Equity in Mental Health Services for Youth at Clinical High Risk for Psychosis: Considering Marginalized Identities and Stressors

Novacek, Derek M.; Adery, Laura Hieber; Herrera, Shaynna; Landa, Yulia; Corcoran, Cheryl; Walker, Elaine F.

doi:10.1080/23794925.2022.2042874

Cited by 19 publications

(13 citation statements)

References 203 publications

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“…Similarly, there may also be differences according to prisoner ethnicity and age but the scenario did not allow these themes to be identified through an intersectional lens and explored in the context of health inequalities. The evidence that combinations of gender, age and ethnicity can affect an individual's experience of the criminal justice 22 and mental health systems [23][24][25] strengthens the recommendation that health inequalities be examined through an intersectional lens in the investigation of prison mental health systems. 25…”

Section: Limitationsmentioning

confidence: 91%

Six nations: a clinical scenario comparison of systems for prisoners with psychosis in Australia, Bolivia and four European nations

et al. 2022

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This paper compares across six nations the mental health systems available to prisoners with the highest acuity of psychosis and risk combined with the lowest level of insight into the need for treatment. Variations were observed within and between nations. Findings highlight the likely impact of factors such as mental health legislation and the prison mental health workforce on a nation's ability to deliver timely and effective treatment close to home for prisoners who lack capacity to consent to treatment for their severe mental illness. The potential benefits of addressing the resulting inequalities are noted.

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Section: Limitationsmentioning

confidence: 91%

Six nations: a clinical scenario comparison of systems for prisoners with psychosis in Australia, Bolivia and four European nations

et al. 2022

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“…To ensure equitable access to care for TAY and families before, during, and following transitions, purposeful efforts are necessary to understand and mitigate the barriers to care that may arise for racialized, marginalized, and vulnerable groups. For example, racialized youth are more likely to experience discrimination in care, face systemic barriers to care (e.g., geographical inaccessibility, lack of insurance), experience cultural differences in experiences of MHA concerns, and are generally less likely than white youth to receive MHA care [ 101 – 103 ]. Similarly, this review highlighted geographic and financial barriers as systemic issues impacting transitions in care that are rooted in the social determinants of health.…”

Section: Discussionmentioning

confidence: 99%

Transitions in mental health and addiction care for youth and their families: a scoping review of needs, barriers, and facilitators

Markoulakis,

Cader,

Chan

et al. 2023

BMC Health Serv Res

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Introduction Transitional-aged youth (TAY) with mental health and/or addictions (MHA) concerns and their families experience significant challenges finding, accessing, and transitioning through needed MHA care. To develop appropriate supports that assist TAY and their families in navigating MHA care, their experiences of transitions in the MHA care system must be better understood. This scoping review identifies and explores the needs, barriers, and facilitators for TAY and their families when transitioning through MHA care. Methods This scoping review commenced with a search of five relevant databases. Three research team members were involved in title, abstract, and full-text scanning and data extraction. Sources focusing on TAY anywhere between the ages of 12–29 years and meeting the study objectives were included. Extractions compiled background and narrative information about the nature and extent of the data. Analysis and synthesis of findings involved numerical description of the general information extracted (e.g., numbers of sources by country) and thematic analysis of narrative information extracted (e.g., family involvement in TAY help-seeking). Results A total of 5894 sources were identified. Following title and abstract scanning, 1037 sources remained for full-text review. A total of 66 sources were extracted. Findings include background information about extracted sources, in addition to five themes that emerged pertaining to barriers and facilitators to access and transitions through care and the needs and roles of TAY and families in supporting help-seeking and care transitions: holistic supports, proactive preparation, empowering TAY and families, collaborative relationships, and systemic considerations. These five themes demonstrate approaches to care that can ensure TAY and families’ needs are met, barriers are mitigated, and facilitators are enhanced. Conclusion This review provides essential contextual information regarding TAY with MHA concerns and their families’ needs when seeking care. Such findings lend to an enhanced understanding of how MHA programs can support this population’s needs, involve family members as appropriate, reduce the barriers experienced, and work to build upon existing facilitators.

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“…Meta-analyses of schizophrenia and CHR studies show that approximately two-thirds of participants identify as male, a proportion that does not seem to align with epidemiological estimates of male-to-female ratios in psychosis ( 66 – 68 ). One possible reason for this gender gap is that women are systematically excluded from study participation due to overdiagnosis of affective psychotic disorders that render them ineligible for psychosis-risk studies ( 11 , 69 – 71 ). Women have also been found to have a later age of onset for psychosis than men, with average onset in their early thirties vs. late twenties.…”

Section: Specific Contextual Factorsmentioning

confidence: 99%

“…Depersonalization and a loss of sense of self are notable psychosis spectrum symptoms ( 87 , 88 ) that may be relevant but not necessarily pathological for young people grappling with their gender identity ( 11 ). For these reasons, assessors should be aware of the unique experiences of the gender-expansive populations they work with and incorporate an understanding of normative identity development to avoid over-pathologizing bias.…”

Section: Specific Contextual Factorsmentioning

confidence: 99%

“…Due to this, most of the research cited originates from the United States. To best meet the goals of this manuscript, we pursued a narrative review approach, drawing upon other recent reviews, published original work, calls to action, and commentaries [see (9)(10)(11)(12)] to identify several specific sociocultural factors that may be most relevant and particularly salient for North American and United States populations. We then screened and selected articles from the reference lists of these papers.…”

Section: Narrative Review Approachmentioning

confidence: 99%

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Review of factors resulting in systemic biases in the screening, assessment, and treatment of individuals at clinical high-risk for psychosis in the United States

Bridgwater

Petti²,

Giljen³

et al. 2023

Front. Psychiatry

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BackgroundSince its inception, research in the clinical high-risk (CHR) phase of psychosis has included identifying and exploring the impact of relevant socio-demographic factors. Employing a narrative review approach and highlighting work from the United States, sociocultural and contextual factors potentially affecting the screening, assessment, and service utilization of youth at CHR were reviewed from the current literature.ResultsExisting literature suggests that contextual factors impact the predictive performance of widely used psychosis-risk screening tools and may introduce systemic bias and challenges to differential diagnosis in clinical assessment. Factors reviewed include racialized identity, discrimination, neighborhood context, trauma, immigration status, gender identity, sexual orientation, and age. Furthermore, racialized identity and traumatic experiences appear related to symptom severity and service utilization among this population.ConclusionsCollectively, a growing body of research from the United States and beyond suggests that considering context in psychosis-risk assessment can provide a more accurate appraisal of the nature of risk for psychosis, render more accurate results improving the field's prediction of conversion to psychosis, and enhance our understanding of psychosis-risk trajectories. More work is needed in the U.S. and across the globe to uncover how structural racism and systemic biases impact screening, assessment, treatment, and clinical and functional outcomes for those at CHR.

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Equity in Mental Health Services for Youth at Clinical High Risk for Psychosis: Considering Marginalized Identities and Stressors

Cited by 19 publications

References 203 publications

Six nations: a clinical scenario comparison of systems for prisoners with psychosis in Australia, Bolivia and four European nations

Six nations: a clinical scenario comparison of systems for prisoners with psychosis in Australia, Bolivia and four European nations

Transitions in mental health and addiction care for youth and their families: a scoping review of needs, barriers, and facilitators

Review of factors resulting in systemic biases in the screening, assessment, and treatment of individuals at clinical high-risk for psychosis in the United States

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