involvement of psychosocial support systems, such as mentoring and sports programs. Dr. Lawrence Malik emphasizes the need for comprehensive investigations into gun violence and suicide, advocating for more significant federal funding to support such research. Meanwhile, Dr. Curtis Adams highlights the crucial role of mental health professionals in advocating for a systems-based approach to community care, encouraging psychiatrists to act as intermediaries between the community and healthcare systems. The emphasis remains on practical solutions that can be implemented immediately, such as relational and community-engaged therapeutic methods, while also identifying the systemic barriers and challenges in policy and official processes that need reform to improve the lives of those affected by gun violence and systemic racism.

Keywords

gun violence

mental health

Black communities

young Black men

forensic pathologist

public health approach

community-based interventions

policy reform

psychiatric perspective

equity-centered approaches

psychosocial support systems

mentoring programs

federal funding

systems-based approach

systemic racism