RESEARCH WEEKLY: July Research Roundup
By Elizabeth Sinclair Hancq
(July 27, 2022) Research Roundup is a monthly public service of the Office of Research and Public Affairs. Each edition describes a striking new data point about severe mental illness and summarizes recently published research reports or developments.
This month’s roundup is in honor of Minority Mental Health Month.
DATAPOINT OF THE MONTH
1.5 times more minorities in public mental health system in Pennsylvania
Minority races are overrepresented in the public mental health system. In Pennsylvania, for example, 35% of individuals served by the public mental health system in 2020 were a minority race, compared to 19% of the total state population. The overrepresentation of minorities in public mental health may be due to a variety of reasons, including income inequity and systemic discrimination.
RESEARCH OF THE MONTH
Black patients with mental illness are more likely to be restrained in an emergency department
Physical and chemical restraints are often used in an emergency department setting for agitated patients. In an analysis of patients undergoing emergency psychiatric evaluation in a large academic medical center emergency department in North Carolina, researchers found that Black patients with mental illness were more likely to experience both physical and chemical restraint. A diagnosis of bipolar or a psychotic disorder were also significant predictors for restraint use in the emergency department setting. The results of the study, published in Psychiatric Services, suggest that more work is needed to reduce bias and promote equity in emergency psychiatric care.
Race not a factor in characteristics of hospitalized patients who are reported to law enforcement
Physical assaults are common in inpatient psychiatric hospitals. Previous research indicates that two-thirds of psychiatric hospital staff have been physically assaulted in a one-year period and an estimated 20% of individuals with mental illness may commit an act of violence while admitted to a hospital. Some of these assaults may be reported to law enforcement and result in legal charges or arrest for the patient.
In a chart review of a psychiatric hospital in the Northeastern United States, researchers found 124 instances of assault of patients on staff. The study, published in Psychiatric Services, found that race was not a significant factor in assaults that are reported to law enforcement. Patients with a diagnosis of a psychotic disorder who assaulted staff were more likely to be reported to law enforcement than those with other diagnoses, as well as those who had previous criminal histories. Although, in this study, race was not a factor in reporting assaultive patients to law enforcement, there is documented, persistent racial bias in the criminalization of individuals with mental illness that needs to be monitored to ensure racial and ethnic minorities do not continue to be disproportionately impacted in all areas.
Disparities in psychotropic medication prescribing in adults with schizophrenia
Non-Hispanic whites with schizophrenia are more likely to be prescribed clozapine, whereas racial-ethnic minorities are more likely to be prescribed long-acting-injectable medications, according to an analysis of U.S. Medicaid data published in Psychiatric Services. Clozapine is the most effective antipsychotic medication for treatment-resistant schizophrenia and is difficult to access in the United States, whereas long-acting-injectable formularies are used to address treatment nonadherence in patients. The authors suggest that the divergences in psychotropic medication prescribing among racial-ethnic groups are due to the uneven distribution of providers that prescribe clozapine and concurrent indications of risk for treatment nonadherence in racial minorities, such as substance use disorders.
