Black people of Caribbean or African descent with first-episode psychosis in Canada were more likely to be coercively referred for treatment and to receive coercive psychiatric services compared with patients of other races and ethnicities, according to a study published Tuesday in Psychiatric Services in Advance.
“Medical coercion refers to the use of force, threats, or other means to gain compliance from another person who is deemed an imminent danger to themselves or others,” wrote Sommer Knight, M.Sc., and G. Eric Jarvis, M.D., M.Sc., of McGill University in Montreal and colleagues. In Canada, the authors continued, “certain groups, particularly ethnic minority groups of African or Caribbean descent, are at greater risk for involuntary admission; this discriminatory treatment may be due to excessive application of the ‘danger’ criterion for psychiatric commitment among members of these groups.”
Knight, Jarvis, and colleagues analyzed data from 208 patients with first-episode psychosis who were referred to the First Episode Psychosis Program in the Institute of Community and Family Psychiatry of the Jewish General Hospital in Montreal. The participants were between the ages of 16 and 30; had been taking antipsychotic medications for less than 30 days; and had exhibited psychotic symptoms such as hallucinations, delusions, or paranoid ideation for more than three consecutive days. Participants’ ethnic and racial identifies were included in their charts, and when that information was unavailable, the authors conducted a search to determine that information based on categories from Statistics Canada, a census of the population, including the participants’ country of birth, languages spoken, immigration status, religion, and family name.
Participants who were brought to emergency services via the police, ambulance, or court order were considered to have been coercively referred to treatment. Whether a participant received a coercive intervention was determined from legal documents and physician notes. Coercive interventions included those required by a Canadian court, as well as those rendered by medical staff, including seclusion, physical restraints, or the administration of urgent intramuscular antipsychotic.
In total, 96 of the participants were White; 42 were Black; and 70 were of Arab, Asian, or Latinx descent (categorized as the non-Black visible minority groups). Half of Black participants in the study were coercively referred for treatment, compared with 24% of White participants and 36% of non-Black minority participants. Further, 81% of Black participants received a coercive intervention, compared with 56% of White participants and 54% of non-Black minority participants. Black participants were also significantly more likely to experience court-involved coercive interventions than White participants.
The findings, the authors concluded, suggest “that systemic racism may be an international problem embedded in medical and legal institutional frameworks of nations and health care systems. Racial discrimination and prejudice are important public health issues and must be addressed to ensure that medical, psychiatric, and legal interventions are implemented according to best practices for all.”
For related information, see the Psychiatric Services article “Coercion and the Inpatient Treatment Alliance.”
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