Mental Health Equity Champion Spotlight: Dr. Bernardo Ng
By Madonna Delfish, M.P.H.
Each quarter we highlight an individual in the field of psychiatry who is a champion for mental health equity—whether through their work in direct care, research, advocacy, or in the community. Our champions are nominated by their APA-member peers to share the tangible ways they incorporate a health equity strategy in their practice and support increasing access to quality of care for diverse populations.
Our Mental Health Equity Champion This Quarter is Dr. Bernardo Ng!
Dr. Bernardo Ng was born in Mexicali, Mexico. He is a medical graduate from the University of Nuevo Leon in Mexico and completed residency at both Texas Tech University and University of California, San Diego. Ng manages his own private practice and directs both the Sun Valley Behavioral and Research Centers in Imperial, California and the Centro Geriátrico Nuevo Atardecer in Mexicali, Mexico. He also works as a preceptor at the University of California system within the Psychiatric Nurse Practitioners program.
Ng is immediate past President of the Asociación Psiquiátrica Mexicana, past President of the American Society of Hispanic Psychiatry, and current APA representative for Zone 2 of the World Psychiatric Association (WPA). He has previously served board-appointed terms on the APA Council on Psychiatric Services and the APA Council of International Psychiatry, where he also served as Council Chair.
He is a Distinguished Life Fellow of the APA and is an active member of APA’s Rural Psychiatry Caucus, Hispanic Caucus, and International Medical Graduate (IMG) Caucus. He is also an active member of both the Mexican Psychiatric Association and the Latin American Psychiatric Association.
He has 126 publications, including 60 original articles, 40 abstracts, 14 book chapters, four book prologues, four handbooks, and four books.
Q&A with Dr. Ng
Q: Can you share more about the community you work with and the patient population you serve?
I am located in Imperial County, which is the furthest south and east county of the state of California. It's a rural, desertic area, highly populated by Latinx or Latinos of Mexican descent, representing about 80% of the population. Half of them are monolingual Spanish speaking. The majority of the other 20% of the population is white; there is also a very small percentage of African Americans, Asian Americans, and Native Americans.
The U.S. Census defines urban versus rural based on how many people live per square mile; almost 85 to 87% of the nation can be defined as rural.
With that said, rural psychiatry is as varied as you want it—from the Appalachian communities in the Midwest, to the highly populated and rural African American communities in the South, to the Mexican border in the West, which Latinx people of mostly Mexican descent highly populate.
Q: What does promoting mental health equity mean to you? And how have you worked to promote mental health equity as a psychiatrist?
The reason I relocated from San Diego County to Imperial County back in the mid-nineties was that I saw there was a gap. For decades, the only existing mental health service in Imperial County was sponsored by the state through what used to be called “County Mental Health.” It is now called Imperial County Behavioral Health Services, but they are focused, by definition, on treating the severely chronically ill.
I noticed that working class, blue-collar employees, agricultural employees, and retail employees, many of whom are of Mexican descent—did not have anywhere to go. The more affluent would drive to San Diego or north to Palm Springs, where they could afford to pay for private care. Unfortunately, these services were not available to the working class in the county. My first motivation was to address that gap.
Q: What types of projects have you worked on or initiated to promote mental health equity on the community level?
One of the things that became very close to my heart was what is now called long-term psychiatric care, which is in nursing skill facilities. One of the first things I did outside of my outpatient services, with the help of a partner, was opening a daycare facility for adults in a city called Calexico.
It was licensed to receive 40 people a day, and now it can care for 100 people a day; this service aims to prevent deterioration, so the clients don't end up in a nursing skill facility. That's been one of my greatest satisfactions.
In 2010, we had a big earthquake—it was 7.8 magnitude. This little, kind of forgotten town had a couple of buildings that were turned into residential facilities for the elderly who don't have families; they became condemned after the earthquake.
So, suddenly the residents didn't have anywhere to go. There was one very tiny, modern hotel that [took everyone in]. At our day program, clients were taking showers, we were washing their clothes, and we were making sure that the pharmacies brought the medicines to the facilities. The regular day program was supposed only to be four hours, but they would stay there and get lunch, breakfast, and dinner.
It was amazing. It was a few weeks of very intense work but very rewarding.
Q: What have been some of your most rewarding parts of mentorship?
As far as mentorship, I'm an international medical graduate, so I have had [both U.S. and Mexico medical students] visit our facility and work with us who have yet to have the experience of seeing how psychiatry is done in the United States.
One rewarding experience was earlier this year, a student from Arizona whose professor knew me said to her, "If you need to make up your mind on what you want to do, go visit this guy." She's an undergraduate student studying psychology.
As we were talking throughout the day, and she was seeing patients with me, she said, "I didn't want to share this with you at the beginning because I was shy about it, but I am taking credits to qualify for pre-med, and now that I see the difference, I want to be a psychiatrist."
This has been the youngest person that has come to visit us and has gotten inspired by the work that we're doing.
Q: Dr. Ng, you've mentioned some amazing projects, and work that you have spearheaded. Is it possible for you to choose one that you're most proud of so far that works to promote health equity?
Finishing high school from an educational point-of-view is the most common goal [in the community I practice in]. People graduate and go to work because that's what they see their parents do.
