Pathways to early intervention services involving police or ambulance and disengagement rates in racialized and immigrant youth compared to the White majority.

OBJECTIVES

Early-intervention services (EIS) are the gold standard for first-episode psychosis (FEP). Immigrants and racialized youth with FEP are more likely to access EIS through adverse pathways (police and/or ambulance-mediated) and to disengage from treatment. We aimed to use a comprehensive, intersectional approach to examine inequalities in pathways to care and EIS disengagement, comparing immigrants stratified by generational and racialized minority status, with White majority non-immigrants.

METHODS

Incident FEP cases from two Canadian EIS were stratified according to immigrant generation and racialized minority status. Pathways to care and disengagement were examined using logistic regression models adjusted for potential confounders.

RESULTS

Of 567 participants, 173 (30.8 %) experienced an adverse pathway. The proportion of adverse pathway was highest among racialized first-generation immigrants (N = 52, 38.2 %), followed by non-racialized (N = 13, 32.5 %) and racialized second-generation immigrants (N = 23, 32.4 %). White non-immigrants (N = 77, 26.9 %) and non-racialized first-generation immigrants (N = 6, 23.1 %) presented lower rates. Odds of adverse pathways were only significantly increased for racialized first-generation immigrants (OR = 1.72, 95 % CI = 1.06-2.80) compared with White non-immigrants. Disengagement was associated with adverse pathways to care (OR = 1.80, 95 % CI = 1.09-2.97), but not with immigrant stratified groups. The relationship between adverse pathways and disengagement was not moderated by immigrant status.

CONCLUSIONS

Racialized first-generation immigrants are more likely to encounter adverse pathways. The interplay between systemic, cultural, and individual factors, including perceived need for mental healthcare knowledge and trust towards healthcare institutions can hinder access to services. Racially differing practices in emergency response may play a role. Further research is needed to understand inequities in EIS access.