The effect of social identities of service-users and clinicians on mental health disparities: A review of theory and facts.

Mental health disparities are differences in health status, risks and care favoring members of advantaged over disadvantaged social groups. the contrasting social identities of clinicians and service-users may account for potential disparities found in clinical encounters, reflected, for example, in the provision of substandard care. the imputed mechanisms, however, remain unknown. Drawing on social psychological research we delineate a model to assist in identifying those mechanisms. we review the literature on processes rooted in social categorization (outgroup bias) and in social power (impaired perspective taking, making automatic attributions) and suggest that the contrasting social identities of clinicians and service-users can partially account for why discordant, compared to concordant ethnic identities in clinical encounters may produce worse outcomes, measured by the quality of the working alliance and the accuracy of diagnostic decisions. we provide preliminary evidence for the proposed model and submit a research agenda to inform evidence-based interventions to counter the negative outcomes of discordant encounters.