Ethnoracial Differences in Coercive Referral and Intervention Among Patients With First-Episode Psychosis

Knight, Sommer; Jarvis, G. Eric; Ryder, Andrew G.; Lashley, Myrna; Rousseau, Cécile

doi:10.1176/appi.ps.202000715

Cited by 22 publications

(30 citation statements)

References 29 publications

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“…A recent study on FEP in Montreal, Canada 43 reported that Black minority FEP were more likely to be exposed to coercive referrals to the health system and any legal interventions. 43 However, they did not report CTO use separately from other legal measures (police interventions, child protection, any court involvement, legally forced hospitalizations, etc.). 43 …”

Section: Discussionmentioning

confidence: 99%

Community Treatment Orders use Among Persons With a First Episode of Psychosis in Quebec

et al. 2022

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Objectives Specialized early intervention for psychosis can reduce the duration of untreated psychosis and improve clinical and functional outcomes. However, poor adherence to treatment is frequent. The literature on community treatment orders (CTOs) use in first-episode psychosis (FEP) as a means to improve treatment adherence is limited. In the context of early intervention for psychosis services (EIS), this study aims to describe (1) the frequency of CTOs utilisation, (2) the trend of CTOs use over time, (3) the timing and reasons for requesting CTOs and (4) the baseline characteristics of FEP patients on CTOs compared to those who were not. Method A 5-year prospective longitudinal study describing the use of CTOs among persons with FEP admitted to two urban EIS in Montreal, Quebec, from 2005 to 2013. At admission, and then annually for 5 years, CTOs data were collected through chart review. Baseline characteristics, assessed by patient interviews, standardized questionnaires and chart review, included socio-demographic data, illness severity, functioning and alcohol and substance use. Descriptive analyses were performed, and FEP patients on CTOs during follow-up and those who were not were compared using analyses of variance, chi-square test and multivariate logistic regression. Results Among 567 FEP patients, 19.2% were placed on CTOs. The main reasons for requesting CTOs were to prevent further deterioration in mental state, social functioning, harmful behaviours to self and others and homelessness. FEP patients on CTOs had poorer premorbid and baseline functioning, more severe symptoms and social dysfunction at admission, including legal problems and homelessness. Conclusions CTOs can be a tool to improve adherence to treatment, which is crucial for relapse prevention in FEP. However, since it is a coercive method that limits a person's fundamental rights, further research is warranted to assess its impact on patients’ lives, clinical and functional outcomes, as well as patients’ and carers’ perception.

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Section: Discussionmentioning

confidence: 99%

Community Treatment Orders use Among Persons With a First Episode of Psychosis in Quebec

et al. 2022

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“…In some cases, these techniques have led to death (Malone et al, 2020;Washington Post, 2020). The use of coercive methods is more frequent in the police response to Black, Indigenous, and People of Colour (BIPOC) in crisis (Knight et al, 2022;Paoline et al, 2018), who are also more likely to encounter the police during a pathway to care when experiencing psychosis (Anderson et al, 2013;Halvorsrud et al, 2018;Morgan et al, 2005). 17 Coercive treatments, including restraint, sedation, and seclusion is also common in health care settings in response to those experiencing psychosis.…”

Section: What Is Worth Investigating? Sets Settings and Neurotransmit...mentioning

confidence: 99%

Psychosis and psychedelics: Historical entanglements and contemporary contrasts

Friesen

2022

Transcult Psychiatry

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Experiences of psychedelics and psychosis were deeply entangled in scientific practices in the mid-20th century, from uses of psychedelic drugs that could model psychosis, to detailed phenomenological comparisons of endogenous and drug-induced madness. After the moral panic of the 1960s shut down psychedelic research, however, these two phenomena became disentangled. In the decades following, the science of psychosis transformed, shedding the language of psychoanalysis, and adopting the new scientific veneer of psychiatry. Today, as psychedelic science re-emerges, the research programs surrounding psychosis and psychedelics now stand in stark contrast. Here, I look closely at how these research programs respond to questions related to what is worth measuring, what is worth investigating, and how we ought to respond to these experiences. This comparison reveals radically different assumptions and values that guide each research paradigm and shape clinical practice. While psychedelic research often includes scales that seek to capture experiences of mysticism, meaningfulness, and ego dissolution, research related to psychosis focuses on the measurement of pathological symptoms and functioning. Research into psychosis primarily seeks universal and reductionist causal explanations and interventions, while psychedelic research embraces the importance of set and setting in shaping unique experiences. Responses to psychedelic crisis involve warmth, compassion, and support, while responses to psychotic experiences often involve restraint, seclusion, and weapons. I argue that these differences contain important lessons for psychiatry. However, as psychedelic research struggles to meet regulatory requirements and fit within the paradigm of evidence-based medicine, these differences may quickly dissolve.

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“…For example, in the United States during the Jim Crow era, African American patients were victimized in settings likened to prisoner of war camps (Smith, 2020). Today, BIPOC patients are disproportionately misdiagnosed (Schwartz & Blankenship, 2014), involuntarily admitted for inpatient care, and subjected to coercive practices (e.g., forced medication; Knight et al, 2022). Those faced with inadequate or harmful care may encounter betrayal trauma (i.e., when a person/institution on whom a survivor depends violates trust; Smith & Freyd, 2014).…”

Section: Racially and Culturally Responsive Trauma-informed Inpatient...mentioning

confidence: 99%

“…For women of color, experiences of racism shape treatment in acute inpatient settings. Black, Indigenous, and People of Color (BIPOC) have endured histories of abusive and inadequate inpatient treatment (Smith, 2020) that continues today (e.g., Knight et al, 2022). Inpatient settings often create retraumatization for this patient population, which likely results in poor outcomes.…”

mentioning

confidence: 99%

Trauma-informed inpatient care for marginalized women.

Gutowski¹,

Badio²,

Kaslow³

2022

Psychotherapy

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Although optimal trauma-informed care in inpatient settings is relationally oriented, gender-sensitive, racially and culturally responsive treatment, this often is not the reality. Instead, inpatient settings frequently create experiences of retraumatization, which likely are associated with poor outcomes. This article extends the literature on trauma-informed care by drawing from existing models for working with trauma and providing culturally responsive treatment to apply an integrated approach to the inpatient care setting with a focus on the unique needs and experiences of marginalized survivors of gender-based violence and racial trauma. It details the rationale for and key elements of three related frameworks for trauma-informed care and then offers recommendations for guiding its conceptualization and implementation. Ideally, these practices will be embraced on all inpatient units and particularly with women from marginalized communities who have survived interpersonal and racial trauma. Clinical Impact StatementQuestion: How can inpatient providers integrate relationally oriented, gender-sensitive, racially and culturally responsive models into trauma-informed practices? Findings: We offer key elements of these three related frameworks followed by a series of recommendations for integrating these perspectives into clinical practice. Meaning: Trauma-informed providers in the inpatient context can embrace this integrated, social justice-oriented approach to respond to the needs of hospitalized survivors, particularly marginalized women who have survived interpersonal and racial trauma. Next Steps: Trauma-informed care that is relationally oriented, gender-sensitive, and racially and culturally responsive is a recommended approach for all inpatient psychiatric units moving forward.

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Ethnoracial Differences in Coercive Referral and Intervention Among Patients With First-Episode Psychosis

Cited by 22 publications

References 29 publications

Community Treatment Orders use Among Persons With a First Episode of Psychosis in Quebec

Community Treatment Orders use Among Persons With a First Episode of Psychosis in Quebec

Psychosis and psychedelics: Historical entanglements and contemporary contrasts

Trauma-informed inpatient care for marginalized women.

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