This is how therapists discriminate against black and working-class patients
A new study finds that therapists are less likely to agree to see clients who are black or working-class—even when they had the same insurance as other groups.
The study, titled, “‘Sorry, I’m Not Accepting New Patients’: An Audit Study of Access to Mental Health Care,” had fake potential clients use different names, accents, vocabulary and grammar to suggest different races and classes when they called therapists asking for appointments. The name Amy Roberts, for example, was used to imply that the caller was a white woman; the name Latoya Johnson was used to suggest a black woman.
To indicate that the caller was “working-class,” the scripts for those callers used more slang and grammatical errors.
Among “middle-class” people who contacted a therapist to schedule an appointment, researchers found that 28 percent of whites received appointments, compared to 17 percent of blacks. “Black” and “white” working-class therapy-seekers were each offered appointments 8 percent of the time.
The author of the study, Heather Kugelmass, a doctoral student in sociology at Princeton University, was shocked by her results: “Although I expected to find racial and class-based disparities, the magnitude of the discrimination working-class therapy seekers faced exceeded my grimmest expectations.”
The study had participants call 320 randomly-selected New York City-based psychotherapists, who had PhDs or PsyDs, and private practices that accepted a large health insurance provider’s HMO plan.
“It is striking that discrimination toward black and working-class therapy seekers occurred even though all therapy seekers had the same health insurance and were contacting in-network providers,” Kugelmass says. “This evidence points to bias rather than financial considerations. It is possible that if insurance coverage had not been held constant, inferences based on racial and class stereotypes would have augmented discrimination even beyond that which was observed.”
Women were also favored over men: White middle-class women did the best in terms of securing a “coveted midweek evening appointment,” the study found—they were 16 times more likely to get the appointment they requested than black working-class men who requested the same one.
In general, therapists’ response rates were low, with only 44 percent returning the call.
People who are actually black and/or working class might be rather less surprised than Princeton academics to find out that they are discriminated against by psychotherapists, given the pervasiveness of racism in America.
There is often justified suspicion of the medical community among poor people of color, long familiar with being marginalized and harmed by institutions supposed to heal. Even if they can get therapy, the DSM (Diagnostic and Statistical Manual), used to diagnose patients, is often used to enforce norms created by the dominant group—black men, for example, are diagnosed with schizophrenia four to five times more frequently than other groups.
Part of the reason for the discrimination could be that “only five to seven percent of mental health care providers in the United States are racial or ethnic minorities,” according to Dr. Joseph R. Betancourt, director of the Disparities Solutions Center at Massachusetts General Hospital and Harvard Medical School. White, middle or upper-class therapists “might feel less of an affinity or ability to care for somebody who is different,” Betancourt said.