Workforce Diversity, Structural Racism, and Mental Health Disparities: A Critical Review

Background and Purpose: Recruitment and retention of a diverse mental health workforce has been suggested as a critical pathway to address the persistent racial inequities that contribute to mental health disparities. Existing literature on healthcare organizations generally suggests that a diverse workforce may have favorable effects (e.g., improved team functions) for reducing disparities in client health outcomes. However, structural racism has been noted to limit the potential positive effects of workforce diversity. The current study explored the mechanisms by which structural racism operates through mental health organizations to undermine workforce diversity to persist inequities.

Methods: Guided by the theories of racialized organizations, the current study used critical reviews of empirical studies underscoring the racial character of organizations as mezzo-level racialized structures that may systematically activate and uphold white racial worldview in the mental health workplace. Based on the findings, we developed a conceptual model to visualize the contention that community mental health organizations can be structurally designed to maintain white superiority that negatively affects minority workforce to constrain equity and justice intent and effects of a diverse mental health workforce.

Results: Findings suggest that in the context of institutionalized white dominance, employees of color within mental health organizations may experience race-based cultural exclusion, identity threat and racialized workplace emotional expression, and be burdened by racialized tasks. Employees of color also may become the means for organizations to attract communities of color due to their diverse characteristics. However, the diverse employees’ effects to address disparities in mental health are minimized due to potential racialized organizational forces, including the whiteness of organizational leadership and color-blindness. Through these mechanisms, employees of color experience racial battle fatigue, which in turn may influence their decision to leave the organization. This in turn may sustain or further increase the gaps in workplace diversity efforts.

Conclusions and implications: Structural racism may create resistance to the efforts and effects of a racially diverse workforce within mental health organizations. The current critical review calls for a race-conscious framework that drastically shifts the traditional organizational structures to an inverted hierarchy (i.e., which situates clients at the top of the hierarchy, followed by direct care providers, supervisors, mid-management, and upper leadership) to maximize their diversity efforts to address racial disparities in mental health. Given that social work clients are diverse in nature, race-conscious and responsive leadership can mobilize the inverted organizational hierarchy to actualize justice goal in mental health service delivery and outcomes. Mental health organizations’ efforts to disrupt the continuing influence of a racialized system are critical to promote an inclusive workplace that can recruit and retain employees of color who may help reduce disparities in mental health. We will present a conceptual model visualizing the mechanisms enforcing racialized structures and processes that may sustain white dominance within mental health organizations to persist inequities. We will demonstrate how social work organizational leaders can disrupt the racialized mechanisms likely to negatively affect workforce diversity. Social work implications to advance research, policy, and practice in workforce diversity will be discussed.