Across the country, access to mental health care is sadly not guaranteed: Roughly 20% of adults with a mental illness don't get the treatment they need. And it may even be worse if you're Black or working-class, a new study finds. For the study, published today in the Journal of Health and Social Behavior, lead author Heather Kugelmass had voice actors call 320 New York City psychotherapists with PhD or PsyD degrees, pretending to be patients seeking an appointment. Each therapist received four calls, supposedly from a Black middle-class person, a white middle-class person, a Black working-class person, and a white working-class person. The actors were instructed to change their voices, accents, and vocabulary based on which caller they were playing. All of the callers made it clear they had the necessary insurance.
In the end, the psychotherapists called back 28% of the white, middle-class callers, versus just 17% of the Black, middle-class callers. Worse, only 8% of working-class callers, regardless of racial signifiers, were called back. The study also found that although all callers mentioned preferred time slots in their initial messages, the psychotherapists were most likely to honor the requests of people playing white, middle-class women. A caller from this group was accommodated by 16 out of 80 therapists, while a Black, working-class man only found one therapist out of 80 who'd fulfill his time request. Kugelmass, who is a PhD candidate in the sociology department at Princeton University, suggested that these cases of discrimination were a product of racial bias. "It is striking that discrimination toward Black and working-class therapy seekers occurred even though all therapy seekers had the same health insurance and were contacting in-network providers," she said in a statement.