People of color underrepresented in mental health fields as patients seek connections

When Tawana Lederman looked for a therapist a few years ago, she specifically sought out another Black woman of Caribbean ancestry to talk not only about family-related stress but about the pressure of feeling like "the sole representation of Black people wherever I am."

“I wanted someone who could relate to me, who has gone through similar trauma,” said Lederman, of Amityville.

Experts say some people benefit from mental health treatment when the therapist is of the same race, ethnicity or culture. But people of color are underrepresented in some mental health fields, compared with their share of the population.

The shortage of mental health professionals who are people of color comes amid a demand for mental health services among all races and ethnic groups that surged during the COVID-19 pandemic and has stayed high. Nearly half of psychologists say they have been unable to meet demand for treatment, according to an American Psychological Association survey released Nov. 15.

The percentage of U.S. psychologists and psychiatrists who are Black and Latino is far lower than those groups’ proportion of the population, according to federal data and a 2020 study.

Black people made up 13.6% of the U.S. population last year, but only 5.6% of psychologists who don't work in schools, according to 2021 Bureau of Labor Statistics data.

Hispanics and Latinos were 18.9% of the population, but in 2013 were only 5.8% of psychiatrists, a study published in Academic Psychiatry in July 2020 found. Psychiatrists, unlike most mental health professionals, can prescribe medication.

A top reason for the low percentage of Black and Latino psychiatrists and psychologists is that those fields require more education and training, leading to more potential financial barriers, experts said.

Latinos also are underrepresented among social workers and mental health counselors, the two largest groups of mental health professionals, as are Asians, bureau data shows.

Similar gaps exist on Long Island, according to data from the labor market analytics firm Lightcast, said Shital Patel, the Long Island labor market analyst for the state Department of Labor.

For example, only 8.3% of psychiatrists on the Island are Latino, compared with the more than 19% of the overall population that is Latino, and 6% of psychiatrists are Black, compared with about 9% of the Island's population. Fewer than 4% of mental and substance abuse social workers are Asian, who comprise 7.5% of the Island's population.

Junhong Cao, a clinical psychologist and founder of Mind Connections, a 13-therapist practice that focuses on Asian clients, including on Long Island, said it’s critical that clients feel free to say what’s on their mind. Many are more likely to do so if their therapist shares their cultural background, she said.

“We’re talking about therapy sessions, and you try to really provide a safe and comfortable and confidential environment for them,” Cao said. “If they feel, ‘I find it so hard to express myself and my therapist cannot understand me,’ that does not really serve the purpose.”

'Definitely a comfort level'

Jennifer Phelps, 36, of Melville, who is Black, sought out a Black female therapist in 2019 after a fire destroyed her apartment and everything she owned. That tragedy led to the resurfacing of a traumatic experience from college.
Having a Black therapist “made me realize that it’s not in my mind," she said. "The things I’ve been through are terrible. This is not something that a normal person can push through, because there’s a stigma with Black women, that we just have to push through, everything’s going to be OK, just get over it. But you know, it clearly wasn’t fine. The more I tried to ignore it, the less sleep I was getting, the worse I felt.”

With a Black woman to talk to, “There was definitely a comfort level," Phelps said.

Nationally and on Long Island, roughly a quarter of social workers — who comprise the largest group of mental health professionals — are Black, data shows. That’s higher than Black residents’ share of the U.S. or Long Island population.

But in some cases, clients may benefit more from a psychologist, who has a doctorate, or a psychiatrist, who can prescribe medications, said Dr. Erica Richards, assistant professor of psychiatry and behavioral sciences at Johns Hopkins University in Baltimore, and co-author of the 2020 study on diversity in psychiatry, which concluded that Blacks, Latinos and American Indians are "significantly underrepresented" in psychiatry.

“We’re seeing slow progress” in increasing the number of Black and Latino psychiatrists, she said.

A key reason why there is a lower representation of Black psychiatrists compared with social workers, who typically have a master’s degree, is the much greater financial burden, because of additional years of education and training, she said. Psychiatrists must attend medical school — usually four years — and finish four years of a psychiatry residency.

The median annual household income for Black families in New York in 2021 was $54,443 — compared with $83,392 for non-Hispanic whites, Census Bureau estimates show. 

Once in medical school, students often opt for what they perceive are more lucrative medical specialties, in part to pay off medical school debt, said Dr. Patrice Malone, an assistant professor of psychiatry at Columbia University.

