The Dangers of “Bureaucra-think&”: Research Demonstrates Structural Bias and Racism in Mental Health Organizations

Editor’s note: This release is a slight modification of a release originally distributed by the Yale School of Medicine on January 3. 

Bias is embedded in the very ways healthcare organizations operate, according to a study published recently in Clinical Psychological Science

Conducted by researchers Miraj U. Desai, Larry Davidson, APS Fellow John F. Dovidio (Yale University), Nadika Paranamana (University of Hartford), and Victoria Stanhope (New York University), the study reveals how organizational-level biases affect how patients and even providers are viewed—and in ways that can produce racial and ethnic inequities. 

The authors specifically focused on mental health organizations, detailing how they may systematically transmit bias and racism through common bureaucratic processes and, in some cases, through staff merely doing their job. 

In an equally disturbing finding, the study revealed that staff often remain unaware of this transmission process and perpetuate it simply by meeting their work requirements—a process that the authors termed “bureaucra-think.” 

Over time, this can lead to care becoming “system-centered” rather than person-centered, let alone equitable, the researchers concluded. 

“We hope that this study aids community members, providers, and policymakers vying for greater equity in healthcare,” said Desai, assistant professor of psychiatry at Yale School of Medicine and the paper’s first author. “At the same time, while the study focused on health settings, we firmly believe that it has direct relevance for institutions and systems outside of healthcare—offering concrete evidence and novel concepts to address how inequity can flourish in very hidden ways.” 

The study carries implications for healthcare and other organizations and suggests novel structural targets for intervention. It also signals a paradigm shift for psychological science, as it demonstrates how structural bias and racism partly depend on collective psychological processes, which psychological science has typically neglected in favor of individualist or internalist accounts. The study thus offers a robust scientific and practical framework to help psychology, healthcare, and related fields address structural bias and racism. 

Funding for the study was provided by the National Institutes of Health and the Yale Center for Clinical Investigation. 

Reference 

Desai, M. U., Paranamana, N., Dovidio, J. F., Davidson, L., & Stanhope, V. (2022). System-Centered Care: How Bureaucracy and Racialization Decenter Attempts at Person-Centered Mental Health Care. Clinical Psychological Science. https://doi.org/10.1177/21677026221133053