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APNA Position: Diversity, Equity, and Inclusion

The American Psychiatric Nurses Association adopts the APNA Issue Brief, Diversity, Equity, and Inclusion are Central to Any Solution to Address Health Disparities and Critical to Advancing Whole Health as an official position of the organization.

Below are key aspects of the Issue Brief which reflect the APNA position and align with current and future APNA initiatives:

Definitions

APNA has adopted the following definitions for the three interconnected values – diversity, equity, and inclusion (AACN, 2017):

  • Diversity: Diversity references a broad range of individual, population, and social characteristics, including but not limited to age; sex; race; ethnicity; sexual orientation; gender identity; family structures; geographic locations; national origin; immigrant/refugee status; language; physical, functional, and learning abilities; religious beliefs; and socioeconomic status.
  • Equity: Equity is the ability to recognize the differences in the resources or knowledge needed to allow individuals to fully participate in society, including access to higher education, with the goal of overcoming obstacles to ensure fairness. To have equitable systems, all people should be treated fairly, unhampered by artificial barriers, stereotypes, or prejudices.
  • Inclusion: Inclusion represents environmental and organizational cultures in which faculty, students, staff, and administrators with diverse characteristics thrive. Inclusive environments require intentionality and embrace differences, not merely tolerate them. Everyone works to ensure the perspectives and experiences of others are invited, welcomed, acknowledged, and respected in inclusive environments.

Discussion

Diversity, equity, and inclusion (DEI) are three closely linked concepts that are best practices in mental health care and key to helping meet the needs of individuals from all walks of life (McKinsey, 2022). To ensure parity in mental health care, psychiatric-mental health (PMH) nurses actively foster diversity, equity, and inclusion throughout the profession, address health disparities, and create positive, sustainable change that supports increased access and delivery of high-quality care. DEI is central to any solution to address health disparities and is critical to advancing whole health.

Diversity is essential to addressing health disparities.

Understanding diversity and the role it plays is key to delivering high quality mental health care. When providers acknowledge and adapt to the evolving populations in need of care, they can greatly improve the care they provide and the mental health outcomes for all populations. Current evidence demonstrates that racial/ethnic minority groups, rural communities, and sex and gender minority groups experience disproportionately poor access to mental health care (Agency for Healthcare Research and Quality, 2022; Gerolamo et al., 2022; Mongelli et al., 2020; Reynish et al., 2021; Willging et al., 2006).

PMH nursing must continue to expand knowledge and understanding of diversity as well as continue to foster a profession that welcomes diverse individuals. Cultural humility is an important aspect of this process – in recognizing the dynamic nature of culture and its impact on forming honest and trustworthy relationships with others (Yeager & Bauer-Wu, 2013).

Equity is essential to addressing health disparities.

Equity in mental health means that everyone has the opportunity to be understood and have access to individualized mental health care, regardless of their circumstances. Inequalities and inequities in mental health care can occur because of disparities in the availability of, or access to care, often due to biases, discrimination, and stigmatization of individuals or groups (Rees et al., 2021; Shim, 2021; Williams & Cooper, 2019). Disparities in social determinants of health – where people are born, live, work, and age that impact quality of life, health outcomes, and risks – can also disenfranchise individuals, preventing them from seeking and engaging in optimal mental health care.

PMH nursing is driven by the understanding that all people are of equal worth and equal value, and that the mental health of each person directly affects the mental health of others.

Inclusion is essential to addressing health disparities.

Inclusive care is based on the philosophy that all health services should be equally accessible to all – regardless of factors such as age, sex, race, sexual orientation, gender identity, or marital status. To be inclusive, PMH nurses seek understanding of both individual experiences and environmental impacts on mental health (Moreno & Chhatwal, 2020; Wilson et al., 2017). Inclusive environments acknowledge the suffering of; understand the distrust, anger, and fear of; and promote reconciliatory efforts toward groups who have been culturally, structurally, and individually discriminated against (Jolley & Peck, 2022).

