Mental health has a race issue: How misdiagnosis is impacting Black employees

When Dr. Jessica Jackson was called to do an evaluation at the hospital where she was the attending psychologist, what she encountered was not a mentally ill patient, but a persistent and dangerous issue rampant in the healthcare system. 

"They asked me to go talk to one of the Black patients, and they kept saying that there was paranoia," says Jackson, now the clinical strategy manager of mental health equity at benefits platform Modern Health. "It turned out he just had really bad experiences with white healthcare workers and didn't want to talk to them, but was happy to talk to me. What would've been classified as a psychotic paranoia was actually a legitimate, healthy paranoia given his experiences."

While Jackson's intervention prevented a mental health misdiagnosis for her patient, many Black individuals haven't benefited from the same experience. Academic studies have found that Black people are misdiagnosed at higher rates than white patients, especially for mental disorders like schizophrenia. And while Black individuals are 20% more likely to experience mental health problems, only a quarter will receive care, compared to 40% of white people, according to the National Alliance on Mental Illness.

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As mental health disorder rates continue to rise and more people seek help, mental health professionals are grappling with some challenging questions, Jackson says. Are Black people getting the treatment they need, or are clinicians, employers and HR leaders not considering factors like racial trauma and cultural stigma in their interactions and benefits?

Dr. Jessica Jackson, clinical strategy manager of mental health equity, Modern Health

"Are we over-pathologizing things that we're seeing in the Black community when people are coming in for treatment?" Jackson says. "Is it that we're seeing increased rates [of mental health disorders] or is it that people are being misdiagnosed? That's a debate in the mental health community."

Mental health disorders like depression, anxiety, bipolar and schizophrenia are notoriously misdiagnosed: according to the National Institutes of Health, major depressive disorder is misdiagnosed nearly 66% of the time; bipolar is misdiagnosed nearly 93% of the time, and anxiety disorder has a misdiagnosis rate of 71%.

A misdiagnosis can start with implicit biases that impact the way a clinician engages with Black patients, says Dr. Reshawna Chapple, a licensed clinical social worker and therapist at Talkspace. For example, Black individuals are more likely to be incorrectly diagnosed with bipolar disorder, due to similarities between how bipolar presents itself and the way Black individuals may express emotions, she explains.

"Folks of color are overdiagnosed with bipolar disorder because they spend a lot of time trying to compose themselves or hold in their personalities and not show any kind of outward rage or anger," Chapple says. "Then when they end up expressing themselves, our bodies are moving, our voices can get elevated. For some people who aren't used to those types of mannerisms, that comes across as being a mental disorder: There's something wrong with this person; they can't control themselves."

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While employers and employees have become more comfortable talking about mental health, those conversations may overlook Black workers who feel constrained by stereotypes.

"For some people, it feels safe to talk about symptoms of depression in the workspace, but if I'm exhibiting symptoms and there's the stereotype of 'the angry Black woman,' people are not going to see that as depression," Jackson says. "These stereotypes that are part of our culture prevent people with different social identities from sharing about their mental health."

Breaking barriers
Stigma is a major barrier to even seeking care in the first place — going to therapy "isn't sexy," Chapple says, and even when someone does seek out a therapist, it may not be a person who understands their background and can relate to them in a meaningful way.

"We tend to not really tell people if we are in pain because that's not acceptable. We don't think we're going to be listened to as well," Chapple says. "Then you'll go to a therapist and you feel like the person doesn't understand you. A lot of my clients will say, 'You're kind of a different therapist. You talk to me like I'm a human being.'"

Creating more of these positive treatment experiences is the mission of Modern Health. Along with access to therapy and mental health education for employees, the platform trains practitioners in culturally competent care. The goal is not to pair Black patients with Black clinicians exclusively, Jackson says — and with just 2% of mental health practitioners identifying as Black, it would be an impossible one. Rather, Black people should be wholly considered, both during their diagnosis and then throughout treatment.

Dr. Reshawna Chapple, licensed clinical social worker and therapist at Talkspace

"As a psychologist myself, when I meet clients and they're coming in, I always bring in their social identities," Jackson says. "How are you experiencing this as a woman? How are you experiencing this as a Black woman? How are you experiencing this as a Black woman who is 55? You cannot have an accurate diagnosis if you're not being holistic."

'Safe spaces'
While that holistic approach should be happening in healthcare settings, it can also be practiced in the workplace. When employers talk about creating a "safe space" for employees, they need to ask what that really means and not be afraid to look for the answers, Jackson says.

"When we're talking about destigmatizing, we have to think about making a space that everyone feels comfortable sharing," she says. "We can't expect employers to know everything, but we can expect them to be able to reach out and get support to figure out the answers and to find the information that they don't know."

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To do that, employers can rely on inclusive mental health benefits. Chapple says that while not every person will find their perfect match, Talkspace allows users to filter through licensed therapists and providers who more closely align to their identities and preferred communication styles.

"For individuals of color, for the most part, we are very action-oriented and action-driven. We want to have a conversation with you instead of saying, 'How did that make you feel?'" Chapple says. "Even though we can't match everybody completely, you do have the ability to search for the particular type of therapist you want. That helps people feel like their needs are being met."

Incorporating DEI into the mental health conversation will take continuous effort, Jackson says, but the payoff can help change the experience Black individuals have with their healthcare, with their workplaces, and with their own mental well-being.

"I can't tell you how many times I've had the conversation about diversity, equity, inclusion and belonging in mental health, and HR professionals kind of have a light bulb moment, like, I hadn't thought about how the two were connected. You can't have one without the other," Jackson says. "If you talk to your employees who are from marginalized communities, they probably have poor mental health. Offer these resources. There isn't this kind of mountaintop that we reach — it's a lifelong journey."