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Special Articles
Published Online: 12 April 2023

Experiences of Black Adults Evaluated in a Locked Psychiatric Emergency Unit: A Qualitative Study

Colin M. Smith, M.D., M.Sc.G.H., Lori-Ann Daley, M.D., Chris Lea, B.S., Keith Daniel, M.Ed., D.Min., Damon S. Tweedy, M.D., Nathan M. Thielman, M.D., M.P.H., B. Lynette Staplefoote-Boynton, M.D., M.P.H., Elizabeth Aimone, M.Sc.G.H., and Jane P. Gagliardi, M.D., M.H.S. [email protected]Authors Info & Affiliations
Publication: Psychiatric Services
Volume 74, Number 10
https://doi.org/10.1176/appi.ps.20220533
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Abstract

Objective:

Evidence shows that Black individuals have higher rates of coercive emergency psychiatric interventions than other racialized groups, yet no studies have elevated the voices of Black patients undergoing emergency psychiatric evaluation. This qualitative study sought to explore the experiences of Black individuals who had been evaluated in a locked psychiatric emergency unit (PEU).

Methods:

Electronic health records were used to identify and recruit adult patients (ages ≥18 years) who self-identified as Black and who had undergone evaluation in a locked PEU at a large academic medical center. In total, 11 semistructured, one-on-one interviews were conducted by telephone, exploring experiences during psychiatric evaluation. Transcripts were analyzed with thematic analysis.

Results:

Participants shared experiences of criminalization, stigma, and vulnerability before and during their evaluation. Although participants described insight into their desire and need for treatment and identified helpful aspects of the care they received, they noted a mismatch between their expectations of treatment and the treatment received.

Conclusions:

This study reveals six major patient-identified themes that supplement a growing body of quantitative evidence demonstrating that racialized minority groups endure disproportionate rates of coercive interventions during emergency psychiatric evaluation. Interdisciplinary systemic changes are urgently needed to address structural barriers to equitable psychiatric care.

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Supplementary Material

File (appi.ps.20220533.ds001.pdf)

Information & Authors

Information

Published In

Go to Psychiatric Services
Go to Psychiatric Services
Psychiatric Services
Volume 74 • Number 10 • October 01, 2023
Pages: 1063 - 1071
PubMed: 37042104

History

Received: 15 October 2022
Revision received: 21 January 2023
Accepted: 15 February 2023
Published online: 12 April 2023
Published in print: October 01, 2023

