But a new study suggests there might be another problem at play when low-income and black people attempt to schedule psychotherapy appointments: They never make it past the first voicemail. The study, published in the June issue of the Journal of Health and Social Behavior, suggests psychotherapists are more likely to offer appointments to middle-class white people than to middle-class African-Americans or to working-class people of any race.

For the study, Heather Kugelmass, a doctoral student in sociology at Princeton University, selected 320 therapists from the directory of Empire Blue Cross Blue Shield’s HMO plan in New York City. She then had voice actors call them and leave voicemail messages saying they were depressed and anxious. They asked for a weekday evening appointment. She distinguished between different income groups by altering the vocabulary and grammar in the scripts, and she used studies on African-American vernacular and Black-accented English to craft the African-American callers’ scripts. The lower-income white callers spoke in a heavy, New York City accent. All of the callers mentioned they had the insurance that the therapists purportedly accepted.

Then Kugelmass counted the callbacks.

She found 28 percent of white, middle-class callers were called back and offered any appointment, compared to just 17 percent of African-American, middle-class callers. Only eight percent of the working-class callers of either race were offered an appointment. When therapists offered appointments in the ideal time slot—weekday evenings—the wealthier, white callers prevailed once again.

Kugelmass also found subtle differences by gender, with the odds largely stacked against black men. If her experiment were to play out in the real world, an identifiably black, working-class man would have to call 80 therapists before he was offered a weekday evening appointment. A middle-class white woman would only have to call five.

Psychotherapists tend to favor patients falling under the acronym “YAVIS”—young, attractive, verbal, intelligent, and successful, according to other studies. They like “psychologically minded” clients who remind them of themselves. One study found that psychiatrists view black patients as “less articulate, competent, [and] introspective,” Kugelmass wrote. Just 5 percent of psychologists are African-American.

In the minds of many psychologists, Kulgelmass said, a preference for richer clients might combine “with stereotypes of black men as hostile or recalcitrant.” Providers might be reluctant “to embark on an intimate, long-term relationship with someone they feel they can’t relate to.”

It’s hard to know precisely what the therapists in Kugelmass’ study were thinking. For one thing, 31 percent of the callback messages weren’t very clear, saying only something like, “please call me back.”