Friday, August 19, 2022

Patients of Color Disproportionately Subjected to Involuntary Admission to Psychiatric Hospitals

Patients of color—particularly patients who identify as Black, multiracial, or another race—are significantly more likely than White patients to be subjected to involuntary psychiatric hospitalization, a study in Psychiatric Services in Advance has found.

Timothy Shea, M.D., of Massachusetts General Hospital and Harvard Medical School and colleagues examined data from 4,393 patients whose initial admission to a psychiatric unit at a large hospital in Boston occurred between 2012 and 2018. Among the patients, 73% identified as White, 11% as Black, 10% as primarily Hispanic or Latinx, 4% as Asian, and 3% as another race or multiracial.

“In Massachusetts, patients can be involuntarily admitted to a psychiatric unit by a licensed clinician,” Shea and colleagues wrote. “At admission, the patient must be offered the opportunity to sign in to the hospital on a conditional voluntary legal status … . If the patient declines or lacks the capacity to sign in, then the physician must determine whether the patient meets commitment criteria on the basis of imminent danger to self or others or grave inability to care for self. The admitting physician can admit such patients for an involuntary hold for an observation period of 3 business days (equivalent to a 72-hour emergency hold in most states).”

Overall, 28% of the patients were involuntarily admitted. Compared with White patients, Black patients had 1.57 times the odds of being admitted involuntarily, and patients who identified as other race or multiracial had 2.12 times the odds of being admitted involuntarily. Furthermore, patients of color were more likely to be diagnosed with a psychotic disorder: 25% of White patients were diagnosed with a psychotic disorder compared with 58% of Black patients, 49% of Asian patients, 41% of Latinx patients, and 41% of patients who identified as other race or multiracial.

Shea and colleagues noted that other studies suggest reasons for these disparities, including interpersonal racism, implicit bias, and differences between racial groups with respect to illness severity, access to and engagement with mental health care, and social determinants of health.

“Future work should interrogate the role of patient-provider–level interpersonal racism, differences in symptom severity, and prehospitalization treatment history in mediating inequities,” the researchers wrote. “Such work may inform interventions designed to ensure that coercive measures are used in an equitable fashion.”

For related information, see the Psychiatric Services article “Ethnoracial Differences in Coercive Referral and Intervention Among Patients With First-Episode Psychosis” and the Psychiatric News article “Psychiatrists Must Get Off Sidelines to Fight Racism.”

(Image: iStock/LightFieldStudios)

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