BlackDoctor.org

It’s a well-documented medical reality that some patients get worse care simply because of who they are.

Women who go to the ER with acute abdominal pain are less likely to receive a painkiller; those who do wait longer for it than men who show up with similar symptoms. Obese people have shorter visits with their doctors and get less health education than their thinner counterparts.

But does the quality of treatment also vary depending on the race of the doctor? Specifically, do African Americans who have mental health problems get more effective care from clinicians of their own race?

A growing number of researchers argue the answer is yes.

African Americans make up only four percent of the nation’s physicians, less than a third of their share of the US population. The lack of diversity is even starker among psychologists, just two percent of whom are African American.

At the same time, studies have shown clinicians are more likely to underdiagnose psychiatric conditions in African American patients than in white patients. They tend to miss more symptoms of bipolar disorder and depression in African American adults and more cases of ADHD in African American children.

Dr. Norissa Williams, a clinical assistant professor for Counseling@NYU, which offers an online master’s in mental healthcounseling from NYU Steinhardt, believes mental health is studded with “cultural pain points” that can lead to missed or mistaken diagnoses.

For instance, Williams, who is African American, says many African American women strongly identify as caretakers. This identification can make them reluctant to admit to any mental distress of their own.

Racial and cultural differences also may surface in the ways patients relay their symptoms. Some Africans Americans may mention body aches and pain when describing their depression. Similarly, some Asian Americans tend to label their symptoms with physical traits like “dizziness” instead of emotional terms.

Those nuances often can go unnoticed by white doctors and therapists, says Williams, co-author of an upcoming paper in “Best Practices in Mental Health” about how cultural bias and stigma shortchange African Americans with psychiatric conditions.

“The problem with misdiagnoses and underdiagnoses is that the client is not going to get the correct treatment or any treatment at all,” Williams says.

Disparities in mental health treatments stem largely from systemic inequities. African Americans on average are seven timesmore likely than a white person to live in poor neighborhoods with little or no access to mental health services. Even with gains under the Affordable Care Act, 16 percent of African Americans remain uninsured.

What’s more, race matching between providers and patients may not have much effect on clinical outcomes. In a 2011 meta-analysis from the American Psychological Association’s Journal of Counseling Psychology, researchers concluded African American mental-health patients in particular strongly preferred to have African American therapists and also rated their experience with them more positively. The improvements in the patients’ conditions, however, were largely unrelated to the race and ethnicity of the therapist.

Nonetheless, some researchers argue that increasing the number of African American mental health professionals makes for good medicine. Trust and rapport between doctor and patient can be particularly important in dealing with mental health issues.

African Americans put a high premium on interpersonal relationships with their doctors, says Babe Kawaii-Bogue, a trauma counselor and the co-author of the paper with Williams. But many clinicians don’t – or can’t afford to – take the time to forge that link.

African Americans also may feel they have historical reasons to mistrust a predominantly white medical establishment. Psychiatric illnesses are stigmatized and misunderstood within some parts of the African American community. However, African American patients strongly favorcounseling to drug therapy.

Clinicians must be mindful when trying to connect or be culturally fluent. Without the right context or tone, their statement could be offensive. To prevent this, Williams suggests that practitioners take the implicit bias association test, in order to identify their own unconscious biases.

In addition to identifying biases, practitioners should be proactive in continuing to educate themselves about the growing demographic of Americans who need mental health treatment. The more well-versed they are, the fewer chances stigma will continue to affect African Americans who are hesitant about seeking treatment.

Alexis Anderson is a Digital PR Coordinator covering K-12 education at 2U, Inc. Alexis supports outreach for their school counseling, teaching, mental health, and occupational therapy programs.