This week, Mad in America examines three studies related to racial discrimination, mental health, and psychiatric detention. The first links racial discrimination to adverse mental health outcomes. The second links ethnic minority identity with increased rates of involuntary psychiatric detention. The third links involuntary psychiatric detention with increased readmission rates. Taken together, this research suggests a compounding cycle of systemic harm where racial discrimination may lead to higher rates of mental health symptoms and involuntary detention for marginalized groups, which then increases the likelihood of future psychiatric readmissions.
Mental Health and Racial Discrimination in the Workplace
A new Canada-based study published in Psychiatric Research finds that workplace racial discrimination (WRD) is linked to symptoms of depression, anxiety, stress, and PTSD. This research, led by Rose Darly Dalexis from the University of Ottawa in Canada, also finds that Black and Indigenous people report higher rates of WRD compared to other minorities in Canada.
The goal of the current work was to examine rates of WRD for Arab, Asian, Black, and Indigenous people in Canada. The authors also wanted to investigate sociodemographic factors that may be associated with WRD in these groups and possible links between WRD and adverse mental health outcomes.
The authors recruited participants through Léger, a Canadian market research firm. People were randomly invited to participate in an online survey. The current work examined a subset of participants that identified as Arab, Asian, Black, Indigenous, mixed, or other. In order to be included, participants also had to be at least 25 years old, living in Canada, able to communicate in French or English, currently or formerly employed, and either employed or retired at the time of the study. In total, the authors examined data from 1,535 participants.
WRD was assessed as present if participants reported having ever been fired, denied a promotion, or not hired due to their race or ethnic background. Participants also provided socidemographic information as well as data on symptoms of anxiety, depression, stress, and PTSD. All the assessments were online self-report surveys.
Overall, 27.43% of participants reported racial discrimination in hiring processes. This rate was highest among Black participants (36.48%), followed by Indigenous (28.76%), other (25.81%), mixed (22.73%), Asian (22.56%), and Arab (19.94%) groups. Nearly 30% of participants reported being denied a promotion or fired due to race. This rate was highest among Indigenous participants (36.56%), followed by Black (32.02%), mixed (31.82%), other (30.88%), Asian (23.59%), and Arab (22.70%) groups.
WRD was linked to higher levels of depression, anxiety, stress, and PTSD. This pattern was true in all examined minority groups except for Asians. Participants reporting discrimination in hiring were more likely to experience anxiety (2.24 times more likely), depression (2.18), stress (2.01), and PTSD symptoms (1.99). Those that were fired or passed over for promotions due to race were also more likely to report anxiety (2.37), depression (2.80), stress (2.43), and PTSD symptoms (2.43).
The design of the study means that the data can only detect associations and cannot speak to causes. This means this research cannot definitively say WRD causes mental health issues. Only two types of racial discrimination were examined, meaning WRD was underestimated. The authors did not assess racial discrimination based on profession or sector. The self-report nature of the data means there could have been bias and under-reporting of WRD due to minimizing past experiences, shame, lack of awareness of more subtle forms of WRD, etc. There is also limited genralizability to populations outside Canada.
Research has linked WRD, and more broadly, racial discrimination in general, to adverse mental health outcomes. Poor mental health can result in involuntary psychiatric detention, with some research finding such measures are disproportionately taken against racial and ethnic minorities.
Discrimination in Involuntary Psychiatric Detention During COVID-19 Lockdowns
A new UK based study published in the British Journal of Psychiatry finds that minorities were disproportionately subjected to involuntary psychiatric detention during the COVID-19 pandemic in the UK. This research, led by Rosanna Hilderley from the Institute of Psychiatry and Neuroscience in London, also finds that while overall admissions to mental health facilities fell during COVID-19 lockdowns, psychiatric detention rose, driven mostly by increases in Black Caribbeans and Black Africans being involuntarily detained.
The goal of the current work was to examine how COVID-19 lockdowns affected voluntary and involuntary psychiatric admissions for minorities. The authors extracted demographic and psychiatric admissions data from the South London and Maudsley NHS Foundation Trust’s clinical records and compared pre-pandemic admissions to admissions during two COVID-19 lockdowns. Due to small sample sizes some minority groups were combined, resulting in six aggregated categories: White British, White Other, Black Caribbean, Black African, South Asian, and Other Ethnicity. In total, the authors examined data from 15,869 people.
During the first lockdown, between March 23, 2020 and May 12, 2020, overall admission (voluntary and involuntary) fell to about 87% of pre-pandemic levels. However, the number of new compulsory detentions increased, driven mainly by detentions of people identifying as Black Caribbean (54% increase). The authors note that the Black Caribbean group did not have a corresponding rise in overall new admissions, and were less likely to be inpatients during the lockdown. This means that while Black Caribbeans were more frequently detained, they were not kept as inpatients for as long as was typical pre-lockdown.
