I’m Angelica! I’m one of the winners of the 2022 Health Equity Challenge for my project titled “Step Up, Stand Down: Developing a Mental Health De-Escalation Toolkit for Providers” in partnership with the Charles R. Drew University. I am in my fourth and final year of medical school with the Charles R. Drew/UCLA Medical Education Program applying into Family Medicine, with the future goal of becoming a primary care provider.

Family Medicine is a specialty that focuses on preparing doctors to meet the needs of the community, whatever that community may be. I want to celebrate health within and outside of the hospital, and a key part of this virtue is in viewing health holistically, by acknowledging both mind and body as intrinsic to a full and healthy life — this is why I’m especially excited about integrating mental health into the primary care setting!

My own path to medicine was paved at an early age: I come from an immigrant community in New Jersey and have been in the company of loved ones navigating their own health issues. For some of my loved ones, the most perplexing concept was that of mental health as its own entity requiring care, as mental health is seen as synonymous with spiritual health in the predominantly Catholic Philippines. Yet, with time, my loved ones found comfort and strength in some of the tenets provided by a “mental wellness” framework.

This interest in mental health followed me to medical school. Some of my favorite conversations with patients focused on exploring their mental health. I have had the privilege to listen to patients as they wondered about their personal goals, social supports, and inner struggles. On a few memorable occasions, I even helped patients take the vulnerable step of seeking help for the first time.

However, throughout my time in medical school, I understood that mental illness is still often stigmatized, even in the hospital and clinic environments. While I feel well-equipped in caring for patients who are willing and able to discuss their emotional state, I’ve also found myself paralyzed by indecision when patients arrive at clinic amid a mental health crisis. Put simply, I was never taught how to engage with these patients! The guidance around caring for a “difficult patient” is often handwaved away with the assumption that we will learn it “on the job”, but in reality, this sets a precedent where providers are not equipped to deal with patients in crisis. As a result, health care systems rely on security measures to manage patients in crisis, further agitating a delicate situation. In these moments, I’ve wondered how I, as a provider, could protect patient respect and integrity during mental health crises.

“Health care systems rely on security measures to manage patients in crisis, further agitating a delicate situation. In these moments, I’ve wondered how I, as a provider, could protect patient respect and integrity during mental health crises.”

The Health Equity Challenge is exciting for this exact reason. This Challenge invites students to think of real-world practical solutions. This is an exercise that has otherwise been rare throughout my medical education — in medicine, I am often identifying the pathology of a situation and providing a prescribed therapy, but inventing a fix is another task altogether. I wanted to ground this work in my future practice as a physician: one that considers my patients as my neighbors. The idea of developing a mental health de-escalation curriculum for health professions students at Charles R. Drew University came naturally from this goal.

This project felt — and still seems — very idealistic and hopeful, but around the time I started thinking about this project idea, one of my friends had asked me: “Is it necessarily bad to be idealistic?” So I arrived at my final proposal with idealism in mind, with the understanding that, if nothing else, the Health Equity Challenge would be a learning experience in placing that hope into words, so that words can (eventually) become actions.

When I received the news that I won, I was taken completely by surprise! I was excited and energized to hear that the people involved with the UCLA/MolinaCares Health Equity Challenge saw my hope for the community as an initiative worth investing in, because this award is a testament to the fact that there are supporters for this labor of love.

Moving forward, I am focusing on highlighting the synergy that the Charles R. Drew University maintains with its local community. The choice to conduct this work at Charles R. Drew University was a no-brainer to me. In the wake of the 1965 Watts Rebellion, the Charles R. Drew University of Medicine and Science came to be: a Historically Black University and the only one of its kind on the West Coast. This partnership is a synergistic one — as the program is especially interested in fostering students who are committed to serving the Latino and Black communities of South Los Angeles, graduates of this school are equipped with the necessary skills to provide for underserved patients in a wide variety of circumstances, from street medicine to low-resourced settings to the bedside. Thus, the addition of de-escalation training within the curriculum would augment the existing resources for future providers who are already committed to serving South Los Angeles.

To this end, this project will be an experiment in directly coordinating with home-grown efforts within the South Central community, as I will continue to develop the modules through an iterative feedback process in which local organizations will weigh in on the direction of the project. In this sense, no one is more qualified to contribute to this effort than the people who live and work within South Central LA, and through this grant, we will be able to financially support the community organizations that have graciously provided their time and wisdom towards this important project.

So far, in planning meetings and soliciting input from other collaborating organizations, my leadership skills are challenged in ways that can only be developed outside of the classroom. I feel a tangible difference the way that I relate to the world around me and continue to strive towards a camaraderie with the community to support social change. In this sense, too, the reward is the journey: of getting to know my community better and collaborate with others in ways that do justice to their history and experience within South Central. These are skills that I will use as a physician, certainly, but these are also skills that I am excited to use as a leader committed to health equity. I look forward to the journey!

By Angelica Johnsen
2022 Health Equity Challenge Winner
Angelica Johnsen’s proposal to develop a de-escalation toolkit for medical providers working with patients who are experiencing mental health crises was one of the two projects funded. Her community partner, Charles R. Drew University, was awarded $50,000 to implement the project. Funding for this award was provided by The MolinaCares Accord.

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