A Conversation About Identity, Disparity, and Working for Equity

If you tuned in to the Minority Fellowship Program Coordinating Center webinar of April 25 (find it here), you got a triple treat. In addition to hearing SAMHSA’s Office of Behavioral Health Equity Director Larke Nahme Huang, Ph.D., explain the great need for behavioral health equity for populations of color and the many ways SAMHSA is trying to meet that need, you also were able to hear from two of the nation’s leading lights on reducing mental health disparities, in scholarship and creating policy: Margarita Alegría, Ph.D., and Teresa Chapa, Ph.D., MPA.

Dr. Alegría is chief of the Disparities Research Unit at Massachusetts General Hospital and a professor in the Department of Psychiatry at Harvard Medical School. She is currently the principal investigator of four National Institutes of Health–funded research studies and has published more than 200 papers, editorials, intervention training manuals, and book chapters, usually on topics related to improving healthcare services delivery for diverse racial and ethnic populations. She has been decorated with numerous awards, most recently with the 2016 Cynthia Lucero Latino Mental Health Award from William James College.

Dr. Chapa’s distinguished career has featured work in education; community, state, and federal service; and authorship of several papers and policy briefs on building a diverse behavioral healthcare workforce, eliminating health disparities, and promoting minority health and integrated care. She most recently served as executive dean and dean of strategic development of the California School of Professional Psychology at Alliant International University, where she was systemwide administrator to six California-based and three international campuses. Her 16-year federal career has included several leadership positions for the U.S. Department of Health and Human Services. She is the recipient of several awards, including the Helen Rodríguez–Trías Social Justice Award from the American Public Health Association, for her work in mental health disparities for underserved and disadvantaged populations. Dr. Chapa continues in her commitment to building inclusive excellence in behavioral health today as a subject-matter expert and consultant.

MFP E-News editor Michael Hopps sat in for a conference call last month with Drs. Alegría and Chapa in which they shared some of their personal experiences, both formative and professional. That conversation follows.

MFP E-News: When and how did you two first meet?.

Dr. Chapa: We’ve been aware of each other’s work. Maggie’s been at Harvard—and I’ve been with the government—forever. How long have you been there, honey?

Dr. Alegría: Sixteen years.

Dr. Chapa: What some folks don’t know is that—especially for Latino or Latina or Latinx providers in behavioral health—it’s a very small community. Maggie and I worked together at a high level. I knew what she was doing; she knew what I was doing. And we were serving the same agenda.

Dr. Alegría: We met each other at conferences. Since there’s not that many people [in our field], we get invited all the time. We see each other quite a bit.

MFP E-News: Do you remember what year you met?

Dr. Chapa: Probably 2003, when I was at the National Institutes of Health, on the Council Health Management Team.

MFP E-News: Dr. Chapa, what were some of your more important personal experiences that motivated you to pursue a career in behavioral health, especially with a focus on minority behavioral health?

Dr. Chapa: I would say my interest in health, education, and justice began as a kid. I grew up in a working-class family in Los Angeles, California—Venice. I’ve been an activist all my life and was fortunate that my family encouraged me to be myself. I volunteered for the United Farm Workers movement with Cesar Chavez beginning in high school and continued throughout my undergraduate years.

In my senior year of high school, I joined a program for prospective teachers and served as a teacher trainee for the special education classroom at Venice High School. In those days, special education students represented an array of intellectual, learning, and mental health disabilities. The kids were marginalized, bullied, and humiliated—leaving a deep impression on me. The head teacher inspired me to read books about psychology, social work, and special education.

MFP E-News: Do you recall sensing injustice in the world at a young age—sensing that certain individuals weren’t being treated the same as others?

Dr. Chapa: Definitely. My interest in minority behavioral health started with looking at myself, my own family and community, especially those who experienced more discrimination. And wondering how I might make a difference. I come from a community that was racially and culturally diverse, yet there were still those who were considered lesser.

MFP E-News: Lesser? Tell us more.

Dr. Chapa: Persons with mental illness who were in a hospital or students who were in special education were treated poorly.

MFP E-News: Did your parents raise you to treat all people with empathy?