During the second lockdown, between November, 2 2020 to March, 8 2021, there was a similar increase in new compulsory detentions for both Black Caribbean (53% increase) and Black African (57%) groups. The researchers also performed an analysis that included only people that were admitted for the first time during the lockdowns to investigate the possibility that the observed changes in compulsory detention may have been related to changes in community mental health service provisions during the lockdowns. This restriction increased the effect size for detentions and showed a higher rate of compulsory admission for Black Caribbeans during the second lockdown (107% increase).
This study examined the effect of COVID-19 lockdowns on psychiatric admission rates for a single provider in a single UK region. Generalizability to other populations is limited. Small sample sizes led to aggregating multiple minority groups. This could have hidden differences within the aggregated identity groups. The authors did not examine other factors that could have affected psychiatric admission rates, such as area deprivation.
The current work, along with past research, finds that racial and ethnic minorities are more likely to face involuntary psychiatric detention. This disproportionately exposes these groups to the adverse effects associated with involuntary treatment.
Involuntary Treatment Linked to Higher Readmission Rates
A new study out of Portugal published in Acta Medica Portuguesa finds that patients that were involuntarily admitted to psychiatric facilities and later transitioned to voluntary status had lower readmission rates one year after discharge compared to patients that remained involuntary during the duration of their admission. This research, led by Margarida Castro from the University of Porto in Portugal, also finds that patients that remained involuntary throughout their admission were more likely to be involuntarily readmitted.
The aim of this research was to compare psychiatric readmission rates for patients that transitioned from involuntary to voluntary status to those that remained involuntary. The authors used clinical data from the inpatient psychiatry department of the Unidade Local de Saúde São João (ULSSJ) to achieve this goal. All patients that were at least 18 years old and involuntarily admitted to the ULSSJ in 2022 were included in the current research. Patients were followed for one year after discharge to assess readmission rates. In total, the authors examined 144 involuntary admissions of 120 individual patients.
The majority of involuntarily admitted patients transitioned to voluntary status during their admission (60.8%). Patients transitioning to voluntary status were more likely to be in the 60 – 69 age group, married, employed, and to have been admitted for a manic episode or bipolar disorder. Those that remained involuntary were more likely to be diagnosed with schizophrenia, have previous psychiatric admissions (including involuntary admissions), and have longer lengths of stay.
Twenty-eight of 120 patients were readmitted within one year of discharge, including 20 that were readmitted involuntarily. Involuntary patients had higher readmission rates (36.2%) compared to voluntary patients (15.3%). Eighty-eight percent of readmissions were involuntary for those that did not transition to voluntary status compared to 45.5% of those that did transition to voluntary status before their initial discharge.
As this study was observational, this data cannot speak to causes. This means the current work cannot definitively say that voluntary status caused reduced readmission rates. The authors did not assess other factors that could have led to reduced readmission, such as severity of symptoms, prognosis, and treatment adherence. The sample size and focus on a single institution in Portugal severely limits generalizability. This study also did not consider the “coercive shadow” of psychiatric treatment in the transition from involuntary to “voluntary” treatment, which describes people accepting unwanted psychiatric treatment to avoid harsher coercion.
In addition to higher readmission rates, research has linked involuntary psychiatric detention to trauma, increased risk of suicide, and increased rates of violent crime. Racial and ethnic minorities also face higher rates of mechanical restraint in psychiatric institutions and racism in patient health records. Both experts and people with lived experience of involuntary psychiatric detention have described involuntary treatment settings as exposing marginalized groups to racism, discrimination, and abuse.
Mad in America will host an upcoming film screening of Woman of the Stars and Mountains, which examines the racism and discrimination faced by Rita, an indigenous woman from Mexico that was involuntarily detained in Kansas psychiatric facilities for 12 years due to hospital staff’s inability to determine where she was from, her identity, or what language she spoke.
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Castro, M., Tavares Coelho, J., Ferreira, A. R., & Salgado, H. (2025). The involuntary-to-voluntary hospitalization transition and the risk of psychiatric decompensation: A retrospective cohort study. Acta Médica Portuguesa, 38(12), 785–794. (Link)
Dalexis, R. D., Farahi, S. M., Pakhalé, S., Cénat, J. M., & Bourgeault, I. L. (2026). Workplace racial discrimination as a major public health threat: Association with depression, anxiety, stress and PTSD symptoms among racialized and indigenous peoples in Canada. Psychiatry Research, 356, 116905. (Link)
Hildersley, R., Oswald, T. K., Bakolis, I., Becares, L., Dregan, A., Dyer, J., Hotopf, M., Ocloo, J., Stewart, R., & Das-Munshi, J. (2025). Ethnic Inequalities in Compulsory Psychiatric Hospital Detentions during UK Covid-19 ‘Lockdowns’: A Regression Discontinuity Design in Time Study. British Journal of Psychiatry. (Link)