New Study Shows How Historical Redlining Policies Impact Access to Behavioral Health Services

Redlining policies from the 1930s are associated with the decreased availability of behavioral health clinicians in those areas, the findings suggest.

housing development from above
May 25, 2022

Researchers at George Washington University’s Milken Institute School of Public Health found that the structurally racist policy of redlining in the past, is associated with current disparities in the availability of behavioral health clinicians in those same areas.

Redlining was a discriminatory practice that began in the 1930s when the federally sponsored Home Owners’ Loan Corporation (HOLC) designated predominately Black and immigrant neighborhoods as high risk. By outlining them in red on maps, they were effectively cut off from investments in financial, health and other services. Along with other forms of structural racism, redlining has been associated with health disparities resulting from delays in diagnosis and treatment. 

This study, published in JAMA Network Open last month, is the first to examine differences in the supply of physicians or other behavioral health clinicians across redlined neighborhoods. 

"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," said Clese Erikson, principal investigator at the GW Fitzhugh Mullan Institute for Health Workforce Equity. "These findings are consistent with other studies examining contemporary economic and health disparities in formerly redlined communities. 

“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."

The cross-sectional study looked at two counties designated as having a shortage in mental health professionals. The team investigated whether behavioral health specialists are equitably allocated across redlined neighborhoods in Richmond City County, Virginia, and Guilford County, North Carolina, home to the cities of Richmond and Greensboro respectively.

The research team, led by Erikson, found redlined areas in both Richmond and Greensboro had fewer behavioral health specialists serving their communities. In Richmond, well-rated areas by the HOLC—consisting of predominantly White residents—had nearly three times as many psychologists, counselors and therapists per capita compared to redlined areas, predominantly occupied by Black residents.

In Greensboro, predominantly white, well-rated areas by the HOLC had more than 20 times the number of psychologists, counselors and therapists per capita compared to predominantly Black redlined areas. Greensboro's redlined areas had no psychiatrists, while its well-rated areas had five psychiatrists per 1,000 population.

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