Inclusive mental health care means that individuals are included and have the opportunity to be involved in all decisions regarding their mental health care. PMH nursing champions these aspects of inclusion and ensures that all those we serve are welcome within mental health care environments. PMH nurses are trained to advocate for the fundamental human right to care that respects autonomy, perspectives, and individuality.

Position

Through its core values, mission, and purpose, the American Psychiatric Nurses Association (APNA) champions the education and preparation of PMH nurses to be culturally competent professionals, supports broad efforts to end mental health disparities, and fosters increasing diversity within the profession to best serve the needs of patient populations.

Diversity, equity, and inclusion are values deeply rooted within PMH nursing. The Psychiatric-Mental Health Nursing: Scope and Standards of Practice underscore the vital role PMH nurses play in preventing and treating mental disorders through promoting mental health literacy, screening for disorders, providing rehabilitation after crises, and delivering ongoing recovery support. Standard 8,
which focuses on the practice of cultural humility, outlines how PMH nurses recognize and address inequities in care that result from “complex and interrelated factors – such as membership in racial/ethnic groups, socioeconomic status, age, gender, citizenship status, disability status, geographic/ environmental location, and sexual orientation.” This standard highlights the ethical duty of PMH nurses to treat each person as an individual with human needs, regardless of race, faith, culture, sexual orientation, gender, or gender identity (ANA, APNA, ISPN, 2022).

Diversity, equity, and inclusion are central to any solution to address health disparities and critical to advancing whole health. In our pursuit to address health inequities and advance whole health, PMH nurses should regularly consider the following:

  • PMH nurses have a responsibility – to those for whom we provide care, the students who we instruct, the institutions in which we serve, and the communities in which we live – to demonstrate that DEI is fundamental to our practice. These values are deeply rooted in the identity and training for all PMH nurses.
  • Foster a culture of curiosity and devote time for self-reflection – seek to notice potential biases you may have. In using aspects of yourself to help people heal, it’s important to be mindful of how the biases we hold can impact the care we provide. Consistently revisit and practice self-assessment to identify potential bias or areas where we can better understand others.
  • PMH nurses have a fundamental role as advocates, ensuring that mental health care is equitable and available to those they serve. Look for opportunities to apply your advocacy skills in your community and within systems and organizations to educate about the importance of DEI and help move whole health forward.
  • Language plays a key role in forming attitudes and countering stigma. Practicing the use of person-first language to emphasize the person before their mental health challenge helps cultivate an inclusive environment in your work.

Conclusion

As the unifying voice for PMH nursing, APNA provides ongoing training and resources to help members refresh their understanding and reflect upon the central role DEI plays in all aspects of their work. All PMH nurses are ethically charged to demonstrate that every human deserves care regardless of personal history or cultural nuances, to be mindful of social justice in our practices, and to “protect human rights, promote heath diplomacy, enhance cultural sensitivity and congruence, and reduce health disparities” (ANA, APNA, ISPN, 2022).

Race and ethnicity, income, gender, sexual preference, and geographic location all continue to play a substantial role in a person’s ability to access high-quality, equitable, and affordable mental health care (NASEM, 2021). Increasing diversity also requires an equally diverse mental health workforce able to serve the needs of individuals from multiple backgrounds, with a culturally proficient, inclusive, and affirming approach (Moreno & Chhatwal, 2020). Psychiatric-mental health nurses are well positioned – by education, culturally sensitive approaches to care, clinical standards, and training – to positively impact equity, access, and inclusion in mental health care (Oleck, 2022). It is important that PMH nurses embrace these perspectives to competently meet the mental health needs of the diverse populations for whom they provide care.

Approved by the APNA Board of Directors June 5, 2024.


