RACIAL DISPARITIES IN ACCESS TO MENTAL HEALTH CARE: A FIELD EXPERIMENTAL APPROACH

Abstract

This dissertation comprises the first field experimental studies of racial disparities in access to mental health care providers (MHPs). Three empirical papers investigate the extent to which MHPs constrain access to care for black, relative to white, individuals seeking therapy (“help-seekers”). They also measure how the observed racial disparities in appointment offers are moderated by non-racial attributes of the help-seeker, characteristics of the provider, and the marketplace in which decisions about access are being made. Together, the studies include more than 2,400 MHPs who practice in private outpatient settings. By employing a field experimental approach, this research revealed otherwise invisible provider-side responses to help-seekers.

In Paper 1, I present a phone-based experiment that examined how the race, social class, and gender of help-seekers affect access to psychotherapists who are solo practitioners and participate in a health insurance network. I found racial disparities among ostensibly middle class but not working class help-seekers, with blacks considerably less likely than whites to be offered an appointment. Furthermore, on average, middle class help-seekers had appointment offer rates almost three times higher than their working class counterparts.

To what extent are Paper 1’s findings generalizable to a varied population of MHPs in a competitive online market? In Paper 2, I present an email correspondence experiment that targeted a variety of mental health care providers (psychologists, social workers, and licensed counselors) nationwide who advertise their services in an online directory of MHP profiles. Racial disparities in access were observed among the less educated help-seekers, but not the more educated ones. Applying the methods developed for Paper 2, Paper 3 explores the influence of racial concordance between MHPs and help-seekers on MHPs’ accessibility. This experiment revealed that white MHPs preferred white help-seekers and that black MHPs did not discriminate on the basis of race.

As a body of work, this dissertation contributes to the literature on racial discrimination by health care providers. It also makes a methodological contribution to sociology. Through the supplementary materials, I show that field experiments in the mental health care sector can be executed in precise, ethical, and economical ways.