Transitioning toward a better future in behavioral health

Racial trauma, betrayal trauma, and institutional betrayal are baked into the history of the United States. This legacy of injustice encompasses direct experiences of racism and discrimination, as well as a broader sense of betrayal in which the very institutions tasked with helping people, such as the U.S. health care system, let them down in egregious, painful, or even fatal ways. Using the theories of racial trauma (i.e., an extreme stress response to cumulative firsthand and vicarious experiences of racism and discrimination), betrayal trauma (i.e., a violation of trust by a person on whom someone is reliant, particularly for well-being), and institutional betrayal (i.e., when the violation of trust is perpetrated by an institution on which someone relies), we describe how Black Americans have been mistreated by the U.S. health care system in the past and at present. We then utilize a modified version of Bronfenbrenner's socioecological framework to explore the role of racial and betrayal trauma in perpetuating harm against Black Americans at the micro, meso, and macrolevels. We also provide concrete examples and strategies to address racial healing and provide racial trauma-informed care to Black Americans by promoting the role of providers in engaging in such practices, the role of administrators in making these practices part of institutional policy, and the role of broader institutions in admitting wrongdoing and promoting full transparency in making meaningful and lasting changes. (PsycInfo Database Record (c) 2026 APA, all rights reserved)

Betrayal · Harm · Injustice · Institutional racism · Moral injury · Racism · Wrongdoing · Cultural Competency in Health Care · Migration, Health and Trauma · Racial and Ethnic Identity Research