Dr. Chapa: I was raised to accept people for who they are. I do believe that part can be attributed to growing up in an extended multigenerational and multicultural family. I was used to people with different backgrounds and languages, and I had a teenage mother who was seen as unconventional.


But. . . it was also a sign of the times. Venice was about hippies, artists, musicians, yogis—free thinkers! I remember a pivotal event in the sixth grade, where kids were brought together from different parts of Los Angeles, to spend a week about sharing and leadership in the Angeles Forest. We were only 10 and 11 years old. We came together and had a dialog about race: our similarities, our differences, about getting along. The dialog was really deep, and we were filled with optimism. The following year, when I was in the seventh grade, Martin Luther King was killed—and Robert Kennedy was later shot and killed, not far from where I lived. Cesar Chavez and the Farm Workers movement were becoming well known. The people who were in my life—my teachers at school and church—they were all very much about service and community, and were all deeply impacted by this. I was equally impacted and am sure changed by all of this.

My family also wanted me to learn from our neighbors—many who had been sent away to Japanese internment camps [during World War II]. I wanted to listen and learn more. That may have been the beginning of something.

MFP E-News: Tell us about the racial makeup of the neighborhood where you grew up.

Dr. Chapa: I’m not sure that we had the best education at Venice High, but we had teachers who really cared and mentored. I would never have found my way to college without their guidance. I was always proud of our very diverse community. We were not a busing school. Busing was a big deal in the 1970s! It was a social policy to enhance integration, so people had equal rights to good education. In Venice, we met the diversity standards without busing. We were Latinos—mostly Mexican—Chicanos, Japanese American, African American, American Indians. Others identified as Jewish—whites, and others were non-Latino whites and people of mixed culture/race.

However, race, culture, gender, and social class were a daily part of life, and the differences were stark. I’m from the working class. I had to work throughout my youth and am still sensitive to snobbery.

MFP E-News: Dr. Alegría, how about you—what personal experiences at a young age motivated you to pursue a behavioral health career?

Dr. Alegría: I grew up in Puerto Rico. I had an unusual family history in the sense that my parents divorced just as I was born, so I moved in with my aunt and uncle. There were mental health issues in the family. I had a very diverse family structure when I was growing up. I got interested in trying to be either a family lawyer or to be a psychologist or psychiatrist to help youth, because when I was growing up some part of it was a contentious arrangement—let’s put it that way. On the other hand, I really was very lucky. I got this great opportunity to experience two very different families growing up.

I attribute some of my resilience and ability to adapt to different environments to those experiences. But it got me very interested in behavioral health issues. One of my mentors got me interested in people in poverty, with HIV, and with not having services. I started into public health, which was a great entryway into how people confront a lot of disadvantage, loss of power, lack of services. Coming from a family that was advantaged, that was fine, it was eye-opening going to see and interview people in poverty.

MFP E-News: Can you give an example?

Dr. Alegría: One time I visited this woman, and she offered me coffee. And I said, “Oh, no, thanks, but how about some water?” And she said, “Sure, help yourself.” I opened the refrigerator, and there was nothing. Water and one piece of fruit. I became perplexed about how we can live in a bubble and not have more empathy for what’s going on with others.

One of my biggest mentors got me interested in working in poverty. Once you get interested in poverty, it’s very easy to segue into disparities and into the people who have power versus those who don’t.

MFP E-News: Please explain this—why it’s so easy to transition from being interested in poverty into being interested in health and mental health disparities.

Dr. Alegría: When you work where people have less access to resources, you cannot get the treatments they want and need. One of my most transformative experiences was a project I did for the Centers for Disease Control in which I worked with women who were at risk of HIV—sex workers. I saw in that study how many of those women needed resources and had no access. So we went to CDC, and they gave us funding to try to get resources. It was an early study on social determinants. We concluded that the health of women is more tied to their social determinants than to anything else.

MFP E-News: Which social determinants?


Dr. Alegría: Housing, safety from violence, being able to move from a very hostile environment, getting an education, being able to go to vocational school—these determine a person’s health and mental health. It was disappointing to see how little our institutional settings are able to respond to reintegrating people who have had a hard time.

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