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Racial and ethnic disparities in mental health
Mental health issues affect all racial and ethnic groups, with 1 in 5 adults and 1 in 6 youth in the U.S. experiencing mental illness each year. However, access to quality care, accurate diagnoses, and culturally informed treatment is far from equal.
This disparity has serious consequences: untreated mental health disorders, mistrust in services, higher rates of misdiagnosis, and poorer outcomes for Black, Indigenous, and People of Colour (BIPOC).
For this to change, mental health professionals must be committed to improving equity and standing as allies. Further, the individuals navigating the mental health space need to feel safe to seek and receive the individualized care they need and challenge instances where this doesn’t happen.
In this article, we explain the ethnic and racial disparities in mental health, explore ways that the mental health sector can be more inclusive, and provide guidance for BIPOC individuals on how to find the right therapist.
Key takeaways
- Racial disparities in mental health are systemic, affecting everything from access and diagnosis to treatment outcomes and trust in services.
- Therapists must adopt culturally humble, trauma-informed practices and reflect on their own identity, power, and potential biases to support clients more effectively.
- Creating an inclusive mental health system requires structural change, including diverse leadership, equitable training pathways, and culturally responsive services.
- Individuals deserve care that recognizes their identity and lived experience, and should take steps to find therapists who provide culturally safe, affirming support.
Where do racial disparities in mental health lie?
Racial and ethnic disparities in mental health care are pervasive and rooted in systemic barriers. Understanding where these disparities appear is essential for creating culturally responsive and equitable practice.
Access to care
Though rates of reported mental illness are comparable or lower among Black, Hispanic, and Asian adults, these groups consistently access care at significantly lower rates. In the 2023 KFF survey, 50% of White adults reporting fair or poor mental health received services in the past three years, compared with just 39% of Black and 36% of Hispanic adults.
Obstacles to accessing care that minority groups report include:
- Cost
- Scheduling difficulties
- Lack of information
- Stigma
- Embarrassment
- Difficulty finding a provider who understands their background and experiences
Diagnosis and treatment
Minority patients often face misdiagnosis. African Americans, Latino Americans, and Hispanic individuals are disproportionately diagnosed with psychotic disorders, such as schizophrenia, compared to Euro-American and White patients (3-4 times higher and 3 times higher, respectively).
In contrast, major depressive disorder and bipolar disorder are underdiagnosed. Further, research found that non-Hispanic White individuals were 26% more likely to receive an ADHD diagnosis than non-Hispanic Black individuals, with Black females the least likely cohort to be diagnosed.
Even if they enter care pathways, minority patients are less likely than Whites to receive the best available treatments for depression and anxiety and are more likely to terminate care early.
Provider bias
Implicit bias contributes to alarmingly high misdiagnosis rates. Women and ethnic minorities are 20–30% more likely than White men to receive a misdiagnosis.
There’s also racial bias in mental health judgments. Evidence suggests that mental health professionals believe that mental illness is less distressing to Black individuals than to White individuals.
More broadly, racial stereotyping and the use of race in clinical decision-making can result in over- or under-treatment. Insights from the UK, for example, reveal that a disproportionate number of people from Black, Asian, and Minority Ethnic communities are detained under the Mental Health Act and that Black people are more than four times more likely to be the subject of 'restrictive interventions' while in hospital.
Cultural stigma
Many BIPOC individuals report experiences with unfair, discriminatory, and racist treatment.
18% of Black, 11% of Hispanic, 10% of Asian, and 12% of American Indian and Alaska Native (AIAN) adults say they have been treated unfairly or disrespected by a healthcare provider in the last three years because of their race or ethnicity, compared to 3% of White adults.
60% of Black, 52% of AIAN, 51% of Hispanic, and 42% of Asian adults say they prepare for possible insults from providers and must be careful about their appearance to be treated fairly, compared with 33% of White adults.
Underrepresentation in the profession
Therapists from ethnic minority backgrounds remain underrepresented, which limits the availability of culturally attuned care.
In 2015, 86% of psychologists in the U.S. were white. 5% were Asian, 5% were Hispanic, 4% were Black/African American, and 1% were multiracial or from other racial/ethnic groups. This is despite Black individuals representing more than 14% of the population of the United States.
Greater diversity among providers is critical to bridging cultural gaps and improving therapeutic rapport.
Understanding white racial identity in counseling
White racial identity in counseling refers to how a therapist’s awareness (or lack thereof) of their racial identity can impact client work.
Many therapists may not have had to consider race as a central part of their identity, but this awareness is crucial. White practitioners occupy a space of power and privilege not just in therapeutic spaces but in the wider community.
White therapists who fail to reflect on this risk unintentionally centering their own experience or reinforcing systemic norms in therapy spaces.
Reflective tools like Janet Helm’s White Racial Identity Development Model or implicit bias testing can support awareness and growth.
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How therapists can support racially diverse clients
Addressing racial disparities in mental health isn’t just about awareness. It requires meaningful, ongoing changes in practice. Therapists play a vital role in creating inclusive, affirming spaces and challenging the structures that perpetuate inequity.
Cultural humility
Rather than aiming for a fixed sense of competence, cultural humility encourages ongoing self-reflection and openness. Acknowledge that you won't always get it right, but be willing to listen, learn, and adapt. Recognize the impact of your own cultural identity, especially if you’re white, and how this may affect the power dynamics in the room.
Ask, don’t assume
Every client’s cultural background, beliefs, and experiences with mental health are unique. Don’t assume you understand their worldview based on race or ethnicity alone. Ask open-ended, respectful questions. Invite clients to bring their full selves into the space and let them lead in how they wish to share.
