Working Paper: NBER ID: w28164
Authors: Luca Fumarco; Benjamin Harrell; Patrick Button; David Schwegman; E Dils
Abstract: Racial, ethnic, and gender minorities face mental health disparities. While mental health care can help, minoritized groups 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 broadly, 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 a correspondence audit field experiment (“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.
Keywords: discrimination; mental health care; transgender; nonbinary; audit correspondence; field experiment
JEL Codes: C93; I11; I14; I18; J15; J16
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| Discrimination by mental health providers (MHPs) (J71) | Access to mental health services for gender, racial, and ethnic minorities (J15) |
| Discrimination by mental health providers (MHPs) (J71) | Mental health disparities (I14) |
| Transgender and nonbinary individuals (African American and Hispanic) (J15) | Discrimination by mental health providers (MHPs) (J71) |
| Access to mental health care services (I11) | Positive response rates from MHPs (C83) |
| Positive response rates from MHPs (C83) | Access to mental health services for gender, racial, and ethnic minorities (J15) |
| Discrimination against cisgender African American women (J79) | Access to mental health services (I19) |