“Just Be Straight with Me”: A Preliminary Exploration of Black Patient Experiences in Initial Mental Health Encounters

Purpose: Studies have yielded divergent findings regarding the relationship between race/ethnicity and mental health treatment outcomes. Knowing how a patient feels about the initial encounter has many advantages for the clinician, however, being in the moment and understanding what is and is not working can be difficult to discern. The challenge is to improve the interaction before the patient exits so as to ensure a second visit. Although there are strong proponents of racially concordant clinical encounters (Cooper et al., 1999; LaVeist and Nuru-Jeter, 2002; Saha et al., 2003), this is not always possible with Black patients because of the limited number of Black mental health providers. This study, supported by a National Institute of Mental Health Diversity Supplement, is one of the first to explore the interpersonal interaction between Black (non-Hispanic/Latino) patients and their non-Black providers, in order to better understand how patients come to describe their initial encounter as good or poor.

Method: Data are reported from face to face, post-intake interviews with 14 Black patients being seen by 11 non-Black providers who participated in the Patient-Provider Encounter Study (PPES). The Black sample represents about 15% of the total PPES sample, as compared to approximately 50% Latino and 39% white patients. Post-intake interviews lasted between 20 to 30 minutes, were audio-taped and professionally transcribed. Data were coded by two independent researchers using a combination of Atdjian and Vega's (2005) concept of scanning, heuristic perspectives derived from Anderson's (1990) interpretation of respect within the Black community, and Whaley's (1997; 1998) interpretation of Healthy Cultural Paranoia as a positive socio-cultural adaptive behavior for Blacks in psychiatric settings.

Results: Each participant seemed to rely upon their past experiences in order to conceptualize their feelings about the current encounter. Race-specific socio-cultural factors influenced patients' feelings and views of their providers. As Black patients interacted with non-Black providers, they actively and passively scanned for feelings of comfort, being listened to and understood, feeling safe to disclose personal information; and feeling trustful of the providers. Issues of respect and healthy cultural paranoia seemed to function implicitly as conduits between what patients scanned for during the encounter and whether they felt favorable after the encounter.

Conclusions and Implications: By exploring how patients make determinations about clinical encounters, we were able gain insight about the process of scanning and learn more about what seemed to matter most for our sample of Black patients during an initial mental health encounter with a non-Black provider. This exploration suggests that when patients make judgments about the initial encounter, many base their feelings primarily on gut reactions towards providers and not on a specific event during the encounter. In many ways, the initial mental health encounter is an opportunity for both the patients and providers to “audition” for the opportunity to work together. If the patient feels that the provider's performance is poor, the clinician's attempts to understand the situation will be superfluous, for the patient may have already disengaged from the interaction and ultimately from seeking mental health treatment.