Patient’s Race May Influence Access to MH Care Following Overdose

Patients who are members of racial or ethnic minorities may be less likely than white patients to receive a mental health assessment during hospitalization for a deliberate overdose, a study in Psychiatric Services in Advance has found.

Elizabeth Charron, M.P.H., of the Department of Public Health Sciences at Clemson University and colleagues reviewed the records of 2,489 adults aged 18 to 64 years who were hospitalized for deliberate drug overdose in South Carolina in 2012 or 2013. They found that the vast majority of patients—94%—received a mental health assessment during their hospitalization. However, compared with white patients, black patients were 48% less likely to receive an assessmen, and patients who identified as other races or ethnicities (such as Asian or Hispanic) were 76% less likely to receive an assessment. They also found that black patients were 40% less likely than white patients to be discharged to an inpatient psychiatric facility. Patients of other races and ethnicities were slightly more likely than whites to be discharged to an inpatient psychiatric facility.

“It is unclear whether the disparities we observed were due to implicit provider bias, cultural differences in patient preferences for care, socioeconomic differences between groups, or other clinically relevant factors,” the researchers wrote.

Charron told Psychiatric News that she was not surprised by the findings.

“In South Carolina, there are perpetual disparities in health and health care among racial-ethnic minorities, particularly African Americans. This study fits into the broader body of evidence highlighting the scope of disparities in American health care,” Charron said. “Understanding factors related to receiving [mental health] services is important in developing strategies for closing gaps in mental health care service delivery.”

The researchers also analyzed the types of drugs used in the overdoses. They found that patients who had overdosed on drugs such as psychotropics, central nervous system stimulants, and central nervous system depressants were nearly 70% more likely to receive a mental health assessment than those who overdosed on opioids or sedative-hypnotics.

“This result stood out to us given the scope of the opioid epidemic. Opioid abuse has been linked to increased risk of depression and suicide, so we did not expect that mental health assessments would be lower in this group,” Charron said.

One possible explanation, noted in the study, is that patients who overdose on opioids and sedative-hypnotics generally do not present with psychological symptoms, whereas those who overdose on drugs such as cocaine or methamphetamine often have symptoms such as agitation or acute psychosis.

The researchers acknowledged limitations of their study, notably that they could not determine whether the patients intended suicide or self-harm by deliberately overdosing. Nonetheless, mental health screening in this population should be routine, said Charron.

“Anyone suspected of being admitted for an intentional overdose should receive a mental health assessment before discharge,” Charron said. “Hospitals and health systems can establish a standardized discharge planning protocol for persons receiving inpatient treatment for intentional overdose.”

The authors reported no outside funding for this study.  ■