Systematic review of pathways to care in the U.S. for Black individuals with early psychosis

Deidre M. Anglin,Oladunni Oluwoye,Beshaun Davis,Franchesca S. Kuhney

doi:10.1038/s41537-021-00185-w

Abstract

The pathway to receiving specialty care for first episode psychosis (FEP) among Black youth in the US has received little attention despite documented challenges that negatively impact engagement in care and clinical outcomes. We conducted a systematic review of US-based research, reporting findings related to the pathway experiences of Black individuals with FEP and their family members. A systematic search of PubMed, PsycInfo, and Embase/Medline was performed with no date restrictions up to April 2021. Included studies had samples with at least 75% Black individuals and/or their family members or explicitly examined racial differences. Of the 80 abstracts screened, 28 peer-reviewed articles met the inclusion criteria. Studies were categorized into three categories: premordid and prodromal phase, help-seeking experiences, and the duration of untreated psychosis (DUP). Compounding factors such as trauma, substance use, and structural barriers that occur during the premorbid and prodromal contribute to delays in treatment initiation and highlight the limited use of services for traumatic childhood experiences (e.g., sexual abuse). Studies focused on help-seeking experiences demonstrated the limited use of mental health services and the potentially traumatic entry to services (e.g., law enforcement), which is associated with a longer DUP. Although the majority of studies focused on help-seeking experiences and predictors of DUP, findings suggests that for Black populations, there is a link between trauma and substance use in the pathway to care that impacts the severity of symptoms, initiation of treatment, and DUP. The present review also identifies the need for more representative studies of Black individuals with FEP.

Highlights

Pathways to care for first episode psychosis (FEP) can be defined as the series of events or contacts with individuals or organizations during the prodromal and onset phase prior to the initiation of outpatient mental health services for FEP1–3 and may include contact with primary care, hospitalization, and interactions with local support groups
Twenty-eight articles were included in present review and of these studies, three were comprised of only family members or support persons[18–20] and four included a mixture of individuals with FEP and their family members[21–24]
The 28 reviewed studies focused on the pathways to care for Black individuals with FEP and their families emanate from a relatively small group of data collection sites (e.g., Georgia mental health care system) and with a restricted range sociodemographically

Summary

Introduction

Pathways to care for first episode psychosis (FEP) can be defined as the series of events or contacts with individuals or organizations during the prodromal and onset phase prior to the initiation of outpatient mental health services for FEP1–3 and may include contact with primary care, hospitalization, and interactions with local support groups. Structural factors (e.g., neighborhood segregation) differentially distribute access to resources in neighborhoods and communities. This access or lack thereof impacts the length of time spent navigating institutions before individuals with FEP and their families reach the appropriate outpatient mental health services (e.g., coordinated specialty care (CSC)), and the types of experiences encountered[6,7]. There is a clear consensus that understanding pathways to care for underserved individuals is important because the quality of the experiences that precede care initiation impact engagement during treatment and psychiatric and functional outcomes[1]

Methods

Results

Conclusion