Table 5.

Examples of how to reduce racial disparities in mental healthcare pathways for Black individuals.

Improving diagnostic accuracy
Structured interviews	• Structured interviews have proven value in improving diagnostic accuracy and can be used in real clinical settings (131).
Racial/ethnic matching	• Methods used in the National Survey of American Life investigating the nature, severity, and impairment of mental disorders in Black and White populations used racial and ethnic matching of interviewers and respondents (132).
Targeted public education in communities of color
Mental health literacy	• Norway's Treatment and Intervention in Psychosis program, Australia's beyondblue initiative for depression and related disorders, as well as Nuremberg's community campaign for depression, represent examples of successful mental health literacy programs (133).
Public awareness campaigns	• One comprehensive mental health awareness program (the Depression is Real Campaign) launched in Louisville, KY (134) developed culturally informed communication about the nature of depression, its symptoms, and treatment for Black communities. A similar approach could be used to raise awareness about psychosis.
Word-of- mouth	• MindStylz is a collaborative project between hair stylists, barbers, and the Ethnic Diversity Task Force of the Connecticut Psychological Association (135). It's mission is to promote mental health awareness among hair stylists, barbers, and their clients in communities of color. MindStylz helps by providing education and resources to hair stylists and barbers for their clients.
Church-based approaches	• In 2022, the first randomized trial of church-based counselling centres for depression counseling in African Americans started. The idea is to improve care in economically disadvantaged areas (136).
Revisiting the role of law enforcement
Training law enforcement	• Police in Louisville Kentucky worked with National Alliance on Mental Illness (NAMI) to reduce the harm caused by mental health crisis calls. Outcomes of a special police crisis intervention team (CIT) were reviewed over a year and compared with available pre-CIT statistics. The arrest rate for the CIT was lower than non-CIT runs while the occupancy of the local mental health unit in the jail stayed about the same (~1,100 patients/year), and referrals to intense psychiatric services (e.g., Central State Hospital) significantly dropped (from 53% in 2001 to 26.8% in 2004).
Alternatives to police involvement	• In both the United States and Canada, traditional law enforcement responders are being replaced with healthcare workers for some emergency calls. Previously, Denver 911 operators only directed calls to police or fire department first responders, but the Support Team Assistance Response (STAR) pilot program created a new track for directing emergency calls to a two-person medical team as did the Vivec Research Team in Ottawa (137, 138).
Anti-racism and anti-bias training for mental health clinicians
Anti-racism training	• In the MGH/McLean Psychiatry residency program, the Division of Public and Community Psychiatry developed a curriculum addressing racial inequities in mental health, particularly those experienced by African Americans. Training discussing racism in formal didactics integrated into the required didactic curriculum was positively rated by participants (139).