2023 14th Annual NUBE Conference

Background: Involuntary psychiatric hospitalization is based upon a patient’s risk of harm or inability to care for themselves and plays an important role in stabilizing patients. However, how “harm” and “inability for self-care” are particularly defined varies by state and is influenced by governmental policy. These discrepancies in definitions increase the risk for differing interpretations by and consequently, inequalities in treatment. Current literature has shown that disparities in involuntary psychiatric care exist amongst minority ethnic groups (Barnett 2019, Rodrigues 2019] specifically, minorities tend to be involuntarily hospitalized at higher rates than their White peers. The purpose of this study was to determine if similar pattern exists within the Veteran Health Administration (VHA) system. Methods: This study was a retrospective chart review querying all inpatient psychiatric admissions, voluntary and involuntary, at a large VA teaching hospital from January 1, 2021 to January 1, 2022. In addition to legal status on admission (voluntary or involuntary), we extracted patient-level data on self-reported race/ethnicity , age, sex, marital status, admitting diagnosis, and length of stay. Results: Of the 792 admissions, 569 patients were identified, with average age of 51.4 years and length of stay of 11.8 days. The rate of involuntary admissions among Asian (67.5%) and Black (61.0%) patients was statistically higher than that of White patients (50.3%), with p-values of 0.035 and 0.025, respectively. Conclusions: Involuntary psychiatric admissions have been associated with stigma, stress and reduced quality of life (Rusch 2013). The reason for the racial disparities observed may be rooted in individual clinician bias, and the level of perceived “threat” a patient has can be subjective. Standardization of risk assessments and definitions can help to combat bias and the risk of unequal treatment. Additionally, contrasting to community hospitals and civilian patients, nearly all patients involved in this study were eligible for VHA outpatient mental health coverage, suggesting that access does not necessarily equate to higher utilization. Furthermore, higher utilization in turn does not necessarily equate to lower rates of involuntary psychiatric hospitalizations, as Black adults were the most likely to use mental health services (SAMHSA 2015). This further highlights the role individual bias may be playing when compared to systemic inequalities.

Learning Objectives:

1. To understand racial and ethnic disparities that exist in involuntary psychiatric care within the Veterans Health Administration System.
2. To explore reasons why these disparities may exist.
3. To formulate future interventions that can help address these disparities.