“Mystery Shopper” Study Suggests Racial/Ethnic Bias in Access to Adolescent Mental Health Care
Given the current youth mental health crisis in America, accessing trauma-informed adolescent mental health services is challenging in the best of circumstances. A “mystery shopper” study co-authored by PhD student Fatima Mabrouk found it’s even more difficult for people who are racial or ethnic minorities.
“Our goals were to explore the first-hand experiences of mothers scheduling appointments to identify barriers to access and the availability of trauma-specific treatment.” Fatima explained. “The fact that racial discrimination may be occurring at the point of scheduling is alarming.”
The study, led by Danielle R. Adams, a NIMH T32 Postdoctoral Fellow at The Brown School at Washington University in St. Louis, used Black, Latina, and White voice actresses to call health centers that are designed to provide mental health services to low-income populations. The actresses posed as mothers seeking to make an appointment for their traumatized adolescent child. They called each center in the spring and again in the summer, alternating their insurance type between Medicaid and private insurance.
Overall, an appointment was offered in only 17% of contacts, with capacity constraints or a requirement to switch to an in-network primary care provider as the primary reasons for denial. In about one-third of attempted contacts, the caller could not speak to the scheduler after at least three calls. While insurance type did not have a significant impact on callers’ ability to get an appointment, their race/ethnicity did, with Black and Latina callers significantly less likely to be offered an appointment than the White caller.
“My own experiences attempting to schedule an appointment for ‘my child’ mirrored the struggles many marginalized parents face,” said Fatima, who participated in the study as both the Black voice actress and a co-author.
Not only were Fatima and her Latina counterpart, Nancy Jacquelyn Pérez-Flores, less likely to be offered an appointment than the White caller, Carolyn Minor, but they were more frequently treated dismissively by receptionists, who frequently played the role of gatekeeper to the scheduler.
“Receptionists were often very short with me and wouldn’t answer questions I had,” said Fatima. “At first, I thought that was normal but in our weekly team meetings where we’d debrief on our calls, I learned they were giving more time to the White caller. They would talk about the issue her child was presenting with and the type of services available while they would rush me and the Latina caller off the phone.”
Fatima recommended anti-discrimination policies and greater funding for mental health services, especially at safety-net providers. She also called for anti-bias training for people at all levels of mental health organizations. “Everyone needs to be involved, not just organizational leadership, and especially those who play a role of gatekeeping access to care.”
Access the article Assessing Access to Trauma-Informed Outpatient Mental Health Services for Adolescents: A Mystery Shopper Study, which is available online first in Psychiatric Services.