The median medical-school debt for the graduating class of 2021 was about $200,000, according to the Washington, D.C.-based Association of American Medical Colleges.

Stigma appears to be decreasing

Malone said “there’s still a lot of stigma associated with mental health in communities of color,” so parents and others may not encourage students to pursue mental health careers — although, she said, that stigma appears to be decreasing.

Lederman, 43, who is the daughter of Jamaican immigrants, said stigma toward mental health treatment among many people from the Caribbean is one reason she resisted going into therapy for years.

When she looked for a therapist, she wanted not only a Black therapist, but one with a Caribbean cultural background.

“I know that Caribbeans have a greater understanding of the dynamics, the culture of being from a Caribbean family, who is aware of the way we communicate, the way we address issues, or the non-addressing of issues,” she said. “I don’t want to explain to another therapist about how my culture works.”

Lederman sought therapy because of a number of personal and professional issues, including a father with dementia, tension with a sister, a first pregnancy and a high-stress finance job with long hours. But, in addition, she wanted to talk about how she typically was the only Black woman in the finance departments she worked in, and the pressure she felt to be “always striving to make sure I represent Black people to the fullest.”

Those conversations are easier with another Black woman, she said.

Amanda Fludd, a Black therapist in Lynbrook, said that for many people of color, “There’s a sense of you having to work so hard in so many settings to sort of prove your worth or prove you’re on equal footing or to sort of fit in. You don’t have to do that with a therapist who looks like you and who can relate to you.”

Kathy Dor, a therapist in West Islip, said some of her clients said they had good experiences with white therapists “until it came to talking about matters involving race.”

“They don’t feel safe talking to their [white] clinician about this topic because they don’t know where they stand on race relations and discrimination,” said Dor, who is Black.

Cao said therapists also may not be aware of cultural differences that could affect approaches to therapy. Therapists in the United States often advise clients to confront their parents over emotional and other problems. But traditional Asian culture more strongly emphasizes respect of parents as authority figures, and convincing clients to confront their parents “could literally cause more problems,” she said.

An Asian therapist may “recommend a different approach that would also mean closure, but not necessarily with confrontation,” she said.

Children also can benefit

In some Latin American cultures, parents call their children “mami” or “papi,” as terms of affection, said Flavia Badillo, a Puerto Rican-born psychologist in private practice and with Epic, an East Meadow nonprofit.

Some therapists may see that as “disturbing,” she said, viewing it as “something wrong in the parents’ psychological development, their role as parents: Are they making the child feel like they’re in charge, confusing roles, that type of thing? … You can pathologize behavior that is perfectly normal to the culture.”

Children also can benefit from therapy with someone of the same cultural background, said Dr. Meena Ramani, an Indian-born child and adolescent psychiatrist based in Melville.

Ramani said some of her clients are children of immigrants who struggle with issues of dual identity — of being immersed in both Indian and American cultures — and of “how much Indianness do I want to embrace, and how do I deal with microaggressions, maybe because my food is different, my religion is different — and maybe I’m subject to bullying.”

The kids view her as a maternal figure who asks more open-ended questions and listens more than their own mothers, she said.

And, she said, "The family trusts the person who understands their culture and understands their religion."

Finding a therapist who speaks the same language also is critical, therapists and clients said — even for clients who are bilingual. More than 13% of Americans 5 and older speak Spanish at home, according to 2021 U.S. Census Bureau estimates, but only 4% of psychologists did in 2021, down from 5% in 2015, an American Psychological Association survey released last month found. 

Ada Cabezas, 33, immigrated from Ecuador at age 8 and is bilingual, but “for me, Spanish is my first language and sometimes there are times when I want to say something and don’t know how to say it in English.”

About 75% of the therapy is in English, and the rest is in Spanish, said Cabezas, of Harrison, New Jersey, who does virtual therapy with Migdalia Rosario, whose practice is in Cold Spring Harbor.

Rosario, who was born in Puerto Rico, said that it’s vital to use the precisely correct word when talking with a therapist about feelings and emotions, and clients often are better able to do that in their native language.

“There are a lot of nuances, and they can better explain themselves,” she said.

CORRECTION: An earlier version of this story misspelled the name of Dr. Erica Richards.

By David Olson

david.olson@newsday.com@DavidOlson11

David Olson covers health care. He has worked at Newsday since 2015 and previously covered immigration, multicultural issues and religion at The Press-Enterprise in Southern California.