RESEARCH WEEKLY: Experiences of Black adults in a locked emergency psychiatric unit

By Hope Parker

(October 18, 2023) Black adults have greater barriers to accessing psychiatric care, such as a higher prevalence of intergenerational poverty and underinsurance, than their white counterparts. However, Black adults simultaneously remain overrepresented in acute inpatient care. The authors of a study published this month in “Psychiatric Services” sought to better understand the lived experiences of Black adults who received psychiatric evaluations on a locked emergency psychiatric unit.   

Study details

Individuals who self-identified as Black were contacted via phone after their release from an eight-bed locked psychiatric emergency unit in Durham, North Carolina. Out of a pool of 235 adults who underwent a psychiatric evaluation in the unit between January and April of 2021, 11 individuals agreed to participate in the study. 

After reviewing literature on psychiatric treatment in restrictive settings, a semi-structured interview protocol was developed by clinicians and researchers. All interviews with participants lasted between 23 and 63 minutes. Each interview was reviewed by two researchers in order to find themes in participants’ responses. 

Key findings

Participants consisted of three men, seven women, and one non-binary individual. Five individuals had been diagnosed with schizophrenia or schizoaffective disorder, five with depression, four with post-traumatic stress disorder, two with anxiety, and one with bipolar disorder. Additionally, eight of the participants had been diagnosed with a substance use disorder. Six of the eleven participants were admitted to an inpatient psychiatric unit after their evaluation.  

Positive experiences 

Kindness from staff was noted as the most positive aspect of treatment. One participant told a story about a nurse helping them celebrate their birthday. Other participants said that their experience was improved by staff taking time to patiently answer questions and help them calm down. 

Negative experiences 

The process of transport, evaluation, and treatment was perceived as criminalizing by nine of the participants. One participant said that they felt as though they were treated like a prisoner, and another two participants compared hospitalization to being in a jail cell. Participants also stated that the presence of police and experience of being handcuffed or restrained contributed to their feelings of restriction and the absence of liberty and choice.  

All participants reported feeling vulnerable and experiencing a loss of agency. Some were distrustful of staff due to what they characterized as staff rudeness or unfriendliness. Others reported feeling violated or even traumatized, with the experience bringing back traumatic memories. One participant said that the experience was also physically uncomfortable, as they were only allowed one blanket and had to sleep on a thin mattress. 

Stigma was brought up by all participants. All eleven individuals felt as though they had either received or witnessed derogatory treatment because of their mental illness, racial identity, ethnicity, or cultural background. One participant said that they felt staff were more willing to communicate with white patients than Black patients, while a different participant said that they felt as though they were looked down upon because of their mental health issues.  

Despite 10 out of 11 participants recognizing that their psychiatric evaluation and treatment were necessary, all participants felt that there was a mismatch between their expectations of therapeutic care and the treatment they received. Some participants felt as though the treatment they received was detrimental to their recovery. One participant noted that while the staff they encountered wanted to help, the actual policies and procedures in place should be reconsidered. 

Suggestions for improvement

Along with sharing their experiences, participants were also asked about how to improve quality of care. Below is a list of some of their suggestions: 

  • Decrease the presence of law enforcement. 
  • Take a trauma-informed approach to patient care. 
  • Proactively respond to patients’ needs, such as cleanliness of the unit, clothing, nutrition, and grooming. 
  • Make sure care is individualized and accounts for differences in severity of symptoms, illness, and circumstances. 
  • More entertainment and programming, such as groups and activities. 
  • Prioritize patient-centered care, including cultural humility, and walk through rules and procedures in a way patients can understand. 
  • Communicate calmly, compassionately, authentically, and without judgment. 
  • Prescribe necessary medications in a timely manner. 


Smith, C. et al. (2023, October). Experiences of Black adults evaluated in a locked psychiatric emergency unit: A qualitative study. Psychiatric Services.  

Hope Parker is a research assistant at Treatment Advocacy Center.

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