Race/Ethnicity and Family Involvement in Pathways to Psychiatric Emergency Services

Introduction: Persistent racial/ethnic differences have been observed in the use of psychiatric emergency services (PES). One explanation for these differences is how families respond to psychiatric crises. This project explored racial/ethnic differences in the involvement of friends/family in PES admissions and the level of psychosocial functioning at admission. Methods: Data were extracted from 717 admissions to San Francisco General Hospital PES that were initiated by non-clinicians (i.e. friends/family, strangers, police, or self) from 1/1/2005-3/1/2005. Study staff rated psychosocial functioning with the Global Assessment Scale (GAS). Chi-square tests and multiple regression were used to examine differences in PES admission patterns and GAS scores. Results: The sample was 45% White, 27% Black, 16% Asian and 12% Latino. Friend/family involvement was observed in significantly more Asian (56.4%) and Latino (47.4%) patients than White (28.5%) or Black (27.4%) patients. Functioning in Black and Asian patients was lower than in White patients, but these differences were attributable to higher GAS scores in admissions of White patients who had friends/family involved. Conclusions: Racial/ethnic differences in functioning at PES admission may be due in part to White patients' friends/family members seeking emergency treatment for less severe impairment. Asian and Black patients' friends/family who delay treatment may experience a greater burden than their White counterparts. This delay may warrant targeted efforts to increase friend/family integration into the public mental system. Interventions targeting patients' friends/family for earlier treatment could be of particular benefit to Asian and Latino populations, which have more family involvement in PES admissions.