Study Points to Structural Bias and Racism in Mental Health Organizations

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         Study Points to Structural Bias and Racism in Mental Health Organizations

Jim Windell

           National data reveal that over the past 75 years, the health of both black and white persons has improved in the U.S. and this is revealed in the increases shown in life expectancy and declines in infant and adult mortality. However, black persons continue to have higher rates of morbidity and mortality than white persons for most indicators of physical health. Hispanics and American Indians also have elevated disease and death rates for multiple conditions.

           Health care plays a role in the health of people and we know that early intervention and the appropriate management of chronic disease play an especially important role in health. It has also become more apparent in recent decades that racial and ethnic differentials in the quantity and quality of care are a likely contributor to racial disparities in health status.

            But what about mental health care and racism?

            Are there racial and ethnic biases in mental health services that ultimately affect the kind and quality of the care people receive? Aren’t all of us in the mental health field particularly sensitive to bias that would interfere with services to minorities?

           A new study, published recently in Clinical Psychological Science, contends that bias is embedded in the very ways healthcare organizations operate. In the research conducted by researchers Miraj U. Desai, Larry Davidson, John F. Dovidio, of Yale University, Nadika Paranamana, with the University of Hartford, and Victoria Stanhope, with New York University, the study reveals how organizational-level biases affect how patients and even providers are viewed – and in ways that can produce racial and ethnic inequities. 

           Desai and his colleagues specifically focused on mental health organizations, detailing how they may systematically transmit bias and racism through common bureaucratic processes and, in some cases, through staff merely doing their job. In an equally disturbing finding, the study revealed that staff often remain unaware of this transmission process and perpetuate it simply by meeting their work requirements – a process that the authors termed “bureaucra-think.” Over time, this can lead to care becoming “system-centered” rather than person-centered, let alone equitable, the authors concluded. 

           According to Desai, assistant professor of psychiatry at Yale School of Medicine and the paper’s first author, “We hope that this study aids community members, providers, and policymakers vying for greater equity in healthcare. At the same time, while the study focused on health settings, we firmly believe that it has direct relevance for institutions and systems outside of healthcare – offering concrete evidence and novel concepts to address how inequity can flourish in very hidden ways.” 

           Desai indicates that the findings revealed how institutional structures powerfully condition clinical operations and providers, creating a risk that clients will be systemically seen as nonpersons; that is, as racialized or bureaucratic objects. Specifically, the study elucidates how racial profiles could become determinants of care within institutions and how another, covert form of institutional objectification could emerge, in which clients are reduced to unseen bureaucratic objects.

           The study carries implications for healthcare and other organizations and suggests novel structural targets for intervention. It also signals a paradigm shift for psychological science, as it demonstrates how structural bias and racism partly depend on collective psychological processes, which psychological science has typically neglected in favor of individualist or internalist accounts. The study thus offers a robust scientific and practical framework to help psychology, healthcare, and related fields address structural bias and racism. 

           To read the original article, find it with this reference:

Desai, M. U., Paranamana, N., Dovidio, J. F., Davidson, L., & Stanhope, V. (2022). System-Centered Care: How Bureaucracy and Racialization Decenter Attempts at Person-Centered Mental Health Care. Clinical Psychological Science.  

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