The fact that African Americans tend to receive health care at the very last moment and often through emergency services due to low socio-economic status and family oriented culture also contributes to bias formation, which, in turn, results in misdiagnosis of schizophrenia. The African American culture in United States is very family oriented, as members of the family are more likely to take care of an ill person themselves rather then take them to a community agency. Consequently, African Americans tend to receive psychotic help at stages when an illness progresses significantly – knowing this factor, clinician is likely to over diagnose mental illnesses alongside with drug abuse, and schizophrenia in the list. Going even further, members of the family are more likely to have higher tolerance for psychosis.

As the vast majority thinks that hospitals are for the Whites, family members are likely to tolerate symptoms without further actions for a longer time and establish social networks for support of ill members of the family. The majority of African Americans does not receive mental health care at all. While 50% do not have health insurance whatsoever, 21% is covered by Medicaid of those who do. Consequently, African Americans receive mental health care through emergency rooms – police, court services, or social services, whereas disposition is most often hospitalization. Alternative methods of treatment are also often in practice – faith healers and spirituals – are normally the first ones to intervene, whereas situation often only becomes worse. When African Americans do get to receive health care, their reaction is often adverse, whereas this reaction can often be understood by a clinician as a symptom of schizophrenia.

Formation of stigma, as African Americans are likely to turn for help only when they feel that “they are really crazy", whereas clinicians are perceived more as an additional problem rather then solution – also contributes to formation of bias. As African Americans turn for help the very last moment and often their behavior is inadequate due to attitude towards the health care system which is followed by a normal defensive reaction against the threat of racism – the diagnosis is often faulty. African Americans, in general, are under represented in outpatient treatment, whereas still over represented in substance abuse programs. They are infrequently treated on an individual basis, instead – youth is treated in residential sectors for disturbed youth, whereas myths, racial bias, and negative attitudes are omnipresent.