We must acknowledge there are racial differences and biases at play in the diagnosis and treatment of people with psychological disorders. The world of providers for people with psychological disorders cannot be separated from the concept of race. These biases affect evaluation of clients, which in turn affects diagnoses. The effects of racial bias on diagnosis lead to an effect on treatment and client outcomes. All practitioners would benefit from an intervention which would spread awareness of racial disparity and bias, striving for a more equitable action moving forward and improving all steps of the process, from evaluation to treatment.
Clinicians are affected by group stereotypes, showing a racial bias in diagnosis. In an experiment conducted by Jenkins-Hall and Sacco (1991), mental health professionals assessed depressed clients on an interpersonal rating scale. The professionals in the study rated white clients more favorably than black clients (Gruman, 2017), showing them to be affected by a racial bias or group stereotype. Unfortunately, these biases are influential enough to affect diagnoses of patients, as can be seen in the lower rates of schizophrenia diagnoses in white patients over black patients (Bresnahan et al., 2007).
To take it a step further, racial biases in diagnosis and evaluation of patients lead to biases in treatment, affecting prescription of medication and potentially patient outcomes. Fewer antidepressants and more antipsychotics are prescribed to black patients over white patients (Cerdeña et al., 2021). More research needs to be done on these disparities, but there are many more out there like them. Over and over again we can see racial bias in treatment of mental health. We need to start asking an important question: what is the effect on patient outcome?
An intervention must be enacted to prevent racial biases from negatively affecting the decisions of practitioners in diagnosis and treatment of patients. Applied social psychology serves to use its power to solve problems. Through intervention and the application of psychological theory, black and white patients could achieve equality in treatment. Not only would patients benefit, but researchers would benefit from a world in which race is no longer a variable.
References
Bresnahan M, Begg MD, Brown A, Schaefer C, Sohler N, Insel B, Vella L, Susser E. Race and risk of schizophrenia in a US birth cohort: another example of health disparity? Int J Epidemiol. 2007 Aug;36(4):751-8. doi: 10.1093/ije/dym041. Epub 2007 Apr 17. PMID: 17440031.
Cerdeña, I., Holloway, T., Cerdeña, J. P., Wing, A., Wasser, T., Fortunati, F., . . . Li, L. (2021). Racial and ethnic differences in psychiatry resident prescribing: A quality improvement education intervention to address health equity. Academic Psychiatry, doi:http://dx.doi.org.ezaccess.libraries.psu.edu/10.1007/s40596-021-01397-z
Gruman, J. A., Schneider, F. W., & Coutts, L. M. (2017). Applied social psychology: understanding and addressing social and practical problems. SAGE.
Tags: Applied social psychology, Bias, diagnosis, equality, intervention, psychological disorders, race, racial differences, treatment
The research you listed regarding implicit biases in providing healthcare is an enormous problem. There is already racial bias in hiring, bank lending, and housing, which further marginalizes a large classification of people. This marginalization puts this population at a greater risk for health problems (Taylor, 2018), and sadly, they can fall victim again when they go for treatment.
The blog mentions an intervention should take place to improve the problem. I agree, but was left wondering if you had an intervention in mind? It seems like there is not much we can do to erase implicit bias, however, education surrounding the fact that we have them seems to help. In fact, there is a project from the University of Wisconsin-Madison called the Prejudice-Habit Breaking Intervention, whose premise is that a bias is a habitual thought. Research on breaking habits shows that they can be overcome with self-awareness, desire to change, education, and hard work (DeAngelis, 2019).
Hopefully, this project and others like it can reduce implicit bias in healthcare, so people can receive the equal treatment they deserve.
References
DeAngelis, T. (2019, March). How does implicit bias from physicians affect patients’ healthcare? Retrieved from American Psychological Association: https://www.apa.org/monitor/2019/03/ce-corner
Taylor, S. E. (2018). Health Psychology. New York: McGraw-Hill Education.
There is a major disparity in the way Black people are treated in this country. It does not surprise me that this implicit racism trickles into the mental health treatment. I believe that a mental health practitioner needs to be completely honest with themselves about any prejudice they might have and not take on clients that fit into that prejudice. My goal is to become a mental health practitioner, I am still on the fence on what the end goal might be (clinical psychologist, licensed mental health worker, psychiatrist). I know whole-heartedly that I would not be able to treat people who suffered from the majority of paraphilic disorders (examples of paraphilic disorders include pedophilic disorder, sexual masochism disorder, frotteuristic disorder). I personally do not understand why any person who chooses to become a mental health practitioner would have issues with racial or ethnic differences. Most people who chose this field are compassionate and empathetic people with the goal of helping. It boggles my mind that studies show that there is racial bias in diagnosis. People should be ashamed of themselves for having bias against melanin. Although I am aware of my judgements in individuals that I would discriminate against in a therapeutic setting, implicit attitudes are not always on the forefront of the providers conscious prior to the bias. Implicit attitudes are thoughts and feelings that exist out of the conscious awareness and are difficult to acknowledge and control (Hall et al., 2015). In a study conducted by Hall et al. (2015), implicit bias was significantly related to patient-provider interactions, treatment decisions, treatment adherence and patient health outcomes (Hall et al., 2015). In addition, implicit attitudes were more often related to patient-provider interactions and health outcomes (Hall et al., 2015). I wish that discrimination based on ethnicity and race would disappear.
References
Willie J. Hall, M. V.-B. (2015). Implicit Racial/Ethnic Bias Among Health Care Professionals and Its Influence on Health Care Outcomes: A Systematic Review. American Journal of Public Health, 60-76.