The historical roots of racial disparities in the mental health system - Counseling Today (2023)

Racial disparities, or unfair differences, within the system of mental health are well documented. Research indicates that compared with people who are white, black, indigenous and people of color (BIPOC) are:

  • Less likely to have access to mental health services
  • Less likely to seek out services
  • Less likely to receive needed care
  • More likely to receive poor quality of care
  • More likely to end services prematurely

Regarding racial disparities in misdiagnosis, black men, for example, are overdiagnosed with schizophrenia (four times more likely than white men to be diagnosed), while underdiagnosed with posttraumatic stress disorder and mood disorders. Additionally, concerns are compounded by the fact that for BIPOC, mental health care is often provided in prisons, which infers a multitude of issues.

BIPOC are overrepresented in the criminal justice system, as the system overlays race with criminality. Statistics show that over 50% of those incarcerated have mental health concerns. This suggests that rather than receiving treatment for mental illness, BIPOC end up incarcerated because of their symptoms. In jails and prisons, the standard of care for mental health treatment is generally low, and prison practices themselves are often traumatic.

The vast majority of mental health treatment providers in the United States are white. For example, approximately 86% of psychologists are white, and less than 2% of American Psychological Association members are African American. Some research has demonstrated that provider bias and stereotyping are relevant factors in health disparities. For nearly four decades, the mental health field has been called to focus on increasing cultural competency training, which has focused on the examination of provider attitudes/beliefs and increasing cultural awareness, knowledge and skills.

Despite such efforts, racial disparities still exist even after controlling for factors such as income, insurance status, age, and symptom presentation.Established barriers for BIPOC are the following:

  • Different cultural perceptions about mental illness, help-seeking behaviors and well-being
  • Racism and discrimination
  • Greater vulnerability to being uninsured, access barriers, and communication barriers
  • Fear and mistrust of treatment

In addition to emphasizing culturally competent services, other recommendations to bridging the gaps and addressing barriers have largely focused on diversifying workforces and reducing stigma of mental illness in communities of color.

(Video) The Historical Roots of Racial Disparities in the Mental Health System

One area not often noted is the historical (and traumatic) context of systemic racism within the institution of mental health, although it is well known that race and insanity share a long and troubled past. This focus may begin to account for how racial differences shape treatment encounters, or a lack thereof, even when barriers are controlled for and the explicit races of the provider and client are not at issue.

Historical context

In the United States, scientific racism was used to justify slavery to appease the moral opposition to the Atlantic slave trade. Black men were described as having “primitive psychological organization,” making them “uniquely fitted for bondage.”

Benjamin Rush, often referred to as the “father of American psychiatry” and a signer of the Declaration of Independence, described “Negroes as suffering from an affliction called Negritude.” This “disorder” was thought to be a mild form of leprosy in which the only cure was to become white. Ironically Rush was a leading mental health reformer and co-founder of the first anti-slavery society in America. Rush did observe, however, that “the Africans become insane, we are told, in some instances, soon after they enter upon the toils of perpetual slavery in the West Indies.”

In 1851, prominent American physician Samuel Cartwright defined “drapetomania” as a treatable mental illness that caused black slaves to flee captivity. He stated that the disorder was a consequence of slave masters who “made themselves too familiar with the slaves, treating them as equals.” Cartwright used the Bible as support for his position, stating that slaves needed to be kept in a submissive state and treated like children to both prevent and cure them from running away. Treatment included “whipping the devil out of them” as a preventative measure if the warning sign of “sulky and dissatisfied without cause” was present. Remedy included the removal of big toes to make running a physical impossibility.

Cartwright also described “dysaethesia aethiopica,” an alleged mental illness that was the proposed cause of laziness, “rascality” and “disrespect for the master’s property” among slaves. Cartwright claimed that the disorder was characterized by symptoms of lesions or insensitivity of the skin and “so great a hebetude [mental dullness or lethargy] of the intellectual faculties, as to be like a person half asleep.” Undoubtedly, whipping was prescribed as treatment. Furthermore, according to Cartwright dysaethesia aethiopica was more prevalent among “free negroes.”

(Video) Racial Disparities in Mental Health Care

The claim that those who were free suffered mental illness at higher rates than those who were enslaved was not unique to Cartwright. The U.S. census made the same claim, and this was used as a political weapon against abolitionists, although the claim was found to be based on flawed statistics.

Even at the turn of the 20th century, leading academic psychiatrists claimed that “negroes” were “psychologically unfit” for freedom. And as late as 1914, drapetomania was listed in the Practical Medical Dictionary.

