2 minute read
Rooting Out Inequities
Faculty Notes
Recent news and accomplishments
The role implicit bias plays in the public realm is finally being grounded in research, data and science. SSW Professor Ora Nakash, M.A., Ph.D., aims to bring that understanding to a decidedly more private realm: the offices of mental health clinicians. Nakash, chair of the Human Behavior in the Social Environment sequence, has researched mental health disparities among racial and ethnic minority groups for 15 years with a goal of improving access to and quality of care for people from marginalized communities.
Her work explores the role of unconscious provider bias in quality of care and treatment outcomes. Her findings suggest that clinicians make assumptions about clients based on their social identity, leading them to miss vital information that would provide a more accurate understanding of the issues bringing clients into the office.
“We find that socially advantaged clinicians have more misdiagnoses with minority clients compared to socially advantaged clients,” said Nakash.
This failure to collect adequate information can have a ripple effect, signaling to the client that the provider lacks an understanding, which in turn makes the client more reticent and less likely to engage, exacerbating potential misunderstandings.
Multiple factors come into play when it comes to inequities in mental health care for members of minority groups, including structural ones such as cost, accessibility and language barriers.
Nakash is trying to more fully understand the subjective factors brought in by providers themselves; these include implicit biases among providers, language and cultural barriers and “cultural disfluency,” when providers “just don’t understand the cultural code” of their clients, she said. That absence of a shared cultural code—and possibly more importantly, the failure to acknowledge the role power differentials play in a therapeutic relationship—means clinicians unintentionally inhibit clients from painting a fuller picture. “They assume things,” said Nakash.
—ORA NAKASH
She acknowledges that assessments are tricky: therapists must balance the task of collecting information with the need to build a relationship with the client. But carefully drawing out a client’s story not only provides important information, it strengthens the relationship.
In relaying findings to clinicians, she reminds them that their most important role is to make a connection with the client. “Be explicit. Ask, ask ask. This is what most clients want you to do,” she said. “Clients really want to feel understood. If they have a provider who treats them with respect and asks more direct questions, they feel better understood and more connected to the provider.”
Nakash has teamed up with Assistant Professor Benjamin Capistrant, Sc.D., on research looking at elderly LGBTQ people of color, a population about whom there is little research, but concerning trends. “We really want to try to understand their mental health needs. Why are there increased levels of depression, suicidality and opioid use?” said Nakash. Also in recent months, Nakash finished work on a book project looking at mental health issues among Palestinian citizens in Israel, published by Indiana University Press. “This is very politically charged,” she said.
She has incorporated her research findings into her own clinical practice as well as into trainings for clinicians to explore the role cultural disfluency and power differentials might play in their work. “I’m an optimist, and, in my research, I try to focus on what’s going well and strengthen it,” she said. —Laurie Loisel