Be trauma-informed
Experiences of racism and discrimination can be traumatic. Understand how racial trauma might show up in therapy, from mistrust to hypervigilance, and validate these responses. Avoid minimizing or over-pathologizing the impact of racism on mental well-being.
Review your materials
Check that your website, forms, language, and visual cues reflect diversity and inclusivity. Representation matters. Clients are more likely to engage when they see that your practice recognizes and values different identities.
Name the power dynamics
Therapy is not neutral. Be transparent about the power you hold and make space for clients to express discomfort or feedback. This builds trust and encourages honesty.
Ongoing training
Learning doesn’t stop. Attend anti-racism workshops, seek out diverse voices, and stay up to date with how systemic inequalities impact your clients’ lives. Allyship is not a one-time act; it’s a continuous process. We have a continuous education course for therapists to complete for those who want more information on racial discrimination and mental health best practices.
Creating a more inclusive mental health space
Improving racial equity in mental health care isn’t the job of individuals alone — it requires collective, structural effort. Whether you're a therapist, practice owner, educator, or policymaker, there are tangible ways to make mental health spaces more accessible, representative, and inclusive for all.
- Diversify leadership and training pipelines to support more therapists of color entering and progressing in the field.
- Fund community-based and culturally specific services that already have trust within marginalized groups.
- Make therapy more affordable and accessible, particularly for those impacted by systemic inequalities.
- Review diagnostic tools and criteria to reduce cultural bias and avoid misdiagnosis.
- Challenge the dominance of White, Western therapy models and integrate diverse healing practices where appropriate.
- Offer language-inclusive services, including translation, interpreter support, or therapy in multiple languages.
- Consult with people from underrepresented communities when designing services, policies, or campaigns.
- Audit referral pathways and waiting lists to check for disproportionate barriers or drop-off rates.
- Celebrate cultural strengths and resilience in mental health messaging, not just disparities or deficits.
- Create psychologically safe workplaces for mental health practitioners of color, with proper support, supervision, and mechanisms for addressing discrimination.
Advice for individuals seeking culturally safe support
It’s common to have some trepidation when considering therapy. There’s a fear of the unknown and of being vulnerable. For BIPOC, this unease can be magnified when negative past experiences, communication barriers, and concerns about not being understood or your experiences being invalidated are added to the mix.
Here are steps you can take to help ensure your mental health support feels safe, affirming, and respectful:
- Look for therapists who explicitly state their experience working with racially and culturally diverse clients on their website or professional profiles.
- Use directories focused on inclusive care, such as Black Female Therapists, Clinicians of Colour, Inclusive Therapists, and the Asian Mental Health Collective.
- Ask friends or family who are comfortable speaking about their experiences of therapy for inclusive recommendations
- Ask questions during initial consultations, such as:
- Have you worked with clients from my background before?
- How do you approach cultural identity and experiences of racism in therapy?
- What steps do you take to ensure your practice is anti-racist and inclusive?
- Trust your instincts. If something feels off or you don’t feel heard, it’s okay to look for someone else.
- If affordability is a barrier, explore organizations offering low-cost or sliding-scale therapy with diverse practitioners.
- Give yourself permission to name cultural issues in therapy. Your identity is part of your mental health.
What to do if you experience discrimination in therapy
Therapy is supposed to be an intervention that takes place in a safe, supportive environment and improves your mental health. If you experience discrimination or ever feel unsafe, you can:
- Raise it with the therapist directly, if you feel comfortable doing so
- Submit a complaint to their local, state, provincial, or territorial psychology licensing board or their professional body, such as the American Counseling Association or National Board for Certified Counselors.
- Reach out to advocacy organizations, such as the NAACP or Color of Change, for advice and support.
Tackling racial and ethnic disparities in mental health care isn’t just the responsibility of individuals experiencing them; it’s something we all need to work on, together. Whether you're a therapist, a client, or part of the wider system, every action counts in creating safer, more inclusive spaces where everyone feels seen, heard, and supported.
By challenging bias, listening with humility, and investing in more culturally responsive care, we can start to close the gaps and build a mental health system that works for all. If you're looking for support, take the first step by finding a therapist who understands and respects your identity. Culturally sensitive, inclusive care is out there, and you deserve nothing less. Find care now with Resilience Lab.
References
- Racial and Ethnic Disparities in Mental Health Care: Findings from the KFF Survey of Racism, Discrimination and Health | KFF (May 2024)
- Racial and Ethnic Disparities in Mental Health Care: Evidence and Policy Implications - PMC (February 2014)
- Racial disparities in mental health: Literature and evidence review (2019)
- Racial disparities in psychotic disorder diagnosis: A review of empirical literature - PMC (December 2014)
- Women and Minorities Bear the Brunt of Medical Misdiagnosis - KFF Health News (January 2024)
- Large-scale analysis reveals racial disparities in the prevalence of ADHD and conduct disorders | Scientific Reports (October 2024)
- Race-based biases in psychological distress and treatment judgments - PMC (October 2023)
- Dr Leesha Ellis-Cox Confronts Racial Bias, Diagnosis Disparities in Mental Health Care (February 2024)
- Identifying the role of Mind in building the anti-racism movement within the mental health sector
- Survey on Racism, Discrimination and Health - Findings - 10257 | KFF (December 2023)
- How diverse is the psychology workforce? (February 2018)
- Facts About the U.S. Black Population | Pew Research Center (January 2025)
- Talking About Race in Therapy: How White Psychologists Can Respond to Clients | Anxiety and Depression Association of America, ADAA (October 2021)
- Rethinking Cultural Competence: Shifting to Cultural Humility - PMC (December 2020)
- A human-centered vision for improving the mental health care ecosystem (July 2022)
- How to Find a BIPOC Therapist | Psychology Today (May 2023)