Mental Health and Stereotypes--Daniel Lee

According to Mental Health America, nearly 1 in 5 American adults will have a diagnosable mental health condition in any given year. Some of the most common mental health conditions are depression and bipolar disorder, commonly categorized as mood disorders. Often, mood disorders are harder to diagnose as patients, especially patients in minority groups aren’t always able to express how they feel or explain why they feel that way (John Hopkins). This may be due in part to implicit and/or explicit biases present in psychiatrists and/or other mental health professionals. For example, research has shown that racial microaggressions are often common between white clinicians and minority outgroup patients (Sue et al, 2007.) Furthermore, stereotypes such as Asians are quiet and submissive and Blacks are loud and rowdy may affect how Asian and Black patients are diagnosed in terms of mood disorders. These biases may appear when diagnosing a patient, affecting patient responses, and therefore the diagnosis of a patient. As a result, there appears to be an increasing need for white clinicians to receive proper training in order to address such biases when diagnosing a patient with a mental disorder. This is particularly concerning when according to the AAMC (Association of American Medical Colleges), 56.2% of active physicians are white. 

On a larger scale, previous research strongly suggests that these racial microaggressions and/or other racial biases have an effect on the larger mental healthcare system in the United States. In a study conducted among 11 private non profit healthcare organizations constituting the Mental Health Research Network, it was found that there were significant racial/ethnic differences in diagnosis and treatment of mental health conditions. Of the 7,523,956 patients in the study, 1,169,993 (15.6%) received a mental health diagnosis in 2011. This varied significantly by race/ethnicity with Native American/Alaskan Native patients having the highest rates of any diagnosis (20.6%) and Asians having the lowest rates (7.5%). However, all outgroups observed, including non-white Hispanics and Blacks exhibited significantly lower rates of mental health diagnoses in comparison to the white ingroup (Coleman et al, 2011). Moreover, the same study found that outgroups were less likely to receive medication to treat their major depression or even be seen by a mental health or medical treatment provider compared to their non-Hispanic white counterparts. Such observations demonstrate the need for further study in order to understand underlying causes of these observed differences and whether processes and outcomes of care are equitable across these diverse patient populations. In another study focused on ethnic minority youth, researchers found that non white children were either misdiagnosed, not diagnosed at all, failed to receive proper medication, or were not treated for their mental illnesses when compared to their white peers (Liang et al.,2016). Interestingly, this study compared racial groups to one another as opposed to just comparing ethnic groups to the white group. For example, African American youth in mental health services were less likely to be diagnosed with ADHD or a mood disorder compared to non-Hispanic White youth and instead were more likely than non-Hispanic White youth to be diagnosed with disruptive behavior disorder and conduct related problems. On the other hand, compared to all other minority groups sampled, Asian American youth had the lowest chance of receiving an ADHD diagnosis from clinicians but a greater chance of receiving disruptive behavior disorder, substance abuse disorders, and psychotic disorders diagnoses. Such results show that even within racial minority groups, there seems to be some factor that distinguishes between processes and outcomes of mental health care across diverse patient populations.

Additionally, in another study they found that under the same reported type of stressors, Asian and Asian Americans sought social support less frequently than European Americans (Taylor et. al, 2004). This information is used to perpetuate stereotyping in the mental health profession, wrongly justifying that Asian Americans are inherently less emotional and therefore require less medical intervention. In addition, Barnes (2008), found that African American clients were less frequently diagnosed with bipolar and major depressive disorders and more frequently diagnosed with schizophrenia than were white clients, implying that clinicians may have a tendency to overlook behaviors and emotions specific to mood based on certain mood stereotypes associated with a patient’s race. In particular, it seemed that clinicians often attributed black patients with more emotion, often uncontrollable excitatory emotion when diagnosing patients with mental disorders.
First proposed in 2002, the stereotype content model suggests that certain emotional and intellectual stereotypes are linked to different racial groups, which are often relied on (conscious or unconsciously) in making mental health diagnoses in racial minorities (Fiske et al, 2002). In particular, outgroups viewed Asians as competent but not warm (Asians as cold but efficient) whereas Blacks seemed to fall in the middle of warmth and competence (was not seen as particularly warm or competent) (Fiske et al, 2002). Given how the different combinations of warmth and competence elicit different emotions for outgroups, it can be implied that that racial stereotypes may affect emotion perception in both outgroups and ingroups, which may provide more insight into the potential behavior of racial outgroup mental health clinicians toward ethnic minorities. In conclusion racial stereotypes, prejudice, and discrimination are a prevalent part of the American mental healthcare system and therefore should be adressed as such. I believe that more awareness and research of the topic is required and will positively reform the American mental healthcare system.