Black or working-class patients are often not welcome in majority of therapists' clinics, a new study has revealed.
A sociologist from Princeton University conducted an experiment and found that getting an appointment with a therapist depends on sex, race and social class.
For the study, sociology graduate student Heather Kugelmass left two types of voicemail messages for 320 therapists in New York, randomly chosen from a list of a major health insurance company. One voicemail message is from a purportedly white patient and the other one is from a purportedly black patient. Gender (male and female) and social class (middle class and working class) were also divided evenly.
Psychotherapists at the doctoral level were chosen for the study as they do solo practice and manage their schedule personally. In the experiment, the name of the caller suggested the race while grammar, vocabulary and accent were used to signal social class. All of the participants have the same health insurance provider and expressed preference for an appointment of weekday evenings.
The results painted a sad picture of discrimination.
The white female from the middle class received affirmative appointments for weekday evenings from 20 percent of 80 therapists. The black male from the working class, on the other hand, received only one offer after 80 calls.
About 30 percent of therapists gave appointment offers to middle-class white patients at any time or date. However, working-class patients - man or woman and black or white - only had 10 percent of therapists willing to give them a slot. About 21 percent of therapists offered the middle-class black female an appointment, while only 13 percent gave the middle-class black male an appointment offer.
"Unlike employers or real estate agents, psychotherapists have not previously faced empirical scrutiny for potentially discriminatory behavior," Kugelmass said. "This research provides a window into an otherwise private exchange that may subtly perpetuate disadvantage."
Rutgers University Board of Governors Professor of Sociology Allan Horwitz, who was not part of the study, said the research contributes to the growing data on mental health care access and discrimination.
The research provides an insight on how gender, race and social class define the ability to pay and the inequality of mental health care access, said Horwitz.
Kugelmass pointed out that although there are health care laws that ensure quality of care, it would be best to ensure that those who need it have access to it.
For instance, an early study found that those who are discriminated at work are more likely to be stressed. If therapists would discriminate against them as well, to whom will they turn to for help?
Government Actions
To address the continuing health care disparity, the Health and Human Services passed [PDF] the HHS Disparities Action Plan that seeks to establish "a nation free of disparities in health and health care," while setting out sets of priorities, strategies and goals to achieve the vision.
Similarly, the Affordable Care Act (ACA) also includes efforts to improve health care provision to populations that are likely to experience discrimination.
The study is published in the Journal of Health and Social Behavior on June 1.
