Study Shows That Some Therapists May Choose Patients Based On Race And Class

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The study showed middle-class messages received appointment offers at more than twice the rate of working-class.

According to a new study, mental health access in the US is harder to obtain for working-class black patients because of biases on the part of therapists. 

Reuters reports that based on calls to hundreds of therapists, a study found that middle-class patients had an easier time getting appointments with therapist compared to working-class patients, and black people were less likely to be offered an appointment. 

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Heather Kugelmass, a doctoral student in sociology at Princeton University in New Jersey, said, "Although we expected to see evidence of racial and class-based discrimination, the magnitude of discrimination against working-class therapy seekers, in particular, exceeded our grimmest expectations."

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Four voice actors were recruited for the study and recorded nearly identical voicemails using racially distinctive names along with class- and race-based voice patterns. Two male and two female voice actors were recruited. Messages were left with 320 psychotherapists in New York, each receiving calls from one black working-class and one white working-class potential patient or one white middle-class and black-middle-class potential patient. Of those calls, 247 were returned. 

The study showed middle-class messages received appointment offers at more than twice the rate of working-class. White middle-class patients received a response to 28% of their calls, while black middle-class patients only received a response to 17% of theirs. Of 80 therapists, only a third of therapists responded to the black middle-class messages.

"Deeply-rooted stereotypes associated with the working class could lead to negative reactions to their requests for care. Even though all therapy seekers in the study were covered by the same insurance, it is possible that mental health care providers view working-class patients as a financial risk because, for example, they cannot be relied upon to keep appointments or pay insurance co-payments at the time of treatment," Kugelmass told Reuters. She also revealed that similar results have been seen in studies done for other marketplaces like real estate and employment. 

Kugelmass continued that the study has its limitations and did not look at the reasons for responses or failures to respond, and did not take into account the race of the therapist. Kugelmass concluded, "This study identified racial and class-based disparities in access, but could not evaluate potential solutions. Also, it’s important to caution that this study investigated only doctoral-level psychotherapists in New York City who were sole practitioners; therefore, recommendations based on this research might not be generalizable."

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