Gender Identity-, Race-, and Ethnicity-Based Discrimination in Access to Mental Health Care.

Abstract

Racial, ethnic, and gender minorities face mental health disparities. While mental health care can help, minorities could face discriminatory barriers in accessing it. Discrimination may be particularly pronounced in mental health care because providers have more discretion over accepting patients. Research documents discrimination, including in access to health care, but there is limited empirical research on discrimination in access to mental health care. We provide the first experimental evidence, from an audit ("simulated patients") study, of the extent to which transgender and non-binary people, African Americans, and Hispanics face discrimination in access to mental health care appointments. We find significant discrimination against transgender or non-binary African Americans and Hispanics. We do not find evidence of discrimination against White transgender and non-binary prospective patients. We are mostly inconclusive as to if cisgender African Americans or Hispanics face discrimination, except we find evidence of discrimination against cisgender African American women. Our study occurred before and during the initial onset of the COVID-19 pandemic and we study if COVID-19 affected access to (or discrimination in access to) appointments. We find some suggestive evidence that increased COVID-19 intensity may have reduced access, and discrimination in access, to appointments.