The Psychiatric Green Book: A Crisis Guide for Black Families

When someone you love is in a mental health crisis, decisions come fast. Should you call for help? Which hospital? What happens if they are held against their will, and what rights do they have once they are inside? Most families face those questions for the first time in the middle of an emergency. The Psychiatric Green Book, a new guide from the Black Emotional and Mental Health Collective (BEAM), is built to change that.

Released in August, the book is titled What I Wish My People Had Known: The Psychiatric Green Book, A Guide for Black Folks. It has drawn coverage from Word in Black and MindSite News, and it offers something rare in mental health: a plain spoken map of the psychiatric system written with Black families in mind.

What the Psychiatric Green Book Covers

The name is a deliberate nod to Victor Hugo Green’s Negro Motorist Green Book, which helped Black travelers find safe passage during Jim Crow. This version is a guide to the roadblocks inside psychiatric care.

BEAM founder and executive director Yolo Akili Robinson edited the book with mental health advocate Kelechi Ubozoh. It was developed with survivors of the psychiatric system, disabled people, psychiatrists, policy experts and families, along with partners including Disability Rights California, the Georgia Advocacy Office and Depressed While Black.

According to BEAM’s book page, the guide covers:

• What a psychiatric hold is under state law and how the process works
• Insights from people who have been through the system and from an antiracist psychiatrist
• How families can advocate for a loved one before, during and after a hospitalization
• Ideas for the future of care, framed through an abolitionist lens

The first edition focuses on the laws in California and Georgia, and BEAM says more state editions are planned. The family checklists are free on BEAM’s site. The digital book is pay what you want, with a $5 suggested price, and the 140 page paperback costs $15.

Why Black Families Need a Crisis Plan

The guide exists because the stakes are uneven. A study of a Boston academic hospital’s psychiatric unit, published in the journal Psychiatric Services, followed nearly 4,400 first admissions from 2012 to 2018. After researchers accounted for diagnosis and other factors, Black patients still had about 57 percent higher odds than white patients of being admitted involuntarily.

In a Psychology Today essay on the book, psychiatrist Rupinder Legha, founder of Antiracist MD, wrote that it takes on police involvement, involuntary hospitalization, restraint, forced medication and misdiagnosis of Black patients, and that it centers the voices of survivors and families rather than professionals.

Crisis services are also uneven. KFF has reported that in 2023, awareness of the 988 lifeline was lower among Black adults than white adults, and that mobile crisis teams, where they exist, are often not available around the clock or statewide.

None of this means Black families should avoid care. It means walking in informed, with a plan, so that the person in crisis keeps as much say as possible in what happens next.

Psychiatric Advance Directives, Explained

One of the most useful tools the book highlights is the psychiatric advance directive, or PAD. The National Resource Center on Psychiatric Advance Directives describes it as a legal document that records a person’s preferences for future mental health treatment and can name a health care proxy to speak for them during a crisis. You write it while you are well, and it is used if you later cannot make decisions.

Mental Health America’s step by step PAD guide suggests a PAD can include:

• Emergency contacts and who should be called first
• Hospitals you prefer, and alternatives to hospitalization you would rather try
• The treatments and professionals you prefer
• Allergies and other medical conditions
• Who may visit you and who may not
• Practical needs, such as who will care for children or pets

Rules vary by state, including whether you need witnesses or a notary. MHA also notes that doctors can sometimes override a PAD in a crisis, so it is a strong tool, not a guarantee.

What to Do Before, During and After a Crisis

Before

• Download BEAM’s free psychiatric hold checklists and fill them out as a family.
• Keep a one page sheet with diagnoses, medications and doses, doctors, insurance information and a trusted contact. Store it on your phone and on paper.
• Create a PAD using your state’s form, and choose a health care agent who will answer the phone.
• Save 988 in your phone, and look up whether your county has a mobile crisis team.
• Find your state’s protection and advocacy agency through the National Disability Rights Network directory. These legally based advocacy groups exist in every state and territory.

During

• Bring the PAD and the information sheet, and hand copies to staff.
• Ask plainly: Is this admission voluntary or involuntary? What law is being used? How long can it last? How do we reach the patient advocate?
• Write down names, times and what you were told.

After

• Ask for a written discharge plan, a follow up appointment and enough medication to bridge the gap.
• If you believe rights were violated, contact your protection and advocacy agency. Their work includes issues like medication concerns and discharge planning in facilities.

For everyday support, our guide to 988 and mental health help for Black communities lists culturally aware options, and our look at Black men’s mental health and the treatment gap covers what helps close it.

No book can make a crisis easy. But a family that has talked it through, signed the forms and knows the questions to ask walks into an emergency room on steadier ground. BEAM’s message is simple and worth taking seriously: do the planning while everyone is well, because that is when your loved one’s voice is clearest.

This article is for general information and is not medical or legal advice. If you or someone you know is in immediate danger, call or text 988 or dial 911.