Flaherty JA, Meagher R.
Measuring racial bias in inpatient treatment.
Am J Psychiatry 1980;137(6):679-82.

“In a retrospective chart audit of 66 black and 36 white male schizophrenic inpatients, the authors found that black patients spent less time in the hospital, obtained a lower privilege level, were given more p.r.n. medications, and were less likely to receive recreation therapy and occupational therapy. Seclusion and restraints were more likely to be used with black patients….”

”Specifically, the mean number of days spent in the hospital was 29.09 for blacks, 48.60 for whites (p<.001). The mean number of p.r.n. medication was ordered was 6.71 for blacks, 3.58 for whites (p<.05); seclusion and restraints were ordered for blacks on 78% of the days they were hospitalized; for whites, 46% (p<.05). At discharge blacks had reached a mean privilege level of 2.64; whites, 3.08 (p<.05). Recreational therapy was ordered for 47% of blacks and 78% of whites. Furthermore, blacks more often left the hospital “against medical advice” (18% of blacks versus 5% of whites), whereas whites were more often “absent without leave” (9% versus 4%).”

“Blacks have been described as more disturbed than whites according to type of diagnosis given, personality inventory scores, and behavioral observation.

“There is some bias in the commonly held assumption that blacks are not amenable to intensive psychotherapies and that they will drop out of treatment prematurely. Although one study has shown a higher drop-out rate for blacks, this rate is lower when blacks are referred for intensive psychotherapy. Yamamoto found that blacks, along with Mexicans and Orientals, were more often referred for medication follow-up only or never seen after the initial interview; they were seldom referred to individual or group psychotherapy. Cited as a reason that might explain blacks’ high drop-out rate was the degree of comfort and perceived understanding that a black patient experiences with a white therapist.”

“Possible explanations for differences in length of stay: bias vs. blacks having a more chaotic social and family life….Another possibility is that white staff feel more comfortable working with white patients…Also, the ward atmosphere created by a white staff may make life uncomfortable for a patient from another culture, thus prompting early discharge.
Possible explanations for greater use of p.r.n. medication, seclusion, and restraints: bias vs. greater size or strength of the patient (which might have been more common in blacks).”

“Concluding that there was racial bias, the authors attribute it to subtle stereotyping and the staff’s greater familiarity with white patients; the authors suggest increased recruitment of black professionals and the inclusion of blacks in each treatment team.”