Racial bias against BIPOC folks has a long history in medical settings and continues to play a role in present-day mental health care.

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When searching for the right therapist, I have a few nonnegotiable factors.

If I’m expected to trust someone with my mental wellness and share some of the most vulnerable parts of myself, then feeling safe and understood is a top priority. For me, this means vetting practitioners who are:

  • women or gender nonconforming
  • Queer-affirming
  • Black

Granted, checking all of these boxes hasn’t been easy, especially when you factor in the even smaller pool of mental health practitioners who take insurance.

But the larger issue is that working with BIPOC (Black, Indigenous, and People of Color) therapists is much more than a matter of preference — often, it’s a direct attempt to avoid further harm.

Some of the race-based issues within mental health care are connected to the lingering presence of racist practices within the field of psychology. But racism in mental health care didn’t end in our history books.

Medical mistreatment

Many are familiar with the Tuskegee experiments or the “immortal” cells of Henrietta Lacks and how these research experiments sowed medical distrust within Communities of Color.

Andreu Gibson, a behavioral technician based in North Carolina, shares their experiences working in hospitals, noting how People of Color are treated differently in clinical settings.

“Black people, Black minds, Black bodies have been used as scientific experiments, and the echoes of that remain,” Gibson says. “It’s not just echoes and shadows — it still happens to this very day, just in different ways.”

Research from 2003 shows a long history of racial and ethnic disparities in clinical care, noting that People of Color are:

  • more likely to be prescribed antipsychotic medications than their white counterparts
  • more likely to be involuntarily hospitalized and placed in isolation during hospitalization
  • are less likely to receive guideline-adherent treatment and follow-up

In addition, a 2018 study highlights how implicit bias in mental health settings against People of Color has impeded access to:

  • appropriate and quality care
  • clinical screening and diagnosis
  • treatment processes
  • crisis response

Gibson adds that sometimes, racial bias begins with the intake process.

They explain that “the age-old notion of ‘Black people are less than,’ ‘Black people are subhuman,’ ‘Black people are incapable of control’” are damaging narratives that create and uphold bias around how the pain and emotions of People of Color are addressed in healthcare settings.

According to Harriet A. Washington’s “Medical Apartheid,” a comprehensive history of medical experimentation on Black people, racial bias has helped many white people to alleviate guilt and justify that slavery was a reasonable aspect of society.

The remnants of medical mistreatment toward Black people in the past have seeped into our present-day interpersonal connections and spilled over into our healthcare practices and policies.

Racism and discrimination in the United States continued into the 21st century with eugenics, a practice that targets marginalized people — most often Black women and folks with disabilities — and forcibly sterilizes them.

Incarcerated folks were also subjected to variations of eugenics well into the 2000s, particularly in California, until at least 2013.

Mental health effects

The effects of persistent racism and racist practices are traumatic, which means that navigating bias and discrimination daily can have negative effects on your mental health.

For instance, a 2016 study suggests that trauma and stress due to racial bias can lead to higher rates of:

Physical health effects

Trauma can also be stored in the body. A mental-physical connection may exist between trauma and chronic pain, according to a 2016 study.

What’s more, many people with chronic pain, especially BIPOC individuals, are denied pain medication or have symptoms that are dismissed.

For instance, a 2016 study highlights the continued assumption by medical professionals that Black people feel pain differently — or less — than their white counterparts.

Healthcare inequities

Data from the Centers for Disease Control and Prevention (CDC) and Mental Health America (MHA) show how Black folks are less likely to receive mental health treatment despite higher rates of symptoms.

This is partially due to how racism often determines who can access resources — shown through racial disparities such as lack of health insurance and poor public transit in low-income areas — and medical distrust.

“The point of mental health and healthcare is to help equip people with tools to aid them in life — what’s happening is we are adding trauma, we’re making it worse,” Gibson says.

“What I’m seeing more of is people falling deeper into a hole, falling deeper into a spiral. People [are] more focused on not wanting to interact with mental health systems again and finding alternate ways of coping.”

At times, the prevalence of racism is directly connected to mental health and its related fields and organizations.

Practitioners of Color

Krystal Jagoo, MSW, a social worker in Ontario, Canada, shares how People of Color are often punished in professional settings when they choose to speak up.

“When I worked for an unemployment help agency, I recall their troubling protocol to ask BIPOC youth if they had a criminal record as a safety precaution,” Jagoo says.

“But shortly after bringing that to my white supervisor’s attention, I was told that I was not a good fit for the organization before my 45-day probationary period ended.”

She adds that BIPOC mental health professionals may feel a lack of support from their non-BIPOC clients or colleagues.

Clients of Color

Racial bias directly impacts how non-POC practitioners treat their clients.

The book “Medical Apartheid” provides examples of how racial disparities affect treatment and assessment, including how Black people are less likely to receive medication.

Odochi Ibe, a freelance journalist based in New York, says a mental health professional denied her request for medication to treat her attention deficit hyperactivity disorder (ADHD).

She says the refusal of proper treatment was “based on her looks,” and that it was wrongly assumed that she was there only to get a stimulant she didn’t actually need.