Furthermore, after slavery was abolished, Southern states embraced the criminal justice system as a means of racial control. “Black codes” led to the imprisonment of unprecedented numbers of black men, women and children, who were returned to slavery-like conditions through forced labor and convict leasing that lasted well into the 20th century.

Scientific racism early on indicates motives of control and containment for profitability. Leading health professionals propagated the idea that blacks were “less than” to justify exploitation and experimentation. The mislabeling of behavior, such as escaping slavery, as a byproduct of mental illness did not stop there. Significant transformations in defining mental illness also occurred in the civil rights era, suggesting that institutional racism becomes more powerful in the context of moments of heightened racial tensions in the collective social consciousness.

Prior to the civil rights movement, schizophrenia was described as a largely white, docile and generally harmless condition. Mainstream magazines from the 1920s to the 1950s connected schizophrenia to neurosis and, as a result, attached the term to middle-class housewives.

Assumptions about the race, gender and temperament of schizophrenia changed beginning in the 1960s. The American public and the scientific community began to increasingly describe schizophrenia as a violent social disease, even as psychiatry took its first steps toward defining The historical roots of racial disparities in the mental health system - Counseling Today (1)schizophrenia as a disorder of biological brain function. Growing numbers of research articles asserted that the disorder manifested by rage, volatility and aggression, and was a condition that afflicted “Negro men.” The cause of urban violence was now due to “brain dysfunction,” and the use of psychosurgery to prevent outbreaks of violence was recommended by leading neuroscientists.

(Video) Historical Frameworks: How the History of Racism Has Impacted Black Mental Health and Healthcare

Researchers further conflated the symptoms of black individuals with perceived schizophrenia of civil rights protests. In a 1968 article in the esteemed Archives of General Psychiatry, schizophrenia was described as a “protest psychosis” in which black men developed “hostile and aggressive feelings” and “delusional anti-whiteness” after listening to or aligning with activist groups such as Black Power, the Black Panthers or the Nation of Islam. The authors wrote that psychiatric treatment was required because symptoms threatened black men’s own sanity as well as the social order of white America.

Advertisements for new pharmacological treatments for schizophrenia in the 1960s and 1970s reflected similar themes. An ad for the antipsychotic Haldol depicted angry black men with clenched fists in urban scenes with the headline: “Assaultive and belligerent?” At the same time, mainstream white media was describing schizophrenia as a condition of angry black masculinity or warning of crazed black schizophrenic killers on the loose. A category of paranoid schizophrenia for black males was created, while casting women, neurotics and other nonthreatening individuals into other expanded categories of mood disorders.

The black psyche was increasingly portrayed as unwell, immoral and inherently criminal. This helped justify the need for police brutality in the civil rights movement, Jim Crow laws, and mass incarceration in prisons and psychiatric hospitals, which at times was an exceedingly thin line. In general, attempts to rehabilitate took a back seat to structural attempts to control. Some state hospitals, presided over by white male superintendents, employed unlicensed doctors to administer massive amounts of electroshock and chemical “therapies,” and put patients to work in the fields. Deplorable conditions went unchallenged as late as 1969 in some states.

Deinstitutionalization, a government policy of closing state psychiatric hospitals and instead funding community mental health centers, began in 1955. Over the next four decades, most state hospitals were closed, discharging those with mental illness and permanently reducing the availability of long-term inpatient care facilities. Currently, there are more than three times as many people with serious mental illnesses in jails and prisons than in hospitals. The shifts in defining what constitutes mental health reflects the reality that the definition is shaped by social, political and, ultimately, institutional factors in addition to chemical or biological ones.


Looking at the historical and systemic context of the mental health system may provide insight into why racial disparities continue to exist and why these disparities have been resistant to interventions such as cultural competency training and standardized diagnostic tools. Focusing primarily on the race of the provider and the client, while valid, is an approach that does not consider the system itself, the functions of the diagnosis, and its structurally developed links to protest, resistance, racism and other associations that work against the therapeutic connection.

(Video) Understanding the Roots of Racism: Mental Health

Racial concerns, including overt racism at times, were written into the mental health system in ways that are invisible to us now. Understanding the past enables new ways of addressing current implications and identified barriers, including how schizophrenia became a “black disease,” why prisons emerged where hospitals once stood, and how racial disparities continue to exist in the mental health system today.


Additional resources


Tahmi Perzichilli is a licensed professional clinical counselor and licensed alcohol and drug counselor working as a psychotherapist in private practice in Minneapolis. Contact her at


(Video) Overcoming Racial Disparities in Health and Mental Health

Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.


