Disproportionate Diagnosis of Mental Disorders among African American versus European American Clients: Implications for Counseling Theory, Research, and Practice.

Racial/ethnic differences in the mental health treatment of clients have received increasing attention during the past decade (Harley & Dillard, 2005). The Surgeon General's recent report on mental health in the United States noted that the needs of persons in certain racial/ethnic groups remain unmet (U.S. Department of Health and Human Services [DHHS], 2001). Moreover, differential mental health care affects clients from certain minority groups more than others. For example, the Surgeon General (DHHS, 1999) noted that African Americans with mental health needs are less likely to receive adequate treatment than are people from the mainstream population. Treatment inequities regarding African Americans include fewer available mental health services (Brown & Keith, 2003) and poorer quality of mental health care compared with resources provided to other racial/ethnic groups (E. J. Lawson & Kim, 2005). When African American clients are compared with European American clients, these treatment differences may in part be the result of poorer insurance coverage, lack of access to culturally compatible providers, or other socioeconomic differences among African American clients (Chow, Jaffee, & Snowden, 2003). Racial/ethnic bias among mental health professionals, however, may also play a significant part in the differential resources devoted to and treatment outcomes noted in African Americans (DHHS, 1999). One consistent trend in the literature is how treatment decisions differ for African American versus European American clients. For example, differences in the type of mental health treatment recommended to African Americans and European Americans (e.g., outpatient vs. inpatient treatment) have been well documented. Thomas, Stone, Osborn, Thomas, and Fisher (1993) compared rates of inpatient admissions at first admission and readmission among African Americans versus other racial/ethnic groups. Results showed that rates of both first admissions and readmissions were significantly higher for African Americans compared with persons of other racial/ethnic groups. Other studies report that African American clients are significantly more likely to be hospitalized in psychiatric facilities and are more likely to be involuntarily committed than are European American clients (W. B. Lawson, Hepler, Holladay, & Cuffel, 1994; Snowden & Cheung, 1990; Whaley, 2004). This trend results in more days off work among African Americans compared with other racial/ethnic groups (DHHS, 1999) and in loss of social freedom. This trend may also correlate with consistent findings that African Americans have skepticism toward mental health care in the United States (Dixon & Vaz, 2005), hold negative attitudes toward mental health delivery systems (Nickerson, Helms, & Terrell, 1994), tend to be suspicious of mental health providers (Whitaker, 2000), and have a broad fear of psychiatric hospitalization (Sussman, Robins, & Earls, 1987). Ultimately, African Americans underuse formal mental health systems (Snowden, 1999) and seek mental health services at rates lower than those of European Americans (Mindel & Wright, 1982). A review of the literature suggests that one of the primary reasons for admission and treatment disparities between African Americans and European Americans could be disproportionately high frequencies of more severe clinical diagnoses among African American clients. A review of the literature revealed that a long-standing trend of disproportionately high rates of more impairing mental disorders in African Americans has been documented (Flaskerud & Hu, 1992; Malzberg, 1940). One consistent finding is the unusually high rate of psychotic disorder diagnoses among African American clients (Chow et al., 2003; DHHS, 1999). Moreover, the overdiagnosis of schizophrenia among African Americans is thought to be the result of misdiagnosis rather than any statistical difference in prevalence according to race/ethnicity (W. …