BACKGROUND This study investigates the role of ethnicity in pathways to emergency mental health care in Toronto for clients with psychosis, while taking into account neighborhood factors. Previous literature has focused on Afro-Caribbean clients, reporting an increased risk of accessing mental health care through negative pathways. METHODS A retrospective chart review for clients from 6 different ethnic origin groups presenting with psychosis - East Asian, South Asian, Black African, Black Caribbean, White European, and White North American - was undertaken in a psychiatric emergency department (ED). Logistic regression models were constructed to examine the relationship between pathways to care (involuntary detention under the Mental Health Act (MHA), police or ambulance referral, accompaniment by family or friends) with individual and neighbourhood factors. RESULTS A total of 765 clients were included in the study. East Asian (OR =2.36, p < 0.01) and South Asian (OR 2.99, p < 0.01) origin clients have increased odds of presenting to the ED while involuntarily detained under the MHA. Involuntary status under the MHA increased the odds of presenting via police or ambulance (OR 8.27, p < 0.001). East Asian origin clients have increased odds of presenting to the ED by police or ambulance (OR =2.10, p < 0.05). Clients from neighbourhoods with higher levels of residential instability have increased odds of presenting by police or ambulance (OR =1.35, p < 0.01), while clients from neighbourhoods with higher levels of ethnic concentration have increased odds of being accompanied to the ED by family or friends (OR =1.33, p < 0.01). CONCLUSION In contrast to previous studies, East Asian and South Asian origin clients with psychosis have increased odds of a coercive pathway to emergency psychiatric services in Toronto. Black African and Black Caribbean origin clients do not have increased odds of a coercive pathway. Clients living in areas with high levels of residential instability are more likely to encounter a negative pathway. Ethnic concentration may be a supportive factor in family and friend accompaniment.