What causes mental health disparities? ›

Racial/ethnic, gender, and sexual minorities often suffer from poor mental health outcomes due to multiple factors including inaccessibility of high quality mental health care services, cultural stigma surrounding mental health care, discrimination, and overall lack of awareness about mental health.

What are racial disparities health? ›

The term "health disparities" is often defined as "a difference in which disadvantaged social groups such as the poor, racial/ethnic minorities, women and other groups who have persistently experienced social disadvantage or discrimination systematically experience worse health or greater health risks than more ...

What demographic has the most mental health issues? ›

Just over a quarter of Black (28%) and Hispanic (27%) nonelderly adults reported having a mental illness or substance use disorder in 2020, compared to 36% of White nonelderly adults (Figure 4).

What do you understand by mental health? ›

Mental health includes our emotional, psychological, and social well-being. It affects how we think, feel, and act. It also helps determine how we handle stress, relate to others, and make healthy choices. 1. Mental health is important at every stage of life, from childhood and adolescence through adulthood.

What does disparities in mental health mean? ›

Behavioral health disparities refer to differences in outcomes and access to services related to mental health and substance misuse which are experienced by groups based on their social, ethnic, and economic status.

How can we prevent disparities? ›

Designate specific leaders for disparities reduction—more than one! Identify and recognize equity champions. Recruit a diverse workforce that reflects the population you serve. Tie compensation to quality goals that include disparities reduction.

What are three root causes of racial and ethnic health disparities? ›

The sources of racial and ethnic health care disparities include differences in geography, lack of access to adequate health coverage, communication diffi- culties between patient and provider, cultural barriers, provider stereotyping, and lack of access to providers.

What is racial disparity in simple terms? ›

Racial disparity refers to the imbalances and incongruities between the treatment of racial groups, including economic status, income, housing options, societal treatment, safety, and myriad other aspects of life and society.

How can racial disparities be reduced in healthcare? ›

Improving Neighborhood and Housing Conditions. Given that virtually every health-enhancing resource is linked to where one lives in the U.S., a key to improving health and reducing disparities is to improve the quality of neighborhood and housing environments in the United States.

Which racial group is most likely to receive mental health services? ›

People of color are less likely to access treatment for their mental illnesses than white people. On average, 43% of all adults with a mental illness receive mental healthcare. White people with a mental illness are the most likely group to get care, with nearly half receiving the care that they need.

Who is most affected by mental health issues? ›

Women are nearly twice as likely to suffer from major depression than men. However, men and women are equally likely to develop bipolar disorder. While major depression can develop at any age, the average age at onset is the mid-20s.

How does race affect depression? ›

DISPARITIES IN DIAGNOSIS OF MAJOR DEPRESSION BY COMMUNITY RACE OR ETHNICITY. The prevalence of diagnosed major depression is 31% lower for majority Black communities and 39% lower for majority Hispanic communities than for White communities (see Exhibit 2).

Why is it important to take care of your mental health essay? ›

Emotional and mental health is important because it's a vital part of your life and impacts your thoughts, behaviors and emotions. Being healthy emotionally can promote productivity and effectiveness in activities like work, school or caregiving.

How important is mental health awareness as a student in our current situation? ›

It is highly important to raise mental health awareness in schools since young people are seriously affected by mental health issues every day. They need a system they can rely on and a source of information to guide them through the process of dealing with their inner issues.

How do you explain disparities? ›

The word is often used to describe a social or economic condition that's considered unfairly unequal: a racial disparity in hiring, a health disparity between the rich and the poor, an income disparity between men and women, and so on.

How do you explain disparity? ›

Disparity is the condition of being unequal, and a disparity is a noticeable difference. Disparity usually refers to a difference that is unfair: economic disparities exist among ethnic groups, there is a disparity between what men and women earn in the same job.

What is the best example of a health disparity? ›

Health and health care disparities are often viewed through the lens of race and ethnicity, but they occur across a broad range of dimensions. For example, disparities occur across socioeconomic status, age, geography, language, gender, disability status, citizenship status, and sexual identity and orientation.

What are two strategies to improve health and reduce disparities? ›

Improving access to high-quality education likely improves health. Early childhood interventions, such as early childhood education and parental support programs, have positive health impacts and help address economic disadvantage and health disparities.

What are examples of disparities? ›

While the term disparities is often used or interpreted to reflect differences between racial or ethnic groups, disparities can exist across many other dimensions as well, such as gender, sexual orientation, age, disability status, socioeconomic status, and geographic location.

