SMI Research Digest: Discrimination
SMI Research Digest is a monthly publication from Treatment Advocacy Center (TAC) that summarizes recently published research on topics related to severe mental illness (SMI). In honor of Mental Health Awareness Month, this month’s Digest seeks to raise awareness about the unjust discrimination that people with SMI experience.
IMD exclusion waivers associated with reduced hospitalization and incarceration rates. The Institution for Mental Diseases (IMD) exclusion is a discriminatory policy that prohibits the use of Medicaid funds for people who receive treatment in IMDs, defined as facilities with more than sixteen beds that are “primarily engaged in providing diagnosis, treatment, or care of persons with mental diseases, including medical attention, nursing care, and related services.” There is no other type of facility for which federal Medicaid law prohibits this funding. As of July 2025, 22% of states had received wavers allowing for federal reimbursement of services provided in IMDs, yet there has been little research examining the impact of these wavers on people with SMI.
A 2025 study published in “The American Journal of Managed Care” sought to fill this research gap by comparing outcomes between 130,000+ people with SMI in states with an IMD exclusion waiver and 3,100,000+ in states with no waiver. After controlling for variation in state mental-health policies and patient characteristics, people with SMI in states with IMD exclusion waivers were found less likely to be incarcerated and hospitalized than in non-waiver states. These findings suggest that removing the IMD exclusion from Medicaid law may lead to better outcomes for people with SMI.
Discrimination against people with psychotic disorders in the hiring process. A recent systematic review and meta-analysis from “Schizophrenia Research” explored employer discrimination toward people with psychotic disorders and found that they experience significantly higher levels of discrimination than people with other health conditions. Research suggests that this discrimination may originate from untrue stereotypes that hiring managers hold toward people with psychotic disorders, including that they do not want to work or would be dangerous in a workplace setting. These findings are especially important given evidence that many people with psychotic disorders want to work. Employed individuals with schizophrenia also display better outcomes, including symptom remission, decreased likelihood of rehospitalization, and improved quality of life. Individual Placement and Support (IPS) is a model of supported employment that has demonstrated effectiveness at helping people with SMI access and maintain competitive employment and may help mitigate the impact of employer discrimination in hiring.
The importance of quality training about schizophrenia for healthcare providers. Negative attitudes and beliefs about people with behavioral health conditions among healthcare providers have been associated with lower quality of care, inadequate referrals, and reduced patient trust. It is accordingly important to understand factors that impact provider perceptions of people with schizophrenia. One recent review from “Frontiers in Psychiatry” found that providers who had more specialized training, personal familiarity, and more opportunities to interact with people living with schizophrenia endorsed fewer stereotypes, reported less social avoidance, and held more positive attitudes about patients. These findings suggest that providing structured clinical training and exposure to patients with schizophrenia in both continuing education and early-career training may help reduce discriminatory attitudes among providers.
If this topic resonates with you, we want to hear your thoughts. TAC is currently creating education materials for frontline professionals and is conducting a survey of training needs and experiences across multiple sectors to find out what would be valuable. All responses will be kept confidential and used only for internal research and training improvement purposes. Take the survey here or contact us at advocacy@tac.org with comments.
SMI Research Digest is a monthly public service by TAC that highlights new, impactful research on topics related to severe mental illness. If you would like to support TAC programs and publications, please consider making a donation today.
