By Nicole Akoukou Thompson
March 23, 2015
Exactitude isn't guaranteed when it comes to assessing the mental health of disadvantaged patients. If fact, disadvantaged patients are two times more likely to be misdiagnosed by mental health professionals.
Due to therapists knowingly or unknowingly allowing their own perceptions of disadvantaged patients to affect their decision making, it's more likely that professionals will misdiagnose mental illness among disadvantaged populations. As a result, tens of thousands of Hispanics/Latinos and other non-whites who suffer from mental illnesses go without professional mental health treatment.
SAGE Publications, an academic and professional publisher of books and journals, recently released findings that addressed the discovery that mental health misdiagnoses are twice more likely for socially disadvantaged groups than their more affluent counterparts.
"For example, a white therapist can interpret affect disregulation symptoms of a client who is also white as rooted in financial pressures and diagnose him/her as having transient adjustment disorder," Ora Nakash, a clinical psychologist at the Interdisciplinary Center in Herzliya, Israel, explained in a statement. "Conversely, if the client is African-American, the same symptoms might be seen as proof of the client's persistent borderline personality disorder."
In the past, Nakash led similar research. She observed comparable information collected during patient intake, and she watched as that information was examined differently, based on a patient's race or ethnicity, leading to a different diagnosis.
With this current study, Nakash and colleague Tamar Saguy investigated further, and visited community of mental health facilities in three major Israeli cities, which predominately served low-to-middle class groups. The observed therapist's interactions with Mizrahi (Jews of Asian/African descent) and Ashkenazi (Jews of European/American descent) patients, and documented their findings.
What did they learn? Ethnic groups of Israelis (who are the majority and experiencers of mental health disparities) tended to receive lower quality mental health care and suffered greater risks, much like in many Western societies. After the intake sessions, researchers asked patients to complete a diagnostic interview, and asked therapists to complete surveys following their sessions. Then, the researchers measured the interviews against surveys and determined if that therapist offered diagnostic accuracy.
"Even in a clinical setting, which offers conditions to overcome bias in decision-making -- motivation to help, and time and space to collect ample information to overcome stereotypical thinking -- we see that misdiagnosis is almost twofold when a socially advantaged therapist meets a socially disadvantaged client compared to seeing a socially advantaged client," Nakash shared in the report.
Researchers claimed that this is the first study of its kind to empirically explore diagnostic accuracy in the context of mental health, engaging a therapist and client. With little exception, disadvantaged groups are frequently misdiagnosed; therefore their mental outcomes tend to be worse. In addition, researchers found that the quality of rapport plummeted in these interactions.
The scholars indicated that the study is a call to action for the clinical community, asking that they "rethink clinical training as well as increase the ethnic diversity of mental health providers." In Nakesh's opinion, clients should ask about their therapist's training and their experience working with a diverse client base to ensure cultural competence. Additionally, cultural competence training and education should be required of all mental health providers.
The researchers will continue to investigate possible reasons behind misdiagnoses, citing favoritism and cross-cultural differences as possibilities. In future investigations, the team plans to study what likely attributes to diagnostic bias, aside from personal perspective. Ultimately, they want to improve accuracy and the work that therapists do with diverse patient populations.
The National Association for Mental Illness (NAMI) reported that only 29 out of every 100,000 mental health professionals are Latino. Also, Latinos across the nation remain underserviced by mental health services. Aside from misdiagnosis, there are numerous reasons for this, including fear of stigma and discrimination, and the barriers that make it difficult to access information and facilities.