The community of academic psychiatry has much to learn by listening to our trainees. The Learner’s Voice papers are brief reflections that center around the experience of learning psychiatry or becoming a psychiatrist.
“Psychiatric Formulation and the Structural Determinants of Mental Health”  reflects on the degree to which our current formulation models incorporate all the perspectives needed to care properly for patients who experience structural racism, who are at risk of experiencing violence and other harm, and whose psychiatric symptoms are precipitated or exacerbated by these stressors. Clearly, to address these injustices optimally, we as practitioners must have a standardized and hardwired approach to “shift our gaze above the level of the individual encounter to recognize how institutions and policies influence the health of our patients.” Current models may classify—without explicitly mandating specific consideration of—these components under the generic categories of social factors or predisposing or perpetuating factors.
It is gratifying to see resident interest in gaining, through an optimized model of diagnostic formulation, a deeper understanding of patients and, ultimately, justice in mental health care. It is also important to note, as the author has, that psychiatrists “must be equipped to listen, learn, and address” themes that traditionally fall in the purview of public health and political science, which may be further incorporated into contemporary psychiatry curricula.
Bailey AM. Psychiatric formulation and the structural determinants of mental health. Acad Psychiatry. 2020. https://doi.org/10.1007/s40596-020-01307-9.
The author declares that he has no conflicts of interest.
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Guerrero, A.P.S. Editor’s Comment on “Psychiatric Formulation and the Structural Determinants of Mental Health”. Acad Psychiatry 44, 806 (2020). https://doi.org/10.1007/s40596-020-01352-4