How Systemic Racism Impacts Patient Access to Mental Healthcare

Despite happening nearly a hundred years ago, the nation is still seeing the impacts of redlining and other forms of systemic racism, with recent data showing that redlining has resulted in present-day limits on patient access to mental healthcare.

The data, published in JAMA Network Open by researchers from the George Washington University Milken Institute of Public Health, found that redlining caused nearly a 20-fold disparity in the mental healthcare workforce in Greensboro, North Carolina, a city with a noted mental healthcare provider desert.

In Richmond, Virginia, which also has longstanding provider shortages, the mental healthcare workforce disparity was six-fold, the researchers said.

"While it may seem hard to understand how structurally racist redlining policies that were implemented nearly 100 years ago would impact access to care today, this initial analysis suggests that could be the case,” Clese Erikson, Principal Investigator at the Fitzhugh Mullan Institute for Health Workforce Equity at The George Washington University, stated publicly.

These findings come as the healthcare industry continues to focus on health equity and acknowledge the role that historical systemic racism, like redlining, has played in current disparities.

Redlining is a 1930s practice of designating predominantly Black or immigrant neighborhoods as “undesirable” for home loans and other financial investments in healthcare, business, and industry. The impacts of redlining have been observed in maternal health disparities as well as COVID-19 occurrence and severity. This latest data demonstrated that redlining has also impacted the mental healthcare workforce.

The researchers used Google Maps data to look at two communities that have been particularly hard-hit by mental health provider deserts—Richmond, Virginia, and Greensboro, North Carolina—and segmented provider addresses by district. The team assessed the density of mental healthcare providers in neighborhoods that were historically redlined and those previously categorized as “favorable” for loans and investment.

In both communities, mental healthcare providers were more densely located in neighborhoods historically deemed “favorable.”

In Richmond, the disparity was six-fold; “favorable” neighborhoods had six times the number of mental healthcare provider addresses than previously relined districts. Only about a third of mental healthcare clinicians were located in redlined districts.

And in Greensboro, the disparity was even starker. “Favorable” neighborhoods had 20 times the number of mental healthcare provider addresses than previously redlined districts. Only about 20 percent of mental healthcare providers were located in redlined districts.

This could impact patient access to mental healthcare for individuals living in previously redlined districts, who to this day tend to be Black or people of color. In Richmond, redlined neighborhoods are 71 percent Black, and in Greensboro, they are nearly 90 percent Black.

People living in redlined districts are also more likely to have financial challenges, with Richmond’s redlined areas having a 71.8 area deprivation score and Greensboro’s scoring a 93.4. By comparison, “favorable” districts in Richmond have a 15.1 area deprivation score, and Greensboro’s “favorable” areas had an area deprivation score of 35.

The researchers acknowledged that simply working off the listed mailing address is not always reflective of a mental healthcare provider’s practice area. However, the findings warrant further investigation into access to mental healthcare providers and how other social determinants of health, like transportation, compound to limit access.

“These findings are consistent with other studies examining contemporary economic and health disparities in formerly redlined communities,” Erikson concluded. “We need to continue this line of research so that we can identify policy solutions that will address racial and ethnic disparities in access to care and advance health equity."