Assessing and Addressing Implicit Organizational Bias to Tackle Mental Health Disparities

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PROJECT SUMMARY/ABSTRACT Mental health disparities among ethnic minorities have reached crisis proportions in the United States. Although ethnic minorities are more likely to experience mental illnesses such as depression and associated social determinants of health like poverty and discrimination, they are less likely to seek help from, have access to, or receive quality mental health services. Efforts to redress such disparities and improve engagement have often focused on adding new services or altering provider characteristics, including the implicit biases they may unknowingly hold. However, recent scientific reviews suggest that cultural and structural barriers deeply embedded in the underlying mental health organization itself are a significant factor in the continued persistence of mental health disparities. While implementation science has advanced our knowledge of the relationship between organizational factors and the uptake of evidence-based practices, there has been comparatively little empirical research on organizational issues as they pertain to mental health disparities. This gap in research may be due, in part, to the relative lack of operationalized constructs of disparity at the organizational level. Based on our research, we have conceptualized a key organizational mechanism of disparities—which we term Implicit Organizational Bias (IOB)—or, the unspoken norms, beliefs, and expectations about the way clients should ideally behave and/or interact with the mental health system to gain optimal benefit from available services (e.g., a client should be verbal, openly admit a problem, accept services, be proactive, be individually-oriented). These preferred organizational norms may conflict with the norms of ethnic minority patients, leading to a higher likelihood of incongruent, suboptimal, or compromised care. The proposed career development award seeks to extend the substantial evidence on implicit bias beyond its focus on individuals to the level of the organization through two phases of participatory, mixed methods research that aim: 1) To systematically operationalize, and develop a tool to assess, Implicit Organizational Bias and its congruence with the culture of ethnic minority communities; and 2) To examine the psychometric properties of the IOB measure and test the pathways of association outlined in our conceptual model. While I have extensive experience in mental health disparities research at the patient and community levels, this K is intended to develop my skillset in: 1) implicit bias research, organizational theory, and implementation science; 2) concept mapping and assessment development, and 3) advanced mixed methods and quantitative research. I have established a comprehensive mentoring and training program involving national and international leaders in disparities, implicit bias, and organizational research. My mentors, in combination with a world-class training environment at Yale University, will guide me towards my goal of becoming an independent investigator of multi-level influences on mental health disparities, with expertise in designing and conducting rigorous, pragmatic research aimed at improving engagement, care, and clinical outcomes for ethnic minorities.