The American Sociological Association has recently conducted a study titled, “’Sorry, I’m Not Accepting New Patients’: An Audit Study of Access to Mental Health Care,” which appears in the June issue of the Journal of Health and Social Behavior. According to the results of this study, therapist are less likely to return calls from prospective patients whom they assume to be poor and Black.
The results presented here provide strong prima facie evidence of racial and class discrimination by psychotherapists. This field experiment largely confirms the hypotheses that help seekers who are black or working class are at a disadvantage with regard to psychotherapists’ accessibility. These results comport with extant studies that demonstrate the persistence of discrimination by health care providers, despite the assumption that those who select such professions have a strong commitment to equity. Moreover, this research demonstrates that audit studies of health care providers can be executed in ethical, precise, and low cost ways; this powerful method need not be relegated to the realms of real estate or labor markets.
- Heather Kugelmass (author/study investigator)
This timeless study sheds much needed light on the racism and classism that still remains within the field of mental health. Not only are the statistics yielded from the study disheartening, but it leaves many (including myself) to wonder “does my mental health matter?”
-ism vs Prejudice
Recently, a student of mine asked me to differentiate between racism and prejudice. From that followed a discussion of whether minority groups could be racist. These types of questions and discussions come up often within the course that I teach, but I know that this continues to be a confusing set of terms for many people.
Prejudice is a bias or preference. This is something everyone is capable of doing or having, including minority groups. For example, I tend to have a preference for engaging in issues and topics that related to race and ethnicity. That is my bias and natural tendency. Likewise, it is quite possible for an individual from a minority group to be prejudice toward another group, which could also result in negative or hateful thoughts, comments, and actions toward those individuals.
-ism (racism, sexism, ableism, classism, heterosexism, etc) ensues when there is prejudice and the power to do something about it. This is not just limited to having a special preference, bias, or hate for another group. This also involves having access to power that can be used to negatively impact the group for which there is prejudice.
So while both prejudice and –isms are harmful and negatively impact a number of individual people, -isms have the power to negatively impact and disadvantage entire groups of people.
What does this look like?
The American Psychological Association (APA) published a graph in their May 2016 issue of Monitor on Psychology. APA pulled data gathered from the National Center for Science and Engineering Statistics, which indicated that of the 2014 recipients of psychology doctorate degrees in the United States, approximately 20% were racial/ethnic minorities. While APA was enthused by the “growth” of racial diversity within the field of psychology from 2005 to 2014, I was more alarmed by the huge disparity in representation of White vs non-White recipients of psychology doctorate degrees. This is in addition to a 2013 statistic that indicated only 1.5% of the American Psychological Association membership were Black psychologists.
Considering the research statistics, the makeup of psychology doctorate recipients and the state of membership makeup within the American Psychological Association, imagine what could happen if some of these psychologists had a tendency to accept clients with “White sounding names” (i.e. Amy Roberts) and decline clients with names that sound more “ethnic” (LaToya Jackson). Or, imagine if some of these psychologists had a tendency to accept cash-paying clients and decline clients with Medicaid. This would create an overwhelming disadvantage for an entire group of people, based on a very specific cultural variable (in these examples, race and class).
Even when we assume that these tendencies are without malice and unintentional, the impact continues to be tremendous. What may start out as an “innocent prejudice,” “unconscious bias,” or simple choice based on “personal preference,” quickly becomes a huge disadvantage for an entire group of people. Even the most well intended professionals still have the capacity and, more importantly, the power (of representation) to make decisions that result in grave consequences for disadvantaged and marginalized groups.
While this research specifically involved classism and racism present within the mental health field, consider the lack of representation afforded to other minority groups, including LGBTQ+, religious minority groups, individuals with visible and non-visible disabilities, older adults, and immigrants and refugees. All of these groups are overwhelmingly underrepresented in the field of mental health and psychology. Therefore, how can we ensure that voices are heard, needs are met, and resources are provided with both empathy and equity?
The current problem with the majority of diversity and multicultural training is that it often excludes the most important part: awareness, ownership, and understanding of one’s own cultural identity and resulting position of power in society. Often times, we are taught that one must learn about the cultures, habits, and behaviors of others in order to reach an optimal level of cultural competence. It’s very common for White racial identity and other “normative” or privileged identities to be excluded from multicultural study material (i.e. Why do we learn about Black, Hispanic, Latino/a, and Asian cultures in diversity courses, but not White culture? Why is White culture so commonly synonymous with American culture and therefore not counted as a diverse group?). However, it seems that these discriminatory practices within the current field are caused by implicit biases, which can only be uncovered and reconciled through self-reflection and understanding of one’s own identity, cultural makeup, innate biases, and power and privileges afforded because of one’s own status within the context of their society.
It simply is not enough to learn about the differences between ourselves and others. We must truly understand our own identity, culture, biases before we are able to assist and positively impact others. Without this understanding, implicit biases and “innocent personal preferences” will continue to disadvantage entire groups of people for many generations.
How can we further dismantle –isms and supremacy within the fields of mental health and psychology?
Dr. Amber Thornton
Clinical psychologist with a passion for family, community, culture, and diversity.