Treating immigrant patients in psychiatric emergency rooms

Abstract

We examine whether patient variables (geographic origin, gender, Spanish language proficiency) and subjective clinician aspects in emergency department psychiatric encounters (diagnostic certainty, clinician’s comfort level with patient) are associated with diagnosis and the use of coercive measures. Using a descriptive cross-sectional design, we recorded 467 visits (400 foreign-born and 67 native-born patients) in hospital psychiatry emergency rooms (ERs) in Barcelona between 2007 and 2015. We first assessed the association of patient variables and subjective clinician aspects of psychiatric encounters with service use outcomes and with mental illness diagnosis. Fitted logistic models predicted the likelihood of service use outcomes and estimated the propensity of receiving each diagnosis. The null model evaluated the role of patient’s geographical origin, while the full model evaluated the additional roles of patient’s gender and language, the clinician’s assessment of the influence of culture in diagnosis, and clinician comfort with two outcomes: patient’s diagnosis and use of coercive measures in the ER. Women were less likely to receive coercive measures or intramuscular medications compared to men. Significant ethnic/racial and gender differences were found in receiving certain diagnoses. Additionally, a patient’s lower Spanish proficiency was correlated with a higher probability of receiving a psychosis diagnosis. The clinician’s level of diagnostic certainty was also positively correlated with increasing clinician-reported comfort with patient. Overall, ethnic factors and the subjective aspects of psychiatric encounters were found to influence diagnosis and the use of coercive measures. Cultural competency programs and interpreter services within psychiatric ER settings should thus be required.

Ethnic disparities in the use of restrictive practices in adult mental health inpatient settings: a scoping review

“…Proportional (non-significant) findings were reported in four studies where foreign nationals were more likely to receive restrictive practices [ 39 , 49 , 66 , 83 ]. No significant differences in ethnicity were reported in relation to findings in eleven studies [ 7 , 8 , 61 , 63 , 64 , 70 – 72 , 74 , 77 , 84 ].…”

“…In total, the studies contain findings based on 491,893 participants (255,342 females and 227,986 males) in the 34 primary studies and 98 studies comprising the four reviews. However, four primary studies failed to report the number of participants [ 57 – 60 ], whereas nine studies reported incomplete or no gender information (missing data: n = 8565) [ 1 , 39 , 57 – 63 ]. Reviews were not comparable by gender.…”

“…As shown in Table 3 , restrictive practices were defined and used very differently across the studies. In 12 studies, types of restrictive practices were not defined [ 8 , 9 , 38 , 39 , 49 , 61 , 63 , 66 – 70 ]. An overview of definitions of restrictive practices used in the remaining studies is provided in the supplementary material.…”

“…Eight studies reported significant associations between ethnicity and restrictive practices [ 7 , 8 , 61 , 63 , 64 , 69 , 73 , 74 ]. Ethnic minorities, in this case people described as Black, with migrant status, of non-European descent or from North Africa (European and US-based studies) or not further defined (review studies) were significantly more likely to receive restrictive practices in all studies, of which the results from two studies were based on adjusted analyses [ 63 , 64 ]. However, in four studies, associations became non-significant after (further) adjusted analysis [ 7 , 61 , 63 , 64 ].…”

“…Ethnic minorities, in this case people described as Black, with migrant status, of non-European descent or from North Africa (European and US-based studies) or not further defined (review studies) were significantly more likely to receive restrictive practices in all studies, of which the results from two studies were based on adjusted analyses [ 63 , 64 ]. However, in four studies, associations became non-significant after (further) adjusted analysis [ 7 , 61 , 63 , 64 ]. Proportional (non-significant) findings were reported in four studies where foreign nationals were more likely to receive restrictive practices [ 39 , 49 , 66 , 83 ].…”