The History of Mental Healthcare: Mental health assessments and potential biases

History of Healthcare
- Research throughout the history of healthcare has mistreated marginalized populations creating a certain level of distrust in the healthcare system.
  - Research of the womens reproductive system on slaves without anesthetic.
  - Sterilization of women at the north american mexico border.
  - The tuskegee experiment
- Throughout history mental health treatment has evolved to be more inclusive and considerate of people from all different backgrounds in an effort to become more equitable.
- The mental health field was originally fore-fathered by primarily white male psychologists, doctors, and philosophers because of this certain multicultural considerations were not made until much later.
  - Dr. Samuel Cartwright coined the diagnosis Drapetomania which was used to describe the behavior in Africans who escaped enslavement.
  - “Drapetomania is from draptise. A runaway slave is mania mad or crazy. It is unknown to our medical authorities, although its diagnostic symptoms be absconding from service, is well known to our planters and overseers. In noticing a disease that, therefore, is hitherto classed among the long list of maladies that man is subject to, it was necessary to have a new term to express it. The cause in most cases that induces the Negro to run away from service is as much a disease of the mind as any other species of mental alienation, and much more curable as a general rule. With the advantages of proper medical advice strictly followed, this troublesome practice that many Negroes have of running away can be almost entirely prevented, although the slaves are located on the borders of a free state within a stone’s throw of abolitionists.”
  - Hysteria was a historical diagnosis given to women as a blanket term for several different mental health disorders and medical conditions that we know today.
Culture was not formally acknowledged as a part of clinical practice until the year 1973. 50 years later and the field is still working to evolve and consider the needs of the people it serves, and this includes mental health assessments.
According to APA, multiculturalism is the quality or condition of a society in which different ethnic and cultural groups have equal status and access to power but each maintains its own identity, characteristics, and mores.
“Diagnostic criteria, structured interviews, psychological tests, statistical prediction rules (including artificial intelligence algorithms), and clinicians can all be biased” (Garb 2021). There are several factors that can impact accessibility to mental health care. Assessments are created after significant research has been conducted with a representative population. This does not always include a large enough representative sample to consider all cultural factors which creates a bias toward those who identify within the underrepresented population.
In order to be culturally continuous in the work that we do, clinicians and testing administrators must consider how the clients cultural background and history can impact the results from the assessment.
Some of these factors (a) how individuals decide whether, when, and how to initiate or continue care, (b) community and family factors such as social networks that influence the initiation and continuation of mental health care, (c) clinical support and decision-making differences including clinical judgment and the validity of clinical tools but also factors such as clinicians’ availability and cultural competency, and (d) the differential influence of health care policy and financing (e.g., insurance coverage and payment mechanisms). (Cook et. al, 2019 as cited by Garb 2021)

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The History of Mental Healthcare: Mental health assessments and potential biases

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