144 CHAPTER 4
cause—discriminatory hiring practices. In contrast, the therapist may see the prob-
lem as internal, in that the patient’s pessimistic thinking leads the patient to behave
in ways that create a self-fulfilling prophecy. In this case, patient and therapist
would be working toward very different points in addressing what each perceives
as the root cause of the patient’s depression about fi nding a better job. The patient’s
thoughts, however, are not necessarily irrational, and if the therapist is not sensitive
to that possibility and aware of how past discrimination has affected the patient’s
sense of self and the world, then the two of them will continue to have different
goals for and expectations of treatment, possibly leading the treatment to be ineffec-
tive or the patient to drop out of treatment.Using Mental Health Services
Although members of minority groups and Whites have similar lifetime preva-
lences of psychological disorders in the United States, minorities generally do not
use mental health services as often as do Whites (U.S. Depart-
ment of Health and Human Services, 2001). Several factors,
some pragmatic, may contribute to this difference. First, mem-
bers of minority groups are less likely to have health insurance
coverage, which creates a fi nancial burden on them and their
families (who must pay for treatment). In addition, immigrants
may not speak English well enough to communicate effectively
about their psychological problems; if bilingual clinicians or
translators are not available, then patients must rely on family
or friends to translate for them—which can create a disincen-
tive to seek treatment (U.S. Department of Health and Human
Services, 2001). Figure 4.7 compares the proportion within each
ethnic group living in the United States that is native-born versus
foreign-born; the foreign-born may not be able to communicate
well in English. Asian Americans and Hispanics are the ethnic
groups most likely to have been born elsewhere.
Beyond these practical barriers to treatment, two addi-
tional factors may explain why minorities use mental health
treatments less often than do Whites: a basic mistrust of such
treatments, and the stigma of receiving treatment. Mistrust
may spring in part from past experiences, in which members of
minority groups may have felt disrespected or judged unfairly
because of their ethnicity or race. In addition, members of minority
groups may be aware of past abuses by mental health institutions and
professionals—and some fear that they will be “experimented on” if
they allow such institutions or professionals to have control over their
fate (LaVeist et al., 2000; Neal-Barnett & Smith, 1997; U.S. Department of Health
and Human Services, 2001).
Moreover, receiving mental health care may carry a stigma in some communi-
ties. Patients or family members may feel ashamed or embarrassed by the patient’s
problems, and hence discourage the patient from receiving treatment (Ng, 1997;
Wahl, 1999). For people already experiencing discrimination, becoming a mental
health patient can add another source of discrimination, making them reluctant to
seek treatment. For instance, one study found that among Asian Americans, only
12% would tell a friend or family member about psychological problems, and only
4% would seek treatment from a mental health clinician; this contrasts with 25%
of white Americans who would both tell friends and family and would seek mental
health treatment (Zhang et al., 1998).
When minority patients do seek treatment, their symptoms tend to be more
severe at the time of assessment than is typical for Whites (Snowden & Cheung
1990; Sue et al., 1991). One explanation for this fi nding is that some people may
hope that the symptoms will disappear on their own and will consult a mentalFigure 4.74.7 • Estimate of Foreign-Born U.S. Population
by Race and Hispanic Origin
Source: Adapted from U.S. Dept. of Health & Human Services, 2001, p. 109.m m t t w g t t t m mg4747 Eti t fF i B USP lti
01020304050607080White Asian American
and Pacific
IslanderAmerican Indian/
Alaska NativeHispanic Black90100Proportion of GroupU.S. born
Foreign born