Provider Referrals, Perceptions Affect Mental Health Disparities

An African-American woman speaks to her white doctorResearch has repeatedly found significant race-based health disparities. For example, African-Americans statistically die younger than whites, and although African-Americans experience fewer mental health problems overall, those who do are less likely to receive proper treatment for these conditions. A new study suggests that these different outcomes may be partially explained by racially biased medical decisions.

Race-Based Treatment Differences

The study, conducted by researchers at the University of California-Davis, evaluated 9,000 people from a variety of backgrounds, including Latinos, African-Americans, non-Hispanic whites, and Asian-Americans. The research found that Asian-Americans were less likely than any other ethnic group to receive referrals for mental health care. Likewise, African-Americans were less likely than other groups to receive recommendations for medications. Latinos, by contrast, were more likely to report receiving referrals for mental health care and to report pursuing counseling.

The study’s authors emphasize that these results suggest serious problems with access to mental health care. People who pursue treatment for mental health conditions have much better outcomes. But when doctors don’t evaluate patients for mental health difficulties, or when they don’t encourage patients to seek mental health care, those people are less likely to get the care they need. This, in turn, can contribute to other racial disparities. Untreated mental illness is a risk factor for being arrested, and people with untreated mental illnesses are four times more likely to be killed by police.

Understanding Bias in Medicine

Although the study doesn’t specifically address why doctors treat patients differently depending on their race, previous research can shed light on the phenomenon. Some doctors may engage in implicit associations without even knowing it. An implicit association occurs when a person unconsciously associates a group with a particular image or descriptor. For example, a doctor might associate white people with depression because of portrayals in the media or previous experience. A black person’s symptoms, by contrast, might be chalked up to another cause.

Some disparities could even be due to misguided attempts to help racial minorities. Dorothy Roberts, a University of Pennsylvania professor and scholar of race, argues in her book on race, Fatal Invention, that mistaken beliefs about medical risk factors can give rise to disparate treatment outcomes. According to Roberts, medical schools increasingly endorse race-based medicine. This approach to medicine relies on statistical data to determine which disease a member of a racial group is most vulnerable to. Thus a doctor might look at statistics on a specific mental health condition and determine that more members of one racial group are diagnosed with depression than another group. This can cause the doctor to make diagnoses based on a person’s race instead of his or her symptoms.

There’s no racial group that is immune to any particular disease. Moreover, race is a social construct and not a biological reality. Roberts points out that people with black skin, for example, are often more genetically similar to people with white skin rather than to dark-skinned people of other races. And some experts believe that socioeconomic differences play a larger part in health disparities than race alone. So while race can sometimes provide information about genetics, it’s not always a source of good or complete information. Consequently, Roberts explains, doctors may be less likely to consider some diagnoses based on a patient’s race.

No matter the cause of race-based mental health disparities, the study’s authors argue that increased access to mental health care is important for all people, regardless of race or socioeconomic background.

References:

  1. Jaffe, E. (2012). Race masks health-disparity complexity. Retrieved from http://www.psychologicalscience.org/index.php/video/jackson-kicks-off-aps-convention.html
  2. Perceptions, referrals by medical providers affect mental-health treatment disparities. (2014, December 1). Retrieved from http://www.ucdmc.ucdavis.edu/publish/news/newsroom/9501
  3. Roberts, D. E. (2011). Fatal invention: How science, politics, and big business re-create race in the twenty-first century. New York, NY: New Press.

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  • Eric

    Eric

    December 8th, 2014 at 10:37 AM

    Do you think that much of this still rests with the minority community as a whole in that it is not deemed socially acceptable to seek out treatment for mental health concerns?

  • Lucinda

    Lucinda

    December 8th, 2014 at 3:18 PM

    Medical providers are what I would naturally consider to be some of our best and our brightest, so if there is still this kind of bias, even unintentional found in medicine then how can we expect that the rest of society can be any better? These are people with degrees and an educational level that most of us can only dream about and yet they are still faced with the same very human prejudices and problems that the rest of society has. They are healers but they are human too, but there are times that you cannot let your own personal feelings get in the way of the treatment that you would prescribe for your patients.

  • sally

    sally

    December 9th, 2014 at 3:53 AM

    We all have our prejudices but in a position like this you can’t allow those to cloud your judgement.
    If you do or have a hard time not letting that affect you them you could have chosen the wrong profession.

  • Justine

    Justine

    December 10th, 2014 at 1:55 PM

    I would have hoped by this point in time we would have moved past letting what someone looks like on the outside determine what we think that they could have going on on the inside. You may think that you know something about someone because of where they are from or what they look like but this shows that there is all the more reason to stay away from those kinds of snap judgments.

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