As mental health becomes more accessible across the United States, more persons of color (POC) have decided to take the plunge into trying therapy. While the rate has increased over the years, there is still a large gap between how often POCs and Whites choose to access therapy. According to the McLean Hospital, “25% of Black people seek mental health treatment when needed, compared to 40% of white people.”1 Meanwhile, for Hispanic/Latino/a populations, Murray and Henry (2022) reported that non-Hispanic White youth were 12-15% more likely than non-White youth to receive treatment for major depression; and for minority youth who experience suicidal ideation, the gap for mental health access was even larger at 18%.2 This serves to indicate that while access has improved, utilization still appears to be low among POCs.

It appears there are two major reasons for these gaps: (1) lack of clinicians of color in the field, and (2) lack of culturally appropriate treatment approaches. In this short article, I look at both reasons and posit potential solutions.

Lack of Clinicians of Color

According to Zippia, which is an online recruitment site which aggregates statistics about specific professions, 72.6% of therapists are White and 75.6% of therapists identify as women.3 The American Psychological Association (APA) used census data to discover that in 2019, 83% of psychologists in the United States identified as White.4 However, they were also able to comment that between 2000 and 2019, the number of psychologists who identify as POCs increased by 116%. This both demonstrates that progress is being done and just how low the numbers of POCs in the field was in 2000. A blog post written by Abby Kirchmeier for Ayana Therapy out of Los Angeles5 points to one of the reasons for the dearth of therapists of color. She comments on the lack of exposure to the field, stating: “Just as minorities do not use psychology services because they do not know it exists, or choose not to adopt it because of stigma, individuals may not choose to work in the psychology field due to their own misconceptions or cultural stigma,” highlighting a circular problem. Since POCs are less likely to engage with mental health, they are less likely to have experiences with mental health providers, and as such, are less likely to think of becoming a mental health provider as a viable career option. 

Additionally, it must be considered that for many POCs who interact with mental health providers at a young age, the experiences are not positive. Frequently, the interaction is from being referred either for behavioral intervention or assessment.9 It is important to consider the circular nature of this problem as it shines light on the idea that the system must be adjusted from the ground, from the roots, in order to be effective in breaking the current status quo. I would like to offer the need for the introduction of mental health as a positive and voluntary concept to children from a very young age. This is to allow them time to become comfortable and ask questions. In addition to not pursuing this field due to misconceptions or lack of positive experiences, the high cost, not only of the education, but of the licensure process must be critically examined for other potential barriers for POCs who do wish to enter the mental health field. 

Lack of Culturally Appropriate Treatment Approaches

The lack of culturally appropriate treatment approaches also serves as a barrier to access. It must be noted most therapeutic approaches were not normed on or originally considered for POCs. Trends have been changing in more recent times as psychological assessments are re-normed to include more diverse populations. For example, the Minnesota Multiphasic Personality Inventory (MMPI) underwent re-norming as part of the release of the third edition of the personality assessment. The University of Minnesota Press released a statement concerning the release, reporting their priorities included, “focus on enrollment of people/persons of color or communities of color . . . toward the goal of increasing generalization of results and improving assessment of diverse individuals and/or groups.”6 While this is an example for psychological assessment, the overall premise holds for therapeutic support, in order to address patterns of historic disenfranchisement and to work towards the re-norming of the psychological practice to apply to all racial groups equitably, there must be intentional investment. Largely, the focus has been on adapting already existing approaches and techniques, as shown above. However, we can also consider reaching for the knowledge held by communities of color and creating specific approaches from our own unique understandings of the world. An example is Cuento Therapy, or the use of storytelling from a Latino/a/x perspective in therapy. This was first mentioned by Constantino (1986)7 as an approach for engaging Puerto Rican children and has recently seen a resurgence in literature and research by Latino/a/x clinicians and researchers. This is a clear example of the use of a technique from a culture, to be applied to the culture, and demonstrates to be highly effective.8 Many authors have done the work to highlight therapeutic approaches, techniques, and skills to work towards more culturally sensitive practice, so I will encourage those interested to seek out that literature. 

In closing, I issue the challenge to consider in your circles how you can advocate for greater investment in POC related research, better visibility, and the easing of barriers for POC entry to these fields.

References:

1. McLean Hospital. Black Mental Health What You Need to Know. From mcleanhospital.org/essential/black-mental-health

2. Murray, T.M., et al. (July 28, 2022). Using Cuento to Support the Behavioral Health Needs of Hispanic/Latinos. From samhsa.gov/blog/using-cuento-support-behavioral-health-needs-hispanic-latinos

3. Zippia The Career Experts. Therapist Demographics and Statistics in the US. From www.zippia.com/therapist-jobs/demographics

4. United States Census Bureau. (May 11, 2021). American Psychological Uses ACS Data to Identify Need for Mental Health Services, Education, and Training. From census.gov/programs-surveys/acs/about/acs-data-stories/psychologists.html 

5. Kirchmeier, A. (April 9, 2019). The Lack of Therapists of Color and Why. From www.ayanatherapy.com/post/the-lack-of-therapists-of-color-and-why#:~:text=The%20first%20reason%20is%20the,own%20misconceptions%20or%20cultural%20stigma

6. University of Minnesota. Update on the MMPI-3. (March 2023). From www.upress.umn.edu/test-division/mmpi-3-update

7. Costantino, G., et al. (1986). “Cuento therapy: A culturally sensitive modality for Puerto Rican children.” Journal of Consulting and Clinical Psychology, 54(5), 639–645. doi.org/10.1037/0022-006X.54.5.639

8. Costantino, G., et al. (2010). Cuento Therapy. In: Clauss-Ehlers, C.S. (eds) Encyclopedia of Cross-Cultural School Psychology. Springer, Boston, MA. doi.org/10.1007/978-0-387-71799-9_107

9. APA. Addressing the Mental Health Needs of Racial and Ethnic Minority Youth: A Guide for Practitioners. From 

   www.apa.org/pi/families/resources/mental-health-needs.pdf

*Marquez Wilson, PsyD (they/them) is the current Vice President of the Northern Region for the Nevada Psychological Association (NPA). They specialize in multicultural psychology, specifically with LGBTQIA+ populations, persons of color, and people with an experience of immigration. Dr. Wilson is a proud faculty member at the University of Nevada, Reno, (Go Pack!), working with college students, and the owner of WilPsych Prof LLC, working with clients in psychological support and offering consultation on areas of inclusion, diversity, and accessibility.