Inpatient Psychiatric Hospitalization

Abstract

Inpatient hospitalization among African American youth has come under heightened scrutiny in recent years because of increased cost, the restrictive nature of the treatment, and the fact that hospitalized youth are at greater risk of rehospitalization within a few weeks of discharge. Furthermore, evidence suggests that African American and other minority youth are more frequently psychiatrically hospitalized rather than receive other less restrictive evidence-based treatments. Because aggression and impulsivity are the two primary reasons for presentation to emergency and inpatient psychiatric services, many clinical issues are overshadowed by the prominence of these externalizing symptoms. There are individual and societal factors that contribute to the overutilization of inpatient treatment including underutilization of outpatient services. Stigma and access are additional key factors. Many African American youth grow up in neighborhoods where there is a paucity of mental health services. Although there is increased insurance coverage through the Affordable Care Act and the Children’s Health Insurance Program, there remains a deficiency of available providers in numerous localities that continues to restrict accessibility to care. This dearth of available services contributes to youth not receiving appropriate interventions, but also likely adds to the overutilization of hospitalization to the exclusion of other more effective and targeted treatments. Identification of African American youth with mental health issues is a challenge and, when identified, many youth receive diagnoses that are incorrect leading to treatment decisions that may not be in their best interest. Cultural incompetence has been acknowledged as a barrier to effective care. Research over the past 20 years chronicles the problems of incorrect diagnosis, overuse of antipsychotic medication, and how treatment is received in more restrictive placements. The use of evidence-based and culturally competent outpatient care will help us to correct this overutilization while making treatment recommendations that are more acceptable to this patient population.