Hello, dear colleagues. My name is Rakesh Jain, and I'm a clinical professor of psychiatry at Texas Tech University School of Medicine in Permian Basin, and I'm also a proud member of Psych Congress Steering Committee. Welcome to this educational video titled "Bridging the Gap, Schizophrenia and Health Equity.”  

Racial, ethnic, and socioeconomic disparities in mental health persist in the United States, driving the gap in outcomes for minority patients. These disparities in access to healthcare and variations in patients’ outcomes are deemed “inequities.” There are many factors that can contribute to health inequities for patients with schizophrenia. These factors can occur at the patient, provider, or systemic level.

People at a socioeconomic disadvantage, whether it be related to unemployment, low income, poverty, or poor housing conditions, are at a higher risk for poorer mental health outcomes.

There is a strong connection between schizophrenia and poverty. Patients experiencing poverty tend to have worse psychiatric outcomes, including more severe symptoms and impaired social and professional functioning.

While providers can’t fix the socioeconomic factors impacting their patients, they can be more aware of the connection between poverty and worse health outcomes in their patients with schizophrenia. Collaboration with community organizations and advocacy groups can help these patients receive the support, and resources, and social inclusion that they truly need.

Healthcare providers can also play an important role in the maintenance of health inequities for schizophrenia patients. Minority patients are 3 to 4 times more likely to be diagnosed with schizophrenia. This is especially true when looking at diagnosis rates for Black patients compared to White patients.  

Originally, this discrepancy was thought to be the result of patients’ limited access to healthcare, but now, research shows it may be due to factors such as racialized bias and differences in applying diagnostic criteria across races. Another hypothesis for the overdiagnosis of Black patients with schizophrenia could stem from the underdiagnosis of other psychiatric conditions, as studies have shown that these patients are less likely to receive diagnoses for bipolar and major depressive disorder.

Actual treatment of schizophrenia differs by race and ethnicity as well. Minority patients are often less likely to receive treatment for mental illness. As an example, among adults with any serious mental health illness in 2023, 74.9% of White patients received treatment, while only 56.4% of Black patients did.

For those who are treated, there may be differences in the medication prescribed. Black and Hispanic patients are more likely to be prescribed higher doses of antipsychotic therapy yet less likely to receive adjunctive treatment. These patients are also less likely to be offered the option of nonpharmacological treatments like cognitive behavioral therapy or family therapy.

Inappropriate treatments can lead to worse outcomes, adverse events, and a higher potential for nonadherence.

What are some potential reasons healthcare providers may treat minority patients with different medications at varying dosages? Research has shown that unconscious bias may play a role, impacting providers’ clinical decisions and communication with patients. Understanding that biases exist is the first step to providing equitable, culturally competent care that can lead to better outcomes for patients.

In general, minority patients are underutilizing healthcare compared to their White counterparts. A recent study sought to explore healthcare usage from 1963 to 2019. Out of 600 000 American participants, the researchers found that White patients accessed healthcare more than Black patients every year. The same trend can be found for mental health services.

When thinking about minority patients and healthcare utilization, another factor impacting equity is the lack of diversity in the healthcare workforce. There remains a predominantly White makeup of the physician workforce. This lack of diversity is linked to worse communication between patients and their providers, shorter visits, less shared decision-making, and a poorer set of outcomes.

There are some factors contributing to health inequities that providers have little or no control over, such as socioeconomic factors. However, providers can be more aware of these issues and how they negatively impact health outcomes for patients with schizophrenia.  

Education on implicit biases and how to overcome them can be another way to ensure that minority patients are not being misdiagnosed or mistreated. Trainings on diversity and cultural differences can also help providers overcome these barriers.  

Efforts to improve healthcare access should be made. Educating patients on schizophrenia and encouraging them to seek medical care when needed is essential. Improving diversity in the workforce of providers can also go a long way in improving outcomes for minority patients.

Thank you so much for joining me today to discuss disparities in mental health. This is an important topic, and I very much appreciate your time and attention to these issues. Goodbye now.

References:

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