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RESEARCH WEEKLY: Black patients less likely to receive follow-up care after psychiatric hospitalization
By Elizabeth Sinclair Hancq
(July 12, 2023) Timely follow-up care after a psychiatric hospitalization is crucial to ensure successful reintegration into the community. Lack of timely follow-up care has been connected to a host of negative outcomes, including relapse and readmission, violence, homelessness, criminal legal system involvement, and suicidal behaviors.
Black patients are less likely to receive timely follow-up care after a psychiatric hospitalization, according to research published this month in “Psychiatric Services.” As July marks BIPOC Mental Health Month, this week’s blog is focused on some of the inequities and disparities Black, Indigenous, and people of color individuals with serious mental illness face in accessing mental health treatment.
Factors contributing to disparities in timely follow-up care
The study researchers examined Medicaid claims data of 17,488 individuals in New York who had been hospitalized in a psychiatric unit and discharged to the community from 2012-2013. The authors connected claims data to other community data sources, such as the American Hospital Association Annual Survey, to examine different community, hospital, and patient factors that impacted access and receipt of outpatient mental healthcare within seven and 30 days of discharge from inpatient psychiatric care.
Almost 40% of all patients studied attended an outpatient visit within seven days of discharge, and 60% of patients received outpatient care within 30 days. Compared with white patients, Black patients were significantly less likely to receive timely follow-up care.
At the community level, urban vs. rural classification and county poverty status had the largest impact on disparities associated with follow-up care. When statistically controlling for being hospitalized in a large urban area or in a community with high poverty levels, much of the difference in receipt of follow-up care after discharge from an inpatient hospital between different racial groups disappeared.
One hospital characteristic that impacted follow-up care was the propensity to schedule an outpatient visit during discharge planning. Additionally, patients who were homeless or had a co-occurring substance use disorder were less likely to receive timely follow-up care, whereas those that had more regular attendance of outpatient visits prior to being hospitalized were more likely to receive outpatient care once discharged.
The authors conclude that, “providers and policy makers need to consider important structural and cultural factors that underly social determinants of mental health and affect health care access and outcomes.” Specifically, policymakers could increase social work services to under-resourced communities, and clinicians could address social needs upon discharge, according to the authors. Addressing social determinants of mental health care, like living in an under-resourced area, could improve some of the racial disparities associated with lack of access to treatment post-discharge from a hospital and the negative consequences that result from not receiving timely care.
Reference
Smith, T. S., et al. (2023, July). Community, hospital, and patient factors contributing to ethnoracial disparities in follow-up after psychiatric hospitalization. Psychiatric Services.
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