A working-class black man has to try 16 times harder to get a therapy appointment than a middle-class white woman

Mental illness in the black community is a public health issue that is all too often grossly underestimated and misunderstood. According to the Department of Health and Human Services, black people living below the poverty line experience a disproportionate amount of serious psychological distress compared to their white counterparts. In 2012, despite the fact that black people were 20% more likely to report symptoms associated with with psychological distress, white people were twice as likely to treat similar symptoms with prescription anti-depressants.

Some of that disparity can be attributed to the stigma attached to mental issues, but a Princeton study published in this month’s Journal of Health and Social Behavior found that even when black people did seek professional help, psychotherapists were less likely to actually offer assistance.

Fifth-year Princeton graduate student Heather Kugelmass worked with a team of professional voice actors to create a series different scripts that would be read on the voicemails of  320 randomly selected therapists working in New York City. Each of the scripts was customized to suggest the caller’s race (by name, ethnically-coded accent, and grammatical patterns) and likely income level. The voice actors were also evenly split by gender.

During each call the voice actors requested an appointment with the therapist, making a point of expressing their desire to meet during a weekday evening. It should also be noted that each of the characters making the call had the same type of private health insurance.

Kugelmass found that, on average, therapists who were responsible for their own scheduling were much less likely to respond to black people’s requests for appointments.

30% of the contacted therapists responded to middle-class white people. 21% of the therapists responded to middle-class black women. 13% responded to middle-class black men. Working class people, regardless of their race or gender, were contacted by less than 10% of the therapists.

That breakdown, Kugelmass concluded, likely had a lot to do with the fact that there isn’t much professional oversight when it comes to how therapists, many of whom run their practices privately, conduct business.

“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.”

The fact that each of the characters attempting to schedule appointments had the same type of insurance prompted Kugelmass to further hypothesize that the anti-black bias that she observed was much more serious.

Many therapists, Kugelmass explained, are known to exhibit a preference for patients that they perceive as being young, attractive, verbal, intelligent, and successful (YAVIS). These patients, whom therapists often see themselves in, commonly come from similar financial and social backgrounds. Kugelmass reasoned that the bias against black people was likely connected to the idea that a white therapist might not be able to “embark on an intimate, long-term relationship with someone they feel they can’t relate to.”

“Ultimately, the goal is high-quality care for all, but people need access at multiple stages in the process in order to get to that point,” Kugelmass said. “There’s no quality of care for people who can’t get through a therapist’s door.”