Finding a therapist who takes your insurance can already be hard. If you’re black, or if you’re working class, it’s even harder.

A new study found 28 percent of white middle class people who called a psychotherapist asking for an appointment, were offered one, while 17 percent of middle class black callers were offered an appointment. Only 8 percent of working class callers – black or white – were offered a slot.

“Broadly, it shows how deeply embedded discrimination against black and working class individuals continues to be in American society, even in realms where people might not expect it,” said Heather Kugelmass, a Princeton University graduate student who conducted the study, published this month in the Journal of Health and Social Behavior.

In the study, she had voice actors call 320 psychotherapists in New York City.

All the callers expressed symptoms of depression or anxiety, like having trouble sleeping, or not wanting to see friends. All said they had the exact same kind of insurance: Empire Blue Cross Blue Shield.

But some went by names like Amy Roberts and Bobby Carpenter. And others went by Latoya Johnson and Darnell Thomas.

“Race was signaled through name and accent,” Kugelmass explained. “And then class was cued through vocabulary, grammar, and accent.”

For example, a middle class white caller said things like, “I’m becoming concerned because I can’t get going in the morning, and it takes a lot of effort to deal with people at work.”

While a working class black caller said, “I just be feeling down and annoyed at work all the time. Now I can’t even sleep right and that ain’t no good.”

Kugelmass said the overall response rate was low, which is similar to findings of a recent KQED survey of San Francisco psychologists.

But the disparities in who the therapists called back were “striking,” Kugelmass said. One out of two middle class white callers got a response, while one in three working class black callers did.

Previous research has shown that psychotherapists have a preference to treat clients they perceive to be verbal, intelligent, and “psychologically minded,” in other words, people who are like them. Another study found that psychiatrists perceive black patients as “less articulate, competent, [and] introspective” compared to white patients.

Kugelmass says her results suggest the therapists contacted for her study – all of whom held doctoral degrees and operated a solo practice – could be turning down potential patients based on unconscious biases or stereotypes.

“These white middle class, or upper middle class, therapists are probably reluctant to embark on what can be an intimate, potentially long-term relationship with someone that they feel they can’t relate to,” Kugelmass said.

The biggest disparity found in the study appeared with weekday evening appointment times – the most coveted slots in therapy.

Of all the calls placed by middle class white women asking for that slot, 20 percent resulted in an appointment offer for a weekday evening. That compares to just one percent of calls placed by working class black men resulting in an evening appointment offer.

“If the magnitude of discrimination against working class men in the study translates to what is happening in the real world,” Kugelmass said, “then they’re facing a virtually insurmountable barrier to getting care from the types of therapists who were investigated here.”

She said she hopes psychotherapy training programs, professional associations, and insurers will take her findings seriously and find a way to address them in practice.

To read more about barriers to mental health care in California, check out KQED’s series, State of Mind

Mental Health Study: Sorry, I’m Not Accepting New (Black or Poor) Patients 6 June,2016April Dembosky

  • carbonware

    I found the story on the radio very interesting today but to me you failed to be clear about part of it. You implied but never actually stated that the calls were with the therapist. I find this hard to believe. When was the last time anyone called a medical professional and actually spoke to the doctor when trying to make an appointment? Unless you prove otherwise it seems logical to me that the people exercisesing the prejudge were typical low wage office workers. In other words middle class and often minority.

    Since you indict the medical professional and not the staff who answered the phone I have to wonder if it was actually middle class and largely minority receptionists and schedulers who were demonstrating prejudge or was it the highly unlikely doctors who almost never actually pick up the phone in a medical office?

    Perhaps you were just unclear but since you repeatedly pointed toward the doctors as the point of failure and not their staff who actually talked to these actors. I’m inclined to think this was not an effective or honest study of discrimination by mental health doctors and more likely a story about how the middle class and minorities demonstrate unfair treatment and discrimination against themselves.

  • George

    I wonder if the results would be the same with Masters level Licensed Clinical Social Workers.


April Dembosky

April Dembosky is the health reporter for The California Report and KQED News. She covers health policy and public health, and has reported extensively on the economics of health care, the roll-out of the Affordable Care Act in California, mental health and end-of-life issues.

Her work is regularly rebroadcast on NPR and has been recognized with awards from the Society for Professional Journalists (for sports reporting), and the Association of Health Care Journalists (for a story about pediatric hospice). Her hour-long radio documentary about home funerals won the Best New Artist award from the Third Coast International Audio Festival in 2009.

April occasionally moonlights on the arts beat, covering music and dance. Her story about the first symphony orchestra at Burning Man won the award for Best Use of Sound from the Public Radio News Directors Inc.

Before joining KQED in 2013, April covered technology and Silicon Valley for The Financial Times, and freelanced for Marketplace and The New York Times. She is a graduate of the University of California at Berkeley Graduate School of Journalism and Smith College.

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