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The Color of Autonomy: Examining Racial Inequity in Coercive Institutional Practices
Helen-Maria Lekas1, Crystal Lewis1, Mark V Bradley1
1Division of Social Solutions and Services Research, Center for Research on Cultural and Structural Equity in Behavioral Health, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York (Lekas, Lewis, Pahl); Department of Psychiatry, Grossman School of Medicine, New York University, New York City (all authors); Veterans Affairs New York Harbor Healthcare System-Brooklyn, New York (Bradley).
Abstract:
Two articles recently published in this journal identified racial inequities in routine psychiatric practice. This Open Forum discusses the need for a paradigm shift in inequities research. The two articles reviewed here, one by Shea and colleagues on racial-ethnic inequities in inpatient psychiatric civil commitment and one by Garrett and colleagues on racial-ethnic disparities in psychiatric decisional capacity consultations, are examples of the new research gaze. Four topics are identified for enhancing understanding of racism and other forms of structural exclusion in psychiatric practice: medical authority and power imbalance between providers and patients, involuntary psychiatric commitment and requests for decisional capacity consultations as strategic research events, limited use of theory, and limitations of the literature on psychiatric inequities.
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