Lisa Rosenberg, a licensed clinical social worker and therapist in New Jersey, shares her experiences providing respite for some of her Black clients.

“Most frequently, Black women clients have said they felt guarded mentioning racist incidents or microaggressions to white therapists,” she said.

Rosenberg has also dealt with Black women being framed as overly reactive and hypersensitive when they were responding appropriately to a micro (or macro) aggression.

She says many clients may question whether micro (or macro) aggressions are racist, “as if an interaction which felt racist to the client — who had a lifetime of experience with racism — was an imagined slight.”

In addition, Rosenberg shares how some white therapists will weaponize “resilience,” failing to challenge their Black clients and applaud them just for showing up.

Because of the pervasive nature of racism, marginalized populations internalize the messaging we’ve received, which only upholds barriers to adequately addressing our mental health.

Community-based stigmas

As an adult who presently understands the importance of addressing stigma head-on, I speak openly with my family about my belief in mental wellness, the importance of self-care, and how I see absolutely nothing wrong with using medication and therapy as tools to do so.

This enthusiasm hasn’t always been present, largely for fear of judgment or wanting to avoid being told I’m not handling my mental health in the right way.

Everyone is entitled to their individual belief system, but danger arises when those lines are blurred by internalized biases surrounding mental health or fear of medical professionals.

How our mental illnesses can go untreated

A research review from 2017 cites a number of sociocultural factors that may play a role in how racial or ethnic minority groups are treated for mental illness or whether they seek treatment at all.

“Although my generation is more open to it, there are still so many Black people who are ill-informed when it comes to mental health,” Ibe says.

C. Imani Williams, a wellness coach and author in Nevada, remembers how her loved ones with mental health conditions were ostracized by other family members. She says the fact that mental health wasn’t openly discussed during her upbringing informed her desire to become a clinician.

“My dad had bipolar disorder,” Williams says. “He was brilliant, but as a Black man living with a mental health condition in the 1970s, he was highly misunderstood.

“There were times growing up where if he was in a manic state, my mother would pack us up, and we would leave until he could get placed in care for a 72-hour hold, and that in itself was traumatic.”

Williams says mental health conditions are present on both sides of her family. Both her father and her maternal aunt were diagnosed with bipolar disorder — formerly called manic depressive disorder — and they leaned on each other to cope.

“I noticed as a kid, even after my parents had divorced, a really sweet, special relationship that my father had with his sister-in-law,” she says. “I thought that was so beautiful, and I didn’t understand how adults could be so cruel.”

Many people agree that issues of race, especially when it comes to healthcare, shouldn’t be a determining factor, but we don’t yet have the luxury of that being a reality.

No quick fix

As time progresses and cultural competency enters the foreground of healthcare conversations, culturally competent therapists and counselors within the mental health field are becoming a necessity.

Addressing the continued prevalence of racism within mental health will be crucial to improving mental health outcomes for historically marginalized communities. This could include strategies such as:

  • improving policies and practices
  • addressing continued self-stigmatization that occurs within marginalized communities
  • exploring the role of racial bias within provider-patient relationships

Policy and language changes

The recent update of the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) to the DSM-5-TR (Text Revision is an example of the necessary institutional changes that are starting to take place.

Roberto Lewis-Fernández, MD, professor of clinical psychiatry at Columbia University and chair of the DSM-5-TR Cross-Cutting Culture Review Group, says the changes within the DSM-5 aimed to address culture, race, and ethnicity-based equity and inclusion. These changes focused on:

  • explicitly racist language
  • gender-discriminatory language
  • social and structural causes of differences found among cultural groups
  • adequacy of data sources utilized

Lewis-Fernández says he believes that the recent changes could help enhance the cultural and contextual validity of clinicians’ diagnoses in mental health care settings.

While the recent DSM-5 updates are promising, it’s important to remember that there’s no quick or easy fix to how a generations-long issue shows up in mental health care.

“There is no immediate solution,” Gibson says.

“Various steps can be taken to mitigate and to bring forth accountability, but like most things, the solution is a shift in mindset, a shift in heart — a cultural shift. It’s the end of racism. You can’t have racism exist in one place and not in another.”

While racism isn’t something that can’t simply be overturned, there are opportunities to reevaluate how we, as mental health professionals and advocates, address and treat clients. This can be through:

  • regular reassessment of policies and practices, including accountability measures for those who have harmed BIPOC clients
  • engaging in diversity, equity, and inclusion (DEI) work led by BIPOC folks
  • addressing internal biases and language pitfalls

Feeling like you have to push to be heard or fight to have your existence acknowledged in therapy can be overwhelming and exhausting. It’s crucial that you’re able to feel safe in the therapeutic setting when it comes to taking care of your mental health.

Taneasha White (she/her), a graduate of English and Gender, Sexuality, and Women’s Studies, is a Black, Queer lover of words, inquisition, and community, and has used her role within both literary and organizational spaces to make room for folks who are often cast aside, silenced, or overlooked. In addition to mental health, her other writing, editing, and sensitivity consulting work covered varied topics related to the intersections of Blackness, fatness, & Queerness, activism, and reproductive justice. Taneasha is excited to continue this work of amplifying marginalized voices, centering intersectionality, and destigmatizing mental health.