Discrimination Against People with Mental Illnesses: Experiences of People Who Are of Color and/or LGB

Background and Purpose: Providers in mental health service systems (MHSSs) have been found to hold stigmatizing attitudes toward people with mental illnesses (PWMI); in addition, PWMI and their families have reported discrimination by providers. Little is known, however, about provider discrimination toward PWMI who are of color and/or lesbian, gay, or bisexual (LGB). This area is important to study because mental health treatment disparities, including poorer access to treatment and inadequate treatment, have been well-documented for these communities. Numerous methods of overcoming disparities have been suggested, including interventions to lessen mistrust of the MHSS. Few, however, have focused on examining and changing providers’ attitudes and resultant discriminatory behaviors. This study asked members of these communities to describe their experiences with mental illness-related discrimination in the MHSS, as perceptions of discrimination may contribute to disparities. We also asked participants to describe aspects of the MHSS that supported recovery. Taken together, responses in these two areas offer guidance for improving services for these communities.

Methods: Twenty adults who identified as of color and/or LGB participated in semi-structured interviews. Participants had been involved in the MHSS as either a PWMI (n=13) or a family member (n=7) of a PWMI. Twelve are lesbian (n=5), gay (n=5), or bisexual (n=2) and 15 are of color; 7 participants are both of color and LGB. Participants of color identified as Mexican American, Native American, African American, and/or Asian American (6 were biracial or multiracial). Participants were recruited through fliers sent to organizations featuring professional and/or peer or family staff. (No transgender individuals responded to the announcement.) Interviews addressed experiences with discrimination and ways in which the MHSS had supported recovery. An iterative analysis of verbatim transcripts identified topic and in vivo codes that emerged from the data, then themes and patterns were identified.

Findings: Nineteen of the 20 participants described incidents of discrimination in the MHSS. Although asked about discrimination related to mental illnesses, 11 participants described experiences with discrimination based on race/ethnicity, sexual orientation, and/or other identities in addition to or instead of mental illnesses. Mental illness-related discrimination most commonly included treating participants as if they were not intelligent, ignoring their opinions regarding treatment, violating confidentiality, and limiting service options. Racial discrimination was described as covert and included staff not understanding or making assumptions about their cultures. LGB discrimination included judging participants for being LGB and not considering this identity in services delivery.

Participants most commonly reported that staff who listened to their opinions; medications; talk therapy; and peer-run programs were helpful toward recovery. Data analysis revealed several ideas for better serving these communities.

Conclusion and Implications: Participants were alert to discrimination related to multiple identities. Perceptions of discrimination may be one factor leading to disparities because they influence a person’s interactions with the MHSS. MHSSs and advocates for PWMI should consider educating providers to reduce covert discrimination; developing programs grounded on the cultures and experiences of people of color and LGB communities; advocating for funding to address staff and program shortages; and implementing empowerment models.