Rates of Discrimination and Racial/Ethnic/Cultural Concerns Among College Students Seeking Counseling Services

Recent national events have renewed our collective focus on racial injustice and the experiences of discrimination and racial, cultural and ethnic concerns. In an effort to contribute to this dialogue, CCMH took a closer look at the frequency in which students initiate counseling with discrimination and/or racial, cultural or ethnic concerns as primary presenting problems. To accomplish this, CCMH examined responses from the Clinician Index of Client concerns (CLICC), which is a checklist of possible presenting problems that is completed by the clinician after evaluating a student who is seeking mental health care. “Discrimination” and “Racial, ethnic, or cultural concerns” are two presenting problems that therapists can choose from a comprehensive checklist of more than 40 problem areas. Clinicians can “check all that apply” within the list of concerns. “Anxiety” and “Depression” have historically been assessed as the most common primary presenting problems experienced by college student seeking services (2019 Annual Report, p.15). Examining a large national sample of 82,685 clients from 98 college counseling centers during the 2018-2019 academic year, CCMH found that clinicians identified Discrimination as a presenting problem for 0.7% of clients and Racial, ethnic, or cultural concerns was selected for 2.7% of clients. Zooming in, it was discovered that the frequency of these presenting concerns varied considerably between majority and minority identity groups. CCMH has outlined the findings below (Please note, these data reflect the rates in which clinicians identify Discrimination and Racial, ethnic, or cultural concerns as primary presenting problems for students entering treatment and do not measure the percentage of clients who report a history of these problems):

While both Discrimination and Racial, ethnic, or cultural concerns are less commonly endorsed by clinicians as primary presenting problems they are much more likely to be identified as primary concerns for clients who hold racial/ethnic minority identities. In fact, for non-white clients, Discrimination and Racial, ethnic, or cultural concerns are respectively 4.4 and 15.7 times more likely to be presenting problems. Across all the minority identity groups represented in the tables above, non-white clients are 3.3 to 8 times more likely to enter treatment with Discrimination as a primary presenting concern than white clients. Even more pronounced, clients identifying as racial/ethnic minorities are 11.8 to 30.3 times more likely than white clients to enter treatment with Racial, ethnic, or cultural concerns. Interestingly, clients who “Self-identify” for Race/Ethnicity present with the highest rates of both Discrimination and Racial, ethnic, or cultural concerns.

Examining gender identity, a similar pattern is observed for Discrimination. Clients who identify as Transgender and Self-identify experience Discrimination as a primary presenting concern 4.6 times more often than cisgender clients (male or female identities). Racial, ethnic, or cultural concerns were presenting problems at consistent rates across gender identities with the exception of Self-identify, which demonstrated a slightly higher rate.

When CCMH evaluated these primary presenting concerns across different sexual orientations, Discrimination was 3.3 times more likely to be identified in clients with a minority sexual identity than heterosexual clients. For all minority sexual orientations (Lesbian, Gay, Bisexual, Questioning, & Self-identify), this ranged from 2 to 7.8 times more likely than heterosexual clients. On the other hand, the rates of Racial, ethnic, or cultural concerns were relatively consistent across different sexual orientation identities, with the exception of clients who identified as gay.

Overall, these findings provide a more nuanced analysis of the aggregate data CCMH gathers annually and leave us with a few highlights and questions:

  1. Clients with minority identities (race/ethnicity, gender identity, sexual orientation) are significantly more likely to seek mental health treatment with Discrimination as a presenting concern compared to those with majority identities. Clinicians should be prepared to evaluate for these concerns, especially for clients who hold multiple intersectional identities.
  2. Racial, ethnic, and cultural concerns are much more likely to be identified as presenting concerns for clients holding a minority racial/ethnic identity, but these problems are fairly consistent across all gender and sexual orientation identities with a few exceptions.
  3. This examination investigated the prevalence of Discrimination and Racial, ethnic, and cultural concerns from the perspective of clinicians, but it raises the question of whether these areas should be directly assessed from the client’s point of view. Perhaps clients would be more likely to identify these concerns than therapists? Would this information received provided by clients change the rate at which therapists assess these problems as primary presenting concerns across all or specific identities? To continue exploring these questions, CCMH will be piloting some new items in the coming year.
  4. Counseling can be helpful to those who have experienced discrimination and its negative impact on mental health. However, discrimination, itself, is not a mental health problem nor should the response to this significant issue primarily land in the mental health realm. Rather, it is incumbent upon colleges and universities to address discrimination and its impact at all levels of the institution in order to effectively identify, manage, protect against, and provide support for this ongoing societal problem.
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