Black Psychiatrists

Two percent of practicing psychiatrists in the United States are Black, against about 14.4 percent of the population [2].

The consequence that has been studied hardest is diagnosis itself. A review of the empirical literature in the World Journal of Psychiatry found that Black patients receive psychotic disorder diagnoses at a rate on average three to four times higher than white patients [1]. The same review reports that Black and Puerto Rican patients are more likely to be diagnosed with schizophrenia even when measures of psychopathology do not indicate that the diagnosis is justified, and that most authors attribute the pattern to racial diagnostic bias, meaning judgments made on the basis of race [1]. It also reports that the clinician's own race did not appear to change the trend [1]. That last point matters, because it means this is not something a patient can fully solve by choosing carefully.

What you can do is make the record harder to misread. Mood symptoms are the ones most often lost. If low mood, sleep loss or a stretch of unusual energy came before the unusual beliefs or the voices, say so in that order, and ask for it to be written in the notes in that order. Ask directly what else was considered and why it was ruled out.

Access is the other half of the problem. In 2024, Black adults were 36 percent less likely than US adults overall to have received mental health treatment in the past year, while the share reporting any mental illness was 20.9 percent against 23.4 percent [3]. Under-treatment and over-diagnosis are not opposites. They travel together, and both get worse when the first psychiatrist someone meets is also the last one they are willing to see.