Are psychotherapists less likely to accept patients that are working class or black? According to a new study from the American Sociological Association, the answer is yes. The study, published in this month’s issue of the Journal of Health and Social Behavior, found that therapists in New York City were less likely to offer appointments to patients who were perceived to be black or lower working-class.
“Psychotherapists are not immune to the stereotypes that influence the decisions of other professionals,” Heather Kugelmass, the author of the study, said. “Moreover, because therapists in solo private practice have high levels of professional autonomy, they have a lot of latitude to make decisions that are consistent with their biases.”
Kugelmass, a doctoral student in Sociology at Princeton, wanted to investigate how health care provider’s biases toward a patient’s race, social class, or gender might impact access to psychotherapy. To do this, Kugelmass contacted 320 psychotherapists with terminal degrees (PhD or PsyD) working as solo practitioners in the New York City Area and left them a voicemail message that could be identified as either middle class, working class, male, female, white or black. Each of the messages requested an appointment with a preference for weekday nights and indicated the same health insurance coverage. The callers were evenly divided by race, gender, and class.
Surprisingly, the call back rates were low for all groups: 51% of white middle-class messages were returned compared to 49% for middle-class black callers, 45% for working-class white callers, and 34% for working-class black callers.
Among those who were called back, however, Kugelmass found a disturbing trend. Once reached, white patients who sounded like they were middle-class were offered an appointment 30% of the time, while middle-class black women were offered an appointment 21% of the time and middle-class black men received such an invitation only 13% of the time. The offer for psychotherapy appointments also seemed to depend on gender and class divisions.
For example, when an identifiably black working-class man with health insurance called 80 therapists in his insurance network to request a weekday evening appointment, only one call elicited an offer. In contrast, 20% of the calls made by a white middle-class woman—with identical insurance coverage—elicited a comparable offer.
Also, even though all participants requested the same meeting time, middle-class white women were sixteen times more likely to get the appointment they had requested than working-class black men.
Kugelmass points out that the fact that only 3% of licensed psychologists nationwide are black and that only 1.5% of the of the members of the American Psychological Association are black might heighten the disparities observed in this study.
“Individuals who experience discrimination during their help-seeking process may view reaching out to psychotherapists as a fruitless activity or develop negative attitudes toward a class of professionals already regarded with skepticism,” she writes.
“For those who do persist in their search for care, every instance of blocked access means additional time and effort spent placing numerous phone calls to identify a psychotherapist willing to respond and accommodate their schedules. This is time and effort that those suffering from mental [health issues]—especially those of low socioeconomic status—do not have to spare.”
Kugelmass, H., 2016. “Sorry, I’m Not Accepting New Patients” An Audit Study of Access to Mental Health Care. Journal of Health and Social Behavior, p.0022146516647098. (Full Text)