When I first began setting up my practice, finding someone with experience in billing, administration, or as a medical assistant for psychiatric patients was tough. There wasn't a career track or certification here for that.
I have an administrator with whom I've been working for 25 years; she is a high school graduate and has learned through the years, working in my practice, about human resources, payroll, and how to motivate her team.
Our medical assistant team has four women; the Lead is a high school graduate. Now she has a direct report with a bachelor's degree in psychology for the first time.
My biller worked in the fields until her twenties, but now she has set up her own company billing for other businesses.
Working with my team has been the most rewarding. I'm very proud of my team. They all see themselves differently and are now promoting mental health just by talking about what they do.
Q: What are current priorities for your scientific research and are there any emerging topics, challenges or innovations you wish to share?
At UCSD, I wrote two papers about pain and ethnicity. There is something called patient control and analgesia; after surgery, [a doctor programs narcotic doses and] gives you a button that you push to medicate yourself; this method was proven to decrease the amount of narcotics you need for your pain.
In reviewing hundreds of records, I was able to prove...the anesthesiologist would put less pain medication in for African American and Hispanics than they would for white patients. So, the main thing is ethnic disparities.
Most of my published research has been, in one way or another, around the Hispanic and Latino populations–either inequities, disparities, or access to care. But I think that what ties it all up is the research on the Hispanic population.
Q: You have been an advocate for increasing the diversity of research participants, especially those from historically excluded groups such as Hispanic and Latinx populations. What role does enhancing diversity and research play in the development of treatments and ultimately access to mental health care for these groups?
I began in 2008 with two partners. At our clinical trial sites, one of the first studies [we conducted] was on dementia. As we dove into this, we realized that in almost all central nervous system clinical trials, but especially in dementia, less than 1% of the participants are of Latino descent. This was similar for other ethnicities--African American, Asian American, Native American, etc.
So, here we are testing new treatment options based on trials where most participants are white. So, we took on the challenge of promoting research participation in the county.
In the beginning, there was a lot of mistrust and criticism. "Oh, no. I don't want to be a guinea pig," and historically...minorities were used [as test subjects] in experiments. So, the fact that they would not have to pay for anything, that they would be given some compensation, that they would be given transportation, that they only have to stay a couple of hours, and that we're going to provide a meal—none of that mattered because of the perception of research.
We haven't finished the job, but we've been able to comply with the contracts we get into; we are now recognized as a site that can recruit Latinos not only in dementia but also in depression, bipolar disorder, and ADHD research.
Q: What motivates you to be such an active APA member?
Well, I'm going to start with Rural Psychiatry because—and this is a message to my colleagues, Hispanic or not, who may be working in any of the rural areas of this beautiful and large nation— Rural Psychiatry is very challenging and can also be very lonely.
When I first got here, I was the only full-time psychiatrist in private practice. So, I was the only one here, and it was very hard; it got very lonely. APA gave me the opportunity to be part of the Rural Psychiatry Caucus, and that changed things for me. I quickly became very active [and connected to the APA].
Q: What advice would you give to students, residents and early career psychiatrists who want to be more involved in the efforts to promote mental health equity? What’s one thing they can do?
Well, I think this will sound like a commercial, but—especially if you're a minority student or resident of any kind—APA has a place where you can meet more people with the same interests. If you are Latino or Hispanic, get involved with the Hispanic Caucus.
During the APA Annual Meeting in the spring, the American Society of Hispanic Psychiatry (ASHP) always meets at the same place. The collaboration between ASHP and APA has become bigger through the years; it's another place to get involved if you are Hispanic or interested in Hispanic psychiatry.
I'm very proud that I was president of that society from 2018 to 2020. During my presidency, we created the Don Quixote Award for early researchers, young psychiatrists, residents, medical students, non-medical students, mental health therapists, and psychologists.
There are societies for other ethnic groups, as well, for example, Indo-American Psychiatric Association.
Those interested in being more involved in mental health equity work should knock on the doors, look for the right websites, and go with it. There is someone already doing whatever you think you want to do. Just find that person.
Q: Are there any resources relating to promoting mental health equity that you can recommend to other psychiatrists and mental health professionals?
APA's LaSaludMental.org—I am very pleased and thankful that they've done this mental health website in Spanish. I'm very honored that I've been invited to be part of it. I want to recognize APA President Dr. Rebecca Brendel and APA CEO and Medical Director Dr. Saul Levin for recognizing the growing presence of the Latino/ Latinx population and the need for mental health resources for those who speak Spanish.
Q: Dr. Ng, before we conclude, is there anything you would like to share that I didn't ask you or anything you would like your colleagues and members to know?
Yes, there's one thing I haven't said, and that's more on the individual level. We have long been fighting for our place professionally in a white, Anglo-dominated field. Sometimes, as we move up in our careers and accumulate this experience, we isolate ourselves from our colleagues.
To help our patients better—our Hispanic patients—we should educate our non-Hispanic counterparts to be more sensitive. So, we need to open ourselves rather than isolate ourselves.
Instead of saying, "In my clinic, I only want people who speak Spanish or are Hispanic," I'd urge you to bring in non-Hispanic team members, have them learn Spanish, tell them about our culture, and tell them about the unique patient needs. That way, you can serve more people in our minority or ethnic group. That's my message.