Over the last few years, campaigns such as Bell Let’s Talk and a greater representation of mental health have increased awareness of and reduced stigma associated with accessing mental health services. Despite these steps forward, many people of colour still have trouble accessing quality services. Sommer Knight, a graduate student in the Department of Psychiatry, attempts to answer this issue in her research. Knight examines pathways to mental health service among minorities and the clinical challenges of involuntary admission for first episode psychosis (FEP) patients.
To observe how differences in involuntary admissions influence help-seeking behaviours, which consist of actively seeking help from health care services, Knight asked FEP patients about their experiences to see how their background affected their attitude toward health care. She also reviewed patient charts to identify which risk factors place people at a greater risk for coercive treatment. These treatments include a wide range of procedures such as forced medication, seclusion, and involuntary admissions.
Involuntary hospitalization is a legal procedure that forces an individual to receive inpatient treatment, where the patient resides in a 24-hour live-in care facility such as a psychiatric hospital, involuntarily. Involuntary admission can produce certain short-term benefits, such as greater treatment adherence, fewer days in the hospital, and fewer violent incidents. However, coercive treatment can also have many negative effects on patients and can create important clinical challenges.
“[Patients] felt that they lost their sense of value,” Knight said in an interview with The McGill Tribune. “[Involuntary admission] also affected whether they felt cared for by their team.”
The long-term detrimental effects of coercive treatments may eclipse their short-term benefits. The method can be traumatic for patients, who lose their agency and control. In the last 10 years, research has shown that individuals who received coercive treatment have a poorer quality of life and lower self-esteem in the long run.
In Canada, minorities seem to be disproportionately targeted by this policy.
“Minorities, specifically those of African and Caribbean backgrounds, are more likely to receive police referrals or maintenance referrals instead of going voluntarily,” Knight said.
High rates of involuntary commitment mean that racialized people often underutilize services.
People of colour also face hurdles that disincentivize the use of mental health services. Language barriers, as well as imbalances of power and authority, impact the care that patients receive. In addition, Knight found that minorities experience abnormally long wait times for initial assessments, and mental health providers often fail to properly recognize and respond to these patients’ needs. As a result, mental health stigma and the belief that mental health treatment is ineffective are widespread within these communities.
Coercive treatment’s negative effects largely stem from the fact that the method is based on the assumption that mentally ill patients are usually dangerous, which is a common misconception. Psychiatrists, however, understand most mental disorders better than ever before and have thousands of available treatments that have much fewer negative effects than coercive treatment. Given that coercive treatment also disproportionately affects minorities, it is more important than ever for Canadians to deal with the problems of involuntary admission and discrimination in the provision of mental health services.
As Knight points out, confronting the issue of discrimination in areas such as health care access is often overlooked, but as Canada becomes increasingly diverse, the issue can no longer be ignored.
“If the goal of medicine is to promote patient welfare, then […] it’s important that we […] ensure that everyone gets the care that they need,” Knight said.