Mental Health Inequities in Emergency Department Care: An Investigation Conducted Through Collaboration with The North Carolina Statewide Telepsychiatry Program (NC-STeP)

Abstract

Background: Current literature indicates significant racial inequities in involuntary psychiatric care and the literature base investigating factors related to boarding of psychiatric patients in the emergency department is scant. Therefore, the current study collaborated with the North Carolina Statewide Telepsychiatry (NC-STeP) program to investigate possible racial inequities in involuntary commitment (IVC) overturns, discharge disposition, and psychiatric diagnosis in telepsychiatry consultations taking place in emergency departments across North Carolina (NC). I hypothesized that People of Color (POC) would be less likely to have IVC’s overturned than White identifying individuals, that non-White identifying individuals would have longer length of stay (LOS) and be more likely to be discharged into a psychiatric care facility than White identifying individuals, and that Black identifying individuals would be more likely to carry a diagnosis of a psychotic disorder. Exploratory binomial regressions were used to investigate factors associated with the boarding of psychiatric patients. Methods: This study included a retrospective chart review compromised of (N = 16,664) emergency department encounters conducted through NC-STeP between January 2017 and June 2023. Data was analyzed via multinomial and binomial modeling using Jamovi 2.4.8. Results: The results for this study were generally encouraging. The hypothesis that non-White identifying individuals would be less likely to have an IVC overturned was not supported. Black identifying individuals were more likely to be discharged to home than White identifying individuals, however, Asian and Indigenous identifying individuals were more likely to be discharged into psychiatric care. The hypothesis that Black identifying individuals would be more likely to receive a diagnosis of a psychotic disorder was supported; with Black identifying individuals being 6.19 times as likely to be diagnosed with schizophrenia when compared to White identifying individuals. Finally, race was not a significant predictor of boarding, however, discharge disposition did emerge as significant factor related to boarding. Discussion: The results from this study suggested that racial inequity did not emerge in IVC overturn and discharge disposition in the manner anticipated based on extant literature. In fact, the study provides evidence that investigation of other sociodemographic variables, such as employment status, may better account for differences emerging related to this topic. However, the study does provide additional support to the consistent finding that Black identifying individuals are more likely to receive a diagnosis of a psychotic disorder. Future research directions for the NC-STeP project may include investigations into the role of mode of arrival on IVC overturn and review of who initiated the IVC and how this influences the likelihood of an IVC overturn.