The role of ethnicity in pathways to emergency psychiatric services for clients with psychosis

Abstract

BackgroundThis study investigates the role of ethnicity in pathways to emergency mental health care in Toronto for clients with psychosis, while taking into account neighborhood factors. Previous literature has focused on Afro-Caribbean clients, reporting an increased risk of accessing mental health care through negative pathways.MethodsA retrospective chart review for clients from 6 different ethnic origin groups presenting with psychosis – East Asian, South Asian, Black African, Black Caribbean, White European, and White North American – was undertaken in a psychiatric emergency department (ED). Logistic regression models were constructed to examine the relationship between pathways to care (involuntary detention under the Mental Health Act (MHA), police or ambulance referral, accompaniment by family or friends) with individual and neighbourhood factors.ResultsA total of 765 clients were included in the study. East Asian (OR =2.36, p < 0.01) and South Asian (OR 2.99, p < 0.01) origin clients have increased odds of presenting to the ED while involuntarily detained under the MHA. Involuntary status under the MHA increased the odds of presenting via police or ambulance (OR 8.27, p < 0.001). East Asian origin clients have increased odds of presenting to the ED by police or ambulance (OR =2.10, p < 0.05). Clients from neighbourhoods with higher levels of residential instability have increased odds of presenting by police or ambulance (OR =1.35, p < 0.01), while clients from neighbourhoods with higher levels of ethnic concentration have increased odds of being accompanied to the ED by family or friends (OR =1.33, p < 0.01).ConclusionIn contrast to previous studies, East Asian and South Asian origin clients with psychosis have increased odds of a coercive pathway to emergency psychiatric services in Toronto. Black African and Black Caribbean origin clients do not have increased odds of a coercive pathway. Clients living in areas with high levels of residential instability are more likely to encounter a negative pathway. Ethnic concentration may be a supportive factor in family and friend accompaniment.

Co‐production for service improvement: Developing a training programme for mental health professionals to enhance medication adherence in Black, Asian and Minority Ethnic Service Users

“…It was agreed that "BAME culture" was not an easily homogenous entity and was instead, complex and multi-layered. 15 However, that is not a reason to ignore the reality of differing cultural needs and expectations. Participants expressed the view that medication effects and side-effects might be more potent for them, leading to poor physical health; their perspective was that they were denied talking therapies and instead had medication prescribed to control them.…”

“…Studies report similar issues in many countries where disproportionate numbers of BAME SUs are compulsorily admitted . An investigation of paths to compulsory treatment in Toronto found that BAME groups were more likely to experience admission via mental health law and less likely to engage with treatment . A retrospective chart review was undertaken for SUs with psychosis from 6 different ethnic groups (East Asian, South Asian, Black African, Black Caribbean, White European, and White North American) with a sample size of 765.…”

“…investigation of paths to compulsory treatment in Toronto found that BAME groups were more likely to experience admission via mental health law and less likely to engage with treatment. 15 A phenomenological study found that BAME SUs on community treatment orders (CTOs) 1 perceived themselves to be receiving additional resources due to being on a CTO. Improved care was appreciated feelings of stigmatization and coercion were experienced.…”

Police and mental health responses to mental health crisis in the Waikato region of New Zealand

“…Police are more likely to come into contact with people in mental health crisis who are of lower socioeconomic status and from ethnic minorities (Cloud & Davis 2015;Rotenberg et al 2017). This is particularly important within the New Zealand context where M aori, the indigenous people, are overrepresented in mental health crises and compulsory treatment and present to mental health services with reportedly aggressive behaviour (Mental Health Commission, 2012;Ministry of Health, 2016b;Tapsell & Mellsop 2007).…”

Psychosocial stressors contributing to emergency psychiatric service utilization in a sample of ethno-culturally diverse clients with psychosis in Toronto

“…The Mental Health Commission of Canada argues that people from different ethnic groups in Canada have different service needs. These have not been fully examined but are reflected in differences in service use, pathways to care and pathways to emergency services [ 1 – 4 ]. Differences in exposure to the social determinants of health and specifically psychosocial stressors could underlie differences in need.…”