Differential dispositions in a psychiatric emergency service: A function of patient race

Terri A. Betts (1997)

Race has been hypothesized to influence mental health treatment process, outcome and access. Black patients are more likely to be psychiatrically hospitalized than white patients (particularly in public mental health hospitals). Black patients are more likely to be diagnosed with schizophrenia as opposed to affective disorders. At the same time the National Institute for Mental Health's Epidemiological Catchment area Study (1985) shows no racial difference in prevalence rates of disorder leaving the question of why differences continue to be manifest. Bias has been hypothesized to be operating in this phenomena. Psychiatric emergency services are an entry point to the public mental health system, as such it is an important place to look at how decisions are made about who is hospitalized, and whether race plays any part in disposition decisions. The current study examined the characteristics of four hundred-thirty three patients who were seen in a psychiatric emergency service during a three month period for the purpose of identifying patient characteristics associated with three dispositions: hospital level of care, respite program and discharge home. The study assessed the profile of a hospitalized vs. nonhospitalized patient and whether the profile was the same for black and white patients. Three hypotheses were tested in the present study they were: (1) Black patients are more likely to be hospitalized than white patients. (2) When the patient and clinician are racially/ethnically different the patient is more likely to be hospitalized. (3) The presence of a paraprofessional of color when the patient and clinician are racially/ethnically different influences the likelihood of a more restrictive disposition. A chi-square with three levels of the first factor (disposition) and two levels of the second factor (patient race) was employed to independently assess the racial makeup of the three disposition groups. Subsequent analysis subjected the 13 independent variables to a discriminant analysis with the three levels of disposition as the dependent variable. The analysis sought to develop a best fit model of factors most likely to be associated with each of the three disposition groups. The discriminant analysis described above assessed the issue of gender of patient main effects and gender of patient X gender of therapist X race of patient and race of therapist interaction. The study found that black patients were more likely to be hospitalized than white patients. Black patients were less likely to be dispositioned to respite than white patients. A high percentage (88%) of hospitalized patients were voluntary, leading to the question of whether some of the patients could have been served in respite. It also suggests that bias is likely operating in the disposition of patients in the emergency service. Implications of these findings for treatment of black patients is presented.