References

2022 National Healthcare Quality and Disparities Report. Rockville, MD:
Agency for Healthcare Research and Quality; October 2022. AHRQ Pub. No. 22(23)-0030

American Association of Colleges of Nursing (2017). Diversity, Equity, and Inclusion in Academic Nursing. https://www.aacnnursing.org/news-data/position-statements-white-papers/diversity-equity-and-inclusion-in-academic-nursing

American Nurses Association, American Psychiatric Nurses Associatoin, & International Socierty of Psychiatric-Mental Health Nurses (2022). Psychiatric-Menatl Health Nursing: Scope and Standards of Practice (3rd Ed.) Silver Spring, MD. (pgs 89-90)

Gerolamo AM, Delaney KR, Phoenix B, Black P, Rushton A, Stallings J (2022). Psychiatric Nursing Workforce Survey: Results and Implications. Journal of the American Psychiatric Nurses Association. 2022;0(0). https://doi.org/10.1177/10783903221146190

Jolley, C.E., Peck, L.P., (May 31, 2022) “Diversity, Equity, & Inclusion Policies of National Nursing Organizations” OJIN: The Online Journal of Issues in Nursing Vol. 27, No. 2, Manuscript 2

McKinsey & Company (2022). What is diversity, equity, and inclusion? https://www.mckinsey.com/featured-insights/mckinsey-explainers/what-is-diversity-equity-and-inclusion

Mongelli F., Georgakopoulos P., Pato M. T. (2020). Challenges and opportunities to meet the mental health needs of underserved and disenfranchised populations in the United States. FOCUS, 18(1), 16–24. https://doi.org/10.1176/appi.focus.20190028

Moreno, Francisco A., Chhatwal, Jasleen (2020). Diversity and Inclusion in Psychiatry: The Pursuit of Health Equity. Focus Journal of Lifelong Learning in Psychiatry, Vol 18, Issue 1. American Psychiatric Association. https://doi.org/10.1176/appi.focus.20190029

National Academies of Sciences, Engineering, and Medicine; National Academy of Medicine (2021). The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. Washington (DC): The National Academies Press. https://doi.org/10.17226/25982

Okoli C (Zim) (2023). Equitable Mental Health Care Is Mental Health Care for All. Journal of the American Psychiatric Nurses Association. 2023;29(3):271-273. https://doi.org/10.1177/10783903231168091

Okoli C (Zim) (2023). Inclusive Mental Health Care Is Responsive Health Care. Journal of the American Psychiatric Nurses Association. 2023;29(1):79-82. https://doi.org/10.1177/10783903221141894

Oleck, L (2022). Board of Directors’ Column: Who We Are: Trailblazers in Health Equity! Journal of the American Psychiatric Nurses Association. 2022;28(4):345-347.
https://doi.org/10.1177/10783903221105449

Rees S. N., Crowe M., Harris S. (2021). The lesbian, gay, bisexual and transgender communities’ mental health care needs and experiences of mental health services: An integrative review of qualitative studies. Journal of Psychiatric and Mental Health Nursing, 28(4), 578–589. https://doi.org/10.1111/jpm.12720

Reynish T., Hoang H., Bridgman H., Nic Giolla Easpaig B. (2021). Barriers and enablers to sex workers’ uptake of mental healthcare: A systematic literature review. Sexuality Research and Social Policy, 18(1), 184–201. https://doi.org/10.1007/s13178-020-00448-8

Shim R. S. (2021). Dismantling structural racism in psychiatry: A path to mental health equity. The American Journal of Psychiatry, 178(7), 592–598. https://doi.org/10.1176/appi.ajp.2021.21060558

Willging C. E., Salvador M., Kano M. (2006). Brief reports: Unequal treatment: Mental health care for sexual and gender minority groups in a rural state. Psychiatric Services, 57(6), 867–870. https://doi.org/10.1176/ps.2006.57.6.867

Williams D. R., Cooper L. A. (2019). Reducing racial inequities in health: Using what we already know to take action. International Journal of Environmental Research and Public Health, 16(4), 606. https://doi.org/10.3390/ijerph16040606

Wilson A., Hutchinson M., Hurley J. (2017). Literature review of trauma-informed care: Implications for mental health nurses working in acute inpatient settings in Australia. International Journal of Mental Health Nursing, 26(4), 326–343. https://doi.org/https://doi.org/10.1111/inm.12344

Yeager KA, Bauer-Wu S. Cultural humility: essential foundation for clinical researchers. Appl Nurs Res. 2013 Nov;26(4):251-6. doi: 10.1016/j.apnr.2013.06.008. Epub 2013 Aug 12. PMID: 23938129; PMCID: PMC3834043.