People of color have held a long and often damaging relationship with mental health researchers, practitioners, and policymakers. Throughout the colonized history of the United States, the mental health of Native Americans, Africans, Asians, Latinos, Pacific Islanders, and other groups of color have been seen as mentally ill or not by a one-way comparison of whites. In addition to those bias comparisons, people of color, especially African Americans have historically been wrongly diagnosed for mental disorders, undertreated, overmedicated, experimented upon, and have had their culture, race, and ethnicity used against them in the name of mental health research.
Through his 1976 book Even the Rat was White: A Historical View of Psychology, Dr. Robert Guthrie brought to the world’s attention what psychologists of color already knew: that many psychological theories and ideas regarding human behavior and personality were deeply rooted in racism. Harriet A. Washington, an expert in medical ethics, also documents the haunting history of the mistreatment at the hands of mental health researchers and experts by African Americans and people of mix race in her book Medical Apartheid.
Mental Health disparities have existed for centuries, although some of the earliest research to pay attention to meaningful differences in services was published in 1974 by Stanley Sue, Herman McKinney, David Allen, and Juanita Hall in the Journal of Counseling and Clinical Psychology. This study highlighted the reality that African Americans and whites have different experiences in the mental health system. The study found that the mental health system was not equipped to serve African Americans. Similar research has found other cultural and ethnic groups also have similar experiences with the mental health system living them out and using the white, European model as the standard for positive mental health. While Native Americans and other groups have suffered from mistreatment in mental health research, Asian Americans, too, have been victims. With the stereotype of the model minority, Asian Americans have been overlooked in mental health. Further, according to researchers examining data from the National Latino and Asian American Study (NLAAS), Asian Americans show a low level of mental health services use. Low use, however, does not mean that the need does not exist, instead there may be structural, cultural, social, and personal barriers that limit mental health services use.
According to the Surgeon General’s Report on Mental Health: Culture, Race and Ethnicity (2001), living in poverty have measurable effects on the rates of mental illness. These effects are disproportionately seen among low-income people of color. Research from the National Council of Science (2000) concluded that economic disadvantages have a long-term effect on the mental health and overall development of children. This and other research suggests that poverty constrains development in a way that forces low-income children in a limited box while non-poor children develop in a spacious playground. If left unchecked or ignored into adulthood, what this translates to is that low-income people of color are at least 2-3 times more likely than white, non-poor individuals to experience a mental disorder.
Low-income people of color are often placed in a spatial cycle where ecological factors increases the probability of mental health stress, yet this same environment limits their access to prevention and intervention services. Lack of jobs, limited access to education and transportation, low-resourced and sometimes dangerous neighborhoods are just some of the factors that directly contribute to poverty and at least indirectly contribute to the higher reported rates of mental illness in low-income people of color. While this higher rate of mental disorder can be linked to poverty, these factors do not work alone and are confounded by racism, microaggressions, lack of access to care, prevention, and early intervention, and over diagnosis based on race, ethnicity, and culture. Lack of access to care is especially important as prevention and early intervention measures can save the need for more chronic mental health conditions.
It is important for researchers to remember, too, that these ecological factors may have risk elements, but potential resilient or more positive elements as well. Cultural factors that contribute to resilience and coping in stressful situations should not be ignored. Several studies document the resilience of often low-income children of color who have been placed at risk, who overcome their adversity and strive.
While the comprehensive nature of racism and mental health is rarely studied, neither do we as researchers examine closely enough the mental health and complicating issues of those society has placed at risk. In research greater attention should be paid to the role of race and social position in mental health. Below we make six recommendations that we believe that mental health researchers should pay greater attention:
- The role of race and racism in current mental health treatment facilities;
- The role that racism, discrimination, and microaggressions play in people of color’s desire to receive and accept mental health treatment;
- The short and long-term effects of discrimination and microagressions o the mental health of people of color;
- The role that neighborhood and other environmental factors contribute to the overrepresentation of people of color in receiving mental health treatment;
- How racism experienced by parents affects the mental health of their children;
- The role of resilience in low-income people of color and how that resilience can be fostered.
While race and racism has been a part of mental health for decades if not centuries, researchers have not fully embraced studying these phenomena. Funding mechanisms for research on race/racism and mental health are rare and specific interventions are rarer still. As with the general population, it has been easier to ignore the effects of race and racism on mental health. Researchers need to take a comprehensive look at how these issues affect mental health and move toward a more in-depth analysis.
