Disproportionate use of psychiatric emergency services by african americans.

It is well documented that African Americans receive a disproportionate share of their mental health care in the emergency room. Yet this disparate and undesirable pattern of service use has been inadequately examined and remains poorly understood. The disparity is often attributed to lack of access to outpatient care and to the low quality of available services, but these explanations represent untested hypotheses. This Open Forum reviews available data to illustrate how African Americans and white Americans are differentially affected by a broad range of social and community processes and trends, including characteristics of mental health systems and communities and changing societal conditions, and describes how these differences can lead to African Americans' disproportionate use of psychiatric emergency services. Investigation of several hypotheses could contribute to a comprehensive explanation of disparities in psychiatric emergency services use. Such an explanation will enable formulation and testing of strategies to reduce disparities in access to and quality of mental health care.