And it’s hard to purposefully make a person sound poor or black. In the working-class white script, for example, the actor said “hiya doc,” instead of “hello,” and mentioned “on the website I seen your name.” The working-class black script included flourishes that bordered on cartoonish, like “a’ight?” and “my numba.”
Lynn Bufka, a psychologist with the APA, said therapists’ biases certainly might have played a role in the results. But, she added, many psychologists might avoid leaving a detailed message on a prospective patient’s voicemail out of privacy concerns. What’s more, it’s unclear whether all of the therapists actually accepted Blue Cross, she said, since sometimes insurance directories are incorrect.
Still, Bufka understands why people might feel help is out of reach. “For someone who’s looking to access psychotherapy, they have to be persistent,” she said. “That’s unfortunate, because you might not have many emotional resources. Calling someone and not being called back feels like rejection. I would hope that we’re all making a good effort to return phone calls, but it doesn’t always happen.”
Discrimination by therapists compounds the already steep obstacles Americans face in accessing mental health care. There are shortages of mental-health providers even in wealthy areas, and more than half of all counties in the U.S. have no practicing psychiatrists, psychologists, or social workers. In any given year, about one in five Americans has a mental illness, according to the National Alliance on Mental Illness, but nearly 60 percent of those people don’t get services.
Patient advocacy groups have long complained that not enough therapists accept insurance, forcing many of their patients to pay high out-of-pocket rates. (Psychologists’ groups, including the APA, contend that insurance companies’ reimbursement rates are not high enough.)
“If it’s a market where you pretty much have to pay for yourself, the rich are always going to win,” Stanford University psychiatry professor Keith Humphreys told KQED recently.
Ngongang finally did get an appointment, but he realized only after the session that the therapist didn’t accept any insurance. He would have to foot the entire $150 bill himself.
“If you have a good session, you want to go once a week,” he said. “That’s like daycare.”
Alicia Raimundo, a mental-health advocate who now lives in Toronto, said the barriers to access in psychotherapy are especially egregious because many people feel ashamed for needing help in the first place.
When Raimundo was looking for a therapist while living in New York several years ago, she said she used a Westernized version of her last name—Raymond—when contacting therapists online. Her email response rates were higher that way, she said.
Ngongang said there might be a tech solution to psychotherapy’s access problems. For years, he said, taxis wouldn’t stop for him. The rise of Uber, where the hailing process is colorblind, has made it much easier to find a ride. Perhaps a similar app for insurance-accepting psychologists would improve things, he mused.
“Now that we recognize mental health is an important piece of wellness, how do we create infrastructure to support that?” he said. “Right now, it’s a luxury. It’s implied that it’s for a certain class.”