How would you deal with the ethnic disparities or differences in health care for some people? ›

  • Raising public and provider awareness of racial/ethnic disparities in care;
  • Expanding health insurance coverage;
  • Improving the capacity and number of providers in underserved communities; and.
  • Increasing the knowledge base on causes and interventions to reduce disparities.
20 Oct 2008

What is meant by racial ethnic disparities in health Why is it an important issue quizlet? ›

Though an organizational theory it integrates components that together will improve minority health care. What is meant by racial /ethnic disparities in health? this term refers to the differences in health status between the majority population subgroups (e.g. racial ethnic minorities, rural poor, etc.).

How do health disparities affect our health care system? ›

Health disparities lead to approximately $93 billion in excess medical care costs and $42 billion in lost productivity per year as well as economic losses due to premature deaths.

What are the most important steps to take to reduce racial differences in punishments Why? ›

Following are recommendations for initiatives that can begin to address these issues.
  • Shift the Focus of Drug Policies and Practice.
  • Provide Equal Access to Justice.
  • Adopt Racial Impact Statements to Project Unanticipated Consequences of Criminal Justice Policies.
1 Oct 2010

How do you use racial disparity in a sentence? ›

Progressive as these approaches were, racial disparities persisted in academic achievement and income. Iowa had the highest racial disparity of the fifty states.

What is the difference between discrimination and disparity? ›

In summation, discrimination is an act or behavior based on prejudicial beliefs about extralegal factors, whereas disparities occur “just because” of legal factors. Discrimination reflects differential treatment of minorities, whereas disparities occur due to differential criminal involvement of minorities.

What are the 5 key areas of disparities in health care? ›

Disparities occur across many dimensions, including race/ethnicity, socioeconomic status, age, location, gender, disability status, and sexual orientation. 2.

How can racial equity be improved in healthcare? ›

Expand the use of community-based providers, such as community health workers, promotoras, and peer navigators. Require graduate medical education to include training on structural racism and implicit bias and how to combat both through antiracist medical practice.

What can nurses do to minimize the impact of healthcare disparities? ›

One of the most powerful things nurses can do to reduce health disparities is to advocate for their patients. This may include advocating for patient rights, appropriate resources, interpreters, distress screening, or even cultural-competence training.

What social groups are most at risk of developing mental health problems? ›

Mental health inequalities
  • poverty.
  • poor housing.
  • family conflict.
  • unemployment.
  • childhood adversity.
  • chronic health problems.
24 Dec 2021

Do racial and ethnic disparities in mental health treatment vary with underlying mental health? ›

We find that in contrast to physical health treatment, Black–White and Hispanic–White disparities in any mental health treatment use widen with higher levels of psychological distress.

Why is mental health important for minorities? ›

All of society benefits when people from racial and ethnic minority groups have access to mental health care, supportive social conditions, freedom from stressors that can compromise mental health, and access to other resources needed for health. We all have a role to play in promoting health equity.

What is the leading cause of mental health issues today? ›

childhood abuse, trauma, or neglect. social isolation or loneliness. experiencing discrimination and stigma, including racism. social disadvantage, poverty or debt.

What challenges might people who have mental health issues face? ›

What's the biggest challenge people with mental illness face?
  • Making yourself a priority. ...
  • Reaching out. ...
  • Identifying moods and feelings. ...
  • Maintaining good routines. ...
  • Living up to expectations. ...
  • The unknown hurdles symptoms bring. ...
  • Planning and navigating the world.
6 Jul 2018

What impact does mental health have on people? ›

Mental health problems can cause a wide variety of emotional symptoms, some of which include:
  • Changes in mood.
  • Erratic thinking.
  • Chronic anxiety.
  • Exaggerated sense of self-worth.
  • Impulsive actions.

What is the cause of race disparities in mental illness? ›

Racial/ethnic, gender, and sexual minorities often suffer from poor mental health outcomes due to multiple factors including inaccessibility of high quality mental health care services, cultural stigma surrounding mental health care, discrimination, and overall lack of awareness about mental health.

What are mental health disparities? ›

Mental health disparity refers to a discrepancy in health, health services, and health determinants. Multiple studies have found open_in_new that racial and ethnic minorities face these disparities even after controlling for variables like income, insurance status, age, and symptom expression.

Does race affect quality of life? ›

Race/ethnicity was associated with all four HRQOL measures, but the directions and effects differed across the measures. We found all minority ethnic groups have higher distress rates in general health than White, consistent with the findings from other studies [17, 18].

How can you overcome challenges in facing problems or situation in your life without affecting your mental health? ›

10 Ways to Overcome Challenges in Life
  • Make A Plan. While you don't know what is going to happen in the future, you can always plan ahead. ...
  • Know You're Not Alone. Every person in this world has their low points. ...
  • Ask For Help. ...
  • Feel Your Feelings. ...
  • Accept Support. ...
  • Help Others. ...
  • Think Big. ...
  • Positive Mindset.

