Pathways to Care for Black Americans with Early Psychosis

Oluwoye, O., Davis, B., Kuhney, F. S., & Anglin, D. M. (2021). Systematic review of pathways to care in the US for Black individuals with early psychosis. Schizophrenia, 7,(1), 1-10. Access the article.

Summary: The series of contacts that individuals have as they become connected to Coordinated Specialty Care (CSC) has been termed the "pathway to care." While research has shown that CSC programs perform poorer at engaging Black youth and Black youth have worse outcomes than white youth, little research has examined the pathways to care for this population. This paper reviewed 28 peer-reviewed articles studying racial differences in the duration of untreated psychosis (DUP) or the help-seeking experiences of Black youth and families on the way to CSC. The review noted that Black youth have higher rates of trauma and substance use prior to entering CSC. A number of barriers were identified in help-seeking across studies, including finances/insurance, inflexible appointment times, and inefficient treatment initiation processes. Importantly, Black youth were less likely to seek outpatient mental health services and more likely to use emergency services. Incarceration, substance use, neighborhood disorder, and family involvement were associated with longer DUP.  

Implications for Practice

• Black youth experience specific barriers to engagement in CSC and may be more likely to access through emergency services, psychiatric hospitals or law enforcement.
• Flexibility in scheduling and efficient protocols for intake are important in engaging Black youth.
• The experience of trauma, including racialized trauma, and substance use may be more common for Black youth and put them at greater risk for early psychosis.
• Activities to reduce stigma and identify signs of psychosis in the Black community can reduce the duration of untreated psychosis.
• Efforts to address social determinants of health, such as financial stress, neighborhood chaos, and access to insurance, can reduce the inequities experienced by Black youth.

Limitations: This review identified studies from a small group of sites. Many of the studies were from the Georgia mental health care system and focused on low income Black youth. Further research should explore a greater diversity of Black youth with early psychosis, such as socioeconomic and geographic differences. The results of this study may not be generalizable to Texas and specific research about racial disparities in pathways to care in Texas is needed.