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Race. Gender. Age. Sexuality. Ability. Profession. What do these things have in common? These are all examples of areas where people might hold implicit biases — and where those biases could have negative effects on the mental health care that people in need receive.
“Implicit bias describes unconscious attitudes we hold towards different groups that can affect our perceptions and actions,” says Guiying (Angel) Zhong, Youth Scholar-Activist. “For example, microaggressions are one way implicit bias can show up in behavior.”
Even when we aren’t aware of it, the biases we have can control how we act. And when you apply this concept to health care providers working with mental health patients — where providers might be making life-altering decisions — things can get serious fast.
Here, Angel and Seika share their insight and their personal experiences on how implicit bias affects mental health care. They also outline actionable steps providers can take to acknowledge their own biases and work toward better health outcomes.
Implicit bias (or unconscious bias) refers to the unconscious association of negative stereotypes and beliefs about different groups of people. This bias operates beneath our awareness, but it influences our perceptions, attitudes, and actions.
“Implicit bias is not inherently ‘your fault,’” says Seika Brown, advocate and global mental health researcher and the founder of YLG Research. “It is the result of historical systems and inequities that have conditioned and taught certain biases. While holding an implicit bias doesn’t make you a bad person, what matters is your willingness to unlearn these harmful associations, both individually and at an organizational level.”
While implicit bias is unconscious, explicit bias is direct. It’s out in the open — something you fully intend to do.
“For example, asking for a male doctor because you believe men are better than women would be an explicit bias,” Seika explains.
When you exercise explicit bias, you consciously endorse negative stereotypes or make discriminatory decisions. And usually, people with explicit biases don’t feel any shame or regret about expressing those beliefs.
We can become more self-aware by reflecting on questions such as this one: Who do you feel comfortable approaching, and who do you avoid? For instance, imagine you’re lost on the street and need directions. Would you feel equally comfortable asking a Black man for help as you would asking a White man, an Asian man, or a woman? Implicit bias might influence your decision, even if you’re not fully aware of it.
“In situations where harm has been done due to implicit bias, the principle of ‘impact over intent’ is crucial,” says Guiying (Angel) Zhong, Youth Scholar-Activist. “Taking accountability for the implicit biases we all hold with self-awareness rather than self-judgment is the first step to mitigating their impact.”
However, Seika also points out that implicit bias does not define your character. “Everyone has implicit biases, but what is essential is the commitment to unlearn them and take action to reduce their impact on others.”
You can also take implicit bias tests online.
“Health care is one of the most common spaces where implicit bias has significant consequences,” Seika says. “Research shows a clear link between providers’ unconscious beliefs about race, gender, or socioeconomic status and the quality of care provided.”
When it comes to mental health care specifically, implicit bias can be tied to disparities in diagnosis; quality of care; and stigma. BIPOC communities, for example, have historically been harmed by bias-driven misdiagnosis and underdiagnosis of mental health conditions.
“Black patients are more likely to be diagnosed with schizophrenia compared to white patients who present with similar symptoms [and] ADHD is underdiagnosed among Asian American children,” Angel explains.
A provider might unconsciously underestimate the mental health concerns of certain patients because of societal norms or limiting views, making incorrect assumptions that hinder care. Another example of implicit bias is that in some cultures, mental health issues are seen as a “Western disease,” leading to the misconception that certain populations are immune to such struggles.
Seika has even experienced the consequences of implicit bias because of her profession: “I sought therapy and was dismissed because I worked in mental health, with the assumption that I should be ‘okay.’ This biased response discouraged me from seeking therapeutic help for years.”
At the end of the day, implicit bias can have a profound effect on who seeks care and how that care is provided. And when implicit biases go unaddressed, they erode trust in health care systems and services, driving people to stop pursuing care and resulting in poorer health outcomes overall.
How can providers move forward in addressing implicit bias — both individually and structurally — to provide better mental health care for everyone? Tackling implicit bias is a long road that needs continual work and attention. But these three steps, suggested by Angel and Seika, are a great start.
Angel knows it can be uncomfortable for people when they’re first learning about implicit bias. They automatically assume it makes them a bad person — and then they get defensive, which isn’t conducive to learning.
“Shifting the conversation from ‘you, as an individual, have this bad trait that must be addressed’ to ‘we, as a community, have a responsibility to mitigate harm by learning about where certain unconscious assumptions we hold come from’ is imperative to facilitating meaningful growth that advances equity,” she says.
Seika adds the following tips for mental health providers who want to work on unlearning implicit bias:
Don’t overlook the community around you. Even if you don’t work directly with patients, taking the initiative to engage with your neighbors, coworkers, or clients can help break down implicit biases by exposing you to diverse perspectives and experiences.
“Develop partnerships with community leaders and community-based organizations to better understand and address the needs of diverse populations,” Angel suggests.
Individual self-awareness is an important and necessary start. But systemic bias is very real, too. “Systemic change is needed to root out deeply ingrained biases that affect care on a larger scale,” Seika says.
Health care institutions might consider creating equity action plans that include:
“Dominant cultural narratives that uphold discriminatory stereotypes can influence how we see and treat marginalized groups without us knowing,” Angel says. “We internalize features of our environment: If that environment has long-standing structural inequality, we will internalize that inequality, resulting in unintended differential treatment and inequitable outcomes.”
Implicit biases are something we all have. But as Angel points out, that means we also all have the power to address them — both individually and collectively. And that’s encouraging news for health care patients and providers across America.
We just have to be willing.
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