What can you say about mental health awareness essay? ›

People should be aware of the consequences of mental illness and must give utmost importance to keeping the mind healthy like the way the physical body is kept healthy. Mental and physical health cannot be separated from each other. And only when both are balanced can we call a person perfectly healthy and well.

What are three barriers that prevent people from seeking help for mental health? ›

Let's look at the top five barriers to mental health care and how we can begin to surpass them.
  • Financial barriers to mental health treatment. ...
  • Lack of mental health care professionals and services. ...
  • Limited availability of mental health education and awareness. ...
  • Social stigma of mental health treatment and conditions.
4 May 2022

What should be done to improve mental health and? ›

5 steps to mental wellbeing
  1. Connect with other people. Good relationships are important for your mental wellbeing. ...
  2. Be physically active. Being active is not only great for your physical health and fitness. ...
  3. Learn new skills. ...
  4. Give to others. ...
  5. Pay attention to the present moment (mindfulness)

How will you promote mental health and prevent mental disorders among your learners? ›

Our teachers provide students with the resources and support they need when it comes to mental health.
  • Here are seven ways to promote mental health awareness in the school: We promote self-esteem. ...
  • Educate Parents and Students on Early Signs and Symptoms. ...
  • A Safe Positive School Environment. ...
  • Encourage Social Time.

Why is it important to promote mental health in our society? ›

Promoting mental health and wellbeing helps reduce risky behaviours such as alcohol and drug misuse – including tobacco – and social and economic problems such as dropping out of school, crime, absenteeism from work, and the rates and severity of physical and mental illness.

What are the major reasons for such disparities? ›

some of the main reasons of such disparities are :
  • on the basis of geography there are differences in regions.
  • In developmental terms some regions are more user friendly.
  • There is differences of importance in some cities and regions by government policies.
12 Feb 2020

What are the factors of disparity? ›

For example, disparities occur across socioeconomic status, age, geography, language, gender, disability status, citizenship status, and sexual identity and orientation. Research also suggests that disparities occur across the life course, from birth, through mid-life, and among older adults.

What is an example of a disparity? ›

The word is often used to describe a social or economic condition that's considered unfairly unequal: a racial disparity in hiring, a health disparity between the rich and the poor, an income disparity between men and women, and so on.

What are some solutions to health disparities? ›

Raising awareness through education can help address health equity. Improving resource coordination can also help populations most harmed by health disparities. For example, health care organizations can help reduce ethnic health disparities by offering cultural competency training to health care providers.

What are the main determinants in health disparities? ›

Social determinants of health such as poverty, unequal access to health care, lack of education, stigma, and racism are underlying, contributing factors of health inequities. The Centers for Disease Control and Prevention (CDC) is committed to achieving improvements in people's lives by reducing health inequities.

What are 10 factors that can contribute to health care disparities? ›

Causes of Health Disparities
  • Poverty. Poverty is a factor that contributes to health disparities tremendously. ...
  • Environmental Threats. Environmental threats on health disparities can range in many ways. ...
  • Inadequate or Unequal Access To Health Care. ...
  • Individual and Behavioral Factors.

Why is it important to address health disparities? ›

On top of being costly, disparities hinder the nation's overall health, as groups who historically have had access to fewer resources have higher rates of illness and death from a variety of preventable conditions.

What are disparities of health and why are they important to address? ›

Health disparities and health inequities are differences between the health outcomes of Whites and people of color in terms of length of life, quality of life, and social well-being. In the United States, life expectancy is 79 years, and any death occurring before that age is premature.

What are the types of disparity? ›

The absolute disparity is a reflection of the difference between the groups of the entire population. Whereas the relative disparity tells us about the relative disparity across all groups in the population, taking into account the size of each group.


1. Racism as a Mental Health Challenge: An Antiracist Counseling Perspective
(TCSPP Counselor Ed. Department)
2. Why Race Matters: Black Mental Health
(PBS Wisconsin)
3. Racial Trauma: How Racism can cause PTSD, with Monnica Williams
(Factor-Inwentash Faculty of Social Work)
4. Racial, Ethnic, Cultural and National Disparities in Psychological Treatment Outcomes are Inevitable
(Dr. Bedi's Research, Teaching, and Service Lab)
5. Health Equities and Racial Disparities | The Pandemic Within a Pandemic | WCM Insights
(Weill Cornell Medicine)
6. The Road to Recovery: Ending Racial Disparities in Healthcare
(Shriver Center on Poverty Law)
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