Keywords

  1. Structural racism
  2. Emergency psychiatry
  3. Racial-ethnic disparities
  4. Stigma
  5. Racial discrimination

Authors

Affiliations

Colin M. Smith, M.D., M.Sc.G.H.
Hubert-Yeargan Center for Global Health, Duke University, Durham, North Carolina (Smith); Department of Psychiatry and Behavioral Sciences (Daley, Tweedy, Staplefoote-Boynton, Gagliardi) and Department of Medicine (Thielman, Staplefoote-Boynton, Gagliardi), School of Medicine, Duke University, Durham, North Carolina; School of Medicine (Lea), Duke University, Durham, North Carolina; Duke Divinity School, Duke University, Durham, North Carolina (Daniel); Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill (Aimone).
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Lori-Ann Daley, M.D.
Hubert-Yeargan Center for Global Health, Duke University, Durham, North Carolina (Smith); Department of Psychiatry and Behavioral Sciences (Daley, Tweedy, Staplefoote-Boynton, Gagliardi) and Department of Medicine (Thielman, Staplefoote-Boynton, Gagliardi), School of Medicine, Duke University, Durham, North Carolina; School of Medicine (Lea), Duke University, Durham, North Carolina; Duke Divinity School, Duke University, Durham, North Carolina (Daniel); Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill (Aimone).
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Chris Lea, B.S.
Hubert-Yeargan Center for Global Health, Duke University, Durham, North Carolina (Smith); Department of Psychiatry and Behavioral Sciences (Daley, Tweedy, Staplefoote-Boynton, Gagliardi) and Department of Medicine (Thielman, Staplefoote-Boynton, Gagliardi), School of Medicine, Duke University, Durham, North Carolina; School of Medicine (Lea), Duke University, Durham, North Carolina; Duke Divinity School, Duke University, Durham, North Carolina (Daniel); Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill (Aimone).
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Keith Daniel, M.Ed., D.Min.
Hubert-Yeargan Center for Global Health, Duke University, Durham, North Carolina (Smith); Department of Psychiatry and Behavioral Sciences (Daley, Tweedy, Staplefoote-Boynton, Gagliardi) and Department of Medicine (Thielman, Staplefoote-Boynton, Gagliardi), School of Medicine, Duke University, Durham, North Carolina; School of Medicine (Lea), Duke University, Durham, North Carolina; Duke Divinity School, Duke University, Durham, North Carolina (Daniel); Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill (Aimone).
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Damon S. Tweedy, M.D.
Hubert-Yeargan Center for Global Health, Duke University, Durham, North Carolina (Smith); Department of Psychiatry and Behavioral Sciences (Daley, Tweedy, Staplefoote-Boynton, Gagliardi) and Department of Medicine (Thielman, Staplefoote-Boynton, Gagliardi), School of Medicine, Duke University, Durham, North Carolina; School of Medicine (Lea), Duke University, Durham, North Carolina; Duke Divinity School, Duke University, Durham, North Carolina (Daniel); Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill (Aimone).
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Nathan M. Thielman, M.D., M.P.H.
Hubert-Yeargan Center for Global Health, Duke University, Durham, North Carolina (Smith); Department of Psychiatry and Behavioral Sciences (Daley, Tweedy, Staplefoote-Boynton, Gagliardi) and Department of Medicine (Thielman, Staplefoote-Boynton, Gagliardi), School of Medicine, Duke University, Durham, North Carolina; School of Medicine (Lea), Duke University, Durham, North Carolina; Duke Divinity School, Duke University, Durham, North Carolina (Daniel); Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill (Aimone).
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B. Lynette Staplefoote-Boynton, M.D., M.P.H.
Hubert-Yeargan Center for Global Health, Duke University, Durham, North Carolina (Smith); Department of Psychiatry and Behavioral Sciences (Daley, Tweedy, Staplefoote-Boynton, Gagliardi) and Department of Medicine (Thielman, Staplefoote-Boynton, Gagliardi), School of Medicine, Duke University, Durham, North Carolina; School of Medicine (Lea), Duke University, Durham, North Carolina; Duke Divinity School, Duke University, Durham, North Carolina (Daniel); Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill (Aimone).
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Elizabeth Aimone, M.Sc.G.H.
Hubert-Yeargan Center for Global Health, Duke University, Durham, North Carolina (Smith); Department of Psychiatry and Behavioral Sciences (Daley, Tweedy, Staplefoote-Boynton, Gagliardi) and Department of Medicine (Thielman, Staplefoote-Boynton, Gagliardi), School of Medicine, Duke University, Durham, North Carolina; School of Medicine (Lea), Duke University, Durham, North Carolina; Duke Divinity School, Duke University, Durham, North Carolina (Daniel); Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill (Aimone).
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Jane P. Gagliardi, M.D., M.H.S. [email protected]
Hubert-Yeargan Center for Global Health, Duke University, Durham, North Carolina (Smith); Department of Psychiatry and Behavioral Sciences (Daley, Tweedy, Staplefoote-Boynton, Gagliardi) and Department of Medicine (Thielman, Staplefoote-Boynton, Gagliardi), School of Medicine, Duke University, Durham, North Carolina; School of Medicine (Lea), Duke University, Durham, North Carolina; Duke Divinity School, Duke University, Durham, North Carolina (Daniel); Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill (Aimone).
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Notes

Send correspondence to Dr. Gagliardi ([email protected]).

Author Contributions

Drs. Smith and Daley contributed equally to this work.

Competing Interests

Dr. Tweedy reports receiving royalty payments and speaking engagement compensation from Macmillan and Macmillan Speaker’s Bureau. Dr. Gagliardi reports receiving compensation for her role as associate director of the Train New Trainers Primary Care Psychiatry program. The other authors report no financial relationships with commercial interests.

Funding Information

This study was supported by the Duke Center for Research to Advance Healthcare Equity (REACH Equity), supported by the National Institute on Minority Health and Health Disparities (award U54 MD-012530); Hubert-Yeargan Center for Global Health; and Duke University School of Medicine, Department of Medicine. The sponsors had no role in the study.The content is solely the responsibility of the authors and does not necessarily represent the official views of Duke University, the Indian Health Service, the U.S. government, or any of its agencies.

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