Literature Collection

BACKGROUND: Historically, a first psychotic episode was thought to lead to lifelong disability. The advent of early intervention programs like Coordinated Specialty Care (CSC) now offers the potential to change this trajectory. However, racial and ethnic minoritized populations in the United States may face barriers in accessing CSC treatment, may be treated differently when hospitalized, and may have poorer outcomes, possibly associated with differences in the use of follow-up outpatient programs. METHODS: A total of 275 individuals were identified aged 15-35 with a first hospitalization for psychosis between January 2019 and December 2020, who were treated in an urban public healthcare system with specialized inpatient and outpatient mental health services, including a CSC program. Inpatient care variables were examined using electronic medical records (EMR) for the index hospital stay. Follow-up data were obtained from the EMR, supplemented by insurance claims data over a 36-month post-discharge period. The primary predictor for care post initial hospitalization was race and ethnicity. Key outcomes included rehospitalization, emergency visits and number of follow-up outpatient behavioral health visits. Statistical analyses included negative binomial regression adjusting for demographic and clinical characteristics. Descriptive analyses also compared the pre-pandemic (2019) and first-year pandemic (2020) cohorts (Tables 1b and 1c). RESULTS: While in the hospital, no significant disparities in care existed between racial and ethnic groups. Only 41 (14.9%) of the 275 patients were referred to the available coordinated specialty care (CSC) program, regardless of race or ethnicity. However, significant disparities in 36-month follow-up care across racial and ethnic groups were identified. Adjusting for demographic and clinical covariates, Black patients had significantly more rehospitalizations, emergency room visits, and behavioral health outpatient visits when compared to other race/ethnic groups (p<0.05). Additionally, those who used multiple substances, regardless of race and ethnicity, also had increased re-hospitalizations and outpatient behavioral health encounters (p<0.05). CONCLUSIONS: The referral to state-of-the-art CSC care subsequent to a first hospitalization for psychosis is crucial for leading to good outcomes. In this cohort, race and ethnicity did not influence choice of referrals, but too few were made. More research is needed to determine if a lack of referral to a CSC programs could be a reason for repeated subsequent emergency room visits and hospitalizations. Education of referring clinicians at acute hospital settings may mitigate this problem. Independent factors that contributed to poorer long-term outcome included either identifying racially as Black, or being a person who abuses substances, regardless of racial identity.

ObjectiveTo evaluate the practice of using reported suicidal ideations (SI) as an important predictor of suicide and as a major indicator to decide the eligibility and priority of access to mental health services.FindingsExamples on the widespread use of SI in triage, screening, and management protocols of mental health presentations, both in emergency and community settings, are presented. Such widespread use comes in contrast to the evidence clearly indicating the limited utility of SI as a suicide predictor. SI limitations are expected when put in the larger context of the generalized failure of suicide prediction tools. The potential detrimental effects of an exaggerated SI status on several aspects of the clinical encounter are discussed. Finally, potential systemic downsides in humanitarian and resource-limited settings are hypothesized, such as hindering mental health integration into primary care, as well as over-reporting of SI by beneficiaries seeking aid and vulnerability status.ConclusionsSI still holds a "canonical" status as a risk indicator and triage guide. This exaggerated status, in addition to lacking evidence, can also lead to potential downsides, especially in overloaded health systems.