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Study Shows Racial Disparities in Promotion of Mental Health Services

Therapists more likely to call back 'Allison' than 'Lakisha' with messages encouraging future services

Lance Smith, associate professor in counseling
Lance Smith, associate professor in counseling, is a lead researcher on a study that suggests that counselors and therapists perpetuate racial bias. (Photo: Ian Thomas Jansen-Lonnquist)

A new study reveals that patients seeking mental health services may be at risk of racial bias.

The study analyzed the callback rates and responses of counselors and psychologists to voicemail messages left by an actor using the name “Allison” or the name “Lakisha,” which, data shows, are names with high correlation in the U.S. to white and black individuals, respectively.

Authors of the forthcoming study in The Counseling Psychologist used audio clips recorded by the same actor to ensure they would be nearly identical in vocal cadence, tone and manner of speaking. Only the names were different. Allison received responses promoting services at a 12 percent higher rate than Lakisha.

It’s among the first racial audit field studies conducted within the mental health profession.

“Our study, like similar studies within the fields of housing, economics and higher education, suggests that counselors and therapists also perpetuate racial bias,” says Lance Smith, associate professor in counseling at the University of Vermont and co-principal investigator of the study. “There’s this dominant idea in our society that one is either a good person or racist, but you can’t be both. Our study underscores the notion that well-meaning, beneficent people — egalitarian people like mental health providers who are ostensibly highly trained in self-awareness and multicultural competence — may exhibit implicit bias towards black people.”

A total of 371 calls were placed to licensed counselors and psychologists from the East Coast and Mid-Atlantic states using online therapist referral databases, with 198 calls placed for Allison and 173 calls for Lakisha. Allison was invited to participate in a phone conversation with a therapist 63 percent of the time, while Lakisha was invited to participate in a phone conversation 51 percent of the time.

Callback rates similar in number, not content

Initially, researchers were interested primarily in callback rates, but after finding no statistically significant difference, they decided to probe deeper. Smith says it was encouraging that counselors and psychologists met their mandated ethical responsibility of returning a potential client’s phone call, but that further examination showed that Allison received more invitations for “follow-up phone calls or outright offers for services than Lakisha.” For example, Lakisha received more messages from therapists who stated things like, “I’m afraid that my case load is full. I’m sorry that I won’t be able to see you."

“We asked ourselves, what is a response from counselors and therapists that promote future services and what are responses that impede future services?" says Smith. "Not receiving a call back at all, or receiving a message that stated one’s case was full fell into the impede services category. Receiving a callback that invited future conversation or an appointment fell into the promote future services category.”

Considering the data in this light revealed a significant difference in mental health care accessibility for "Allison" and "Lakisha."

Prior studies attempting to explain inequitable patterns of mental health service delivery between white and black individuals have focused primarily on cultural and behavioral factors within the black community such as negative attitudes toward mental health care or difficulty admitting help is needed.

“The purpose of this study was to shift away from the emphasis on why black individuals ‘fail’ to seek mental health services to a focus on what counseling professionals may be doing to block the provision of services to potential black clients,” write the authors.

Training key to identifying subconscious bias

The study’s findings support a growing body of empirical evidence that professionals are not immune from internalizing racial biases even though they may genuinely hold egalitarian values.

“Although a counselor or psychologist consciously possesses an overt and strong attachment to values such as fairness and egalitarianism, they may be simultaneously in denial of subconscious biases that can be activated by a racialized name,” according to the study.

Authors of the study suggest a “doubling down” on the current approach by counseling and psychology programs to infuse social justice issues into curricula and training, and to encourage practitioners, students and trainees to do what Smith calls the "uncomfortable work of interrogating one’s subconscious biases and stereotypes of traditionally marginalized groups."