Gender Identity, Race, and Ethnicity Discrimination in Access to Mental Health Care: Preliminary Evidence from a Multi-Wave Audit Field Experiment
A broad body of interdisciplinary research establishes that transgender and non-binary individuals face discrimination across many contexts, including healthcare. Simultaneously, transgender individuals face various mental health disparities, including higher rates of depression and anxiety, suicidality, and PTSD. Therefore, understanding the role of discrimination in access to mental health care is essential. However, no previous research quantifies the extent to which transgender and non-binary people face discrimination in mental healthcare markets. We provide the first experimental evidence, using an audit study, of the extent to which cisgender women, transgender women, transgender men, non-binary people, and racial and ethnic minorities (African American and Hispanic individuals) face discrimination in access to mental health services. While data collection is ongoing, we find significant discrimination against transgender or non-binary African Americans and Hispanics in access to mental health care appointments.
The views expressed in this paper do not necessarily represent the views of the Office of Evaluation Sciences, the General Services Administration, or the United States government. We are thankful for internal grant support from the Murphy Institute, the School of Liberal Arts, the Newcomb Institute, and the COR Research Fellowship. We also thank the National Institutes of Health via a postdoctoral training grant for Patrick Button (5T32AG000244-23), which funded his early research on this project at the RAND Corporation. The views expressed are our own and not those of any funders. We thank Sean Alvarez, Emma Brick-Hezeau, Batu El, Christopher Hoffler, Lucía Paternostro, Nile Pierre, Matthew Shernicoff, Gregory Shoats, Kodhai Thirumalai, Brandon Ware, and especially Kyla Denwood for excellent research assistance and comments. We also thank Lee Badgett, Stephanie Budge, Kitt Carpenter, Joanna Lahey, Thomas LaViest, Kathleen Mullen, Derek Ruiz, and Janna Wisniewski for helpful comments and discussions. We received helpful feedback from seminar and conference participants at RAND, the CSQIEP Virtual Seminar, the Advances in Field Experiments Seminar at UChicago, the Vanderbilt Applied Microeconomics conference, the Association for Public Policy Analysis and Management Conference, the Southern Economic Association conference, and the Triangle Health Economics seminar. This study was approved by the Tulane University IRB (2019-1122-TU Uptown). This experiment is pre-registered at the American Economic Association's registry for randomized controlled trials (RCT ID: AEARCTR-0006560). The views expressed herein are those of the authors and do not necessarily reflect the views of the National Bureau of Economic Research.