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Many believed that the advent of the Affordable Care Act was a huge step toward resolving racial disparities in health care. However, a new study suggests otherwise.
‘Sorry, I’m Not Accepting New Patients’, published in the Journal of Health and Social Behavior‘s June issue, examined the biases of private therapists in New York City.
Heather Kugelmass, Princeton University doctoral candidate and study author, found that the therapists regularly discriminate against prospective patients who are Black or working-class, regardless of insurance standing.
The sociology student enlisted the help of actors for the study, who left voicemail messages requesting an appointment with one of 320 psychotherapists randomly selected from Empire Blue Cross Blue Shield’s HMO plan.
Each therapist received a call from two middle-class patients of the same gender: one Black, the other white; or two working-class patients of the same gender, both Black and white.
All callers said they preferred a weekday evening appointment and gave the same private health insurance provider. Kugelmass carefully crafted scripts for clues to socioeconomic status, using vernacular and heavily accented language to denote working-class, while differing names were used to indicate race.
Middle-class African-Americans with insurance were less likely to get a call back from therapists than whites with similar characteristics.
Just 17 percent of purportedly middle-class Blacks received appointment offers, while 28 percent of white middle-class callers were contacted.
Kugelmass said she anticipated class- and race-based inequities, but the degree of discrimination against working-class individuals far exceeded her “grimmest expectations.”
The rate of appointment offers for both Black and white working-class callers was just 8 percent.
The study has damaging implications for African-Americans seeking therapy in this country.
African-Americans are 20 percent more likely than whites to suffer from serious mental health conditions, such as depression and post-traumatic stress disorder, according to the U.S. Health and Human Services Office of Minority Health.
And African-Americans face a higher rate of poverty, a known contributor to psychological illnesses, than the general population. Those living below the poverty line are three times more likely to report psychological distress.
Homelessness, a side-effect of poverty, plagues the Black community at epidemic proportions: Some 40 percent of African-Americans are homeless, the federal agency reports.
African-Americans face many stumbling blocks on the path to quality mental health care: the myth of the strong, Black woman and her hyper-agressive male counterpart; an at times dogmatic reliance on spirituality to heal all ailments; and a general distrust of medical institutions in the U.S. due to the countless number of unethical experiments and treatments performed on unsuspecting Black patients in the past.
This is not the first study to highlight discrimination among mental health professionals.
Last month, Georgia State University researchers released a study that found psychiatrists were less likely to medicate Black patients with mental disorders, though they are almost twice as likely to be diagnosed with schizophrenia. Researchers did find that African-Americans were more often treated for schizophrenia and depression through formal psychotherapy sessions.
In this year’s annual Medscape lifestyle report on physician bias and burnout, 48 percent of psychiatrists admitted to having biases against particular groups of patients. The email questionnaire surveyed 15,800 doctors from all over the United States who specialized in 25 areas.
Though doctors pointed to patient emotional problems as the most common source of prejudice. CNN reported that intelligence, language differences, insurance coverage, age, income level, race and attractiveness also played significant roles.
The information does nothing to quell widely held suspicions that individuals covered by social service programs like Medicaid or Medicare generally receive lower-quality medical attention.
The Princeton study indicates that private health insurance does not save minorities from racial prejudice in this country.
“Access to health insurance may not be sufficient to ensure equal access to therapy,” Kugelmass concludes in the study. “In fact, psychotherapists may unintentionally stymie efforts to promote equal access when they have discretion over their clientele. Macro-level barriers to accessing care are incredibly important, but the influence of interactions between therapists and prospective patients should not be overlooked.”
