Ethnic variations in pathways to acute care and compulsory detention for women experiencing a mental health crisis

Abstract

Background: Much recent debate on excess rates of compulsory detention and coercive routes to care has focused on young black men; evidence is less clear regarding ethnic variations among women and factors that may mediate these.Aim: To explore ethnic variations in compulsory detentions of women, and to explore the potential role of immediate pathways to admission and clinician-rated reasons for admission as mediators of these differences.Method: All women admitted to an acute psychiatric inpatient ward or a women’s crisis house in four London boroughs during a 12-week period were included. Data were collected regarding their pathways to care, clinician-rated reasons for admission, hospital stays, and social and clinical characteristics.Results: Two hundred and eighty seven (287) women from white British, white other, black Caribbean, black African and black other groups were included. Adjusting for social and clinical characteristics, all groups of black patients and white other patients were significantly more likely to have been compulsorily admitted than white British patients; white British patients were more likely than other groups to be admitted to a crisis house and more likely than all the black groups to be admitted because of perceived suicide risk. Immediate pathways to care differed: white other, black African and black other groups were less likely to have referred themselves in a crisis and more likely to have been in contact with the police. When adjustment was made for differences in pathways to care, the ethnic differences in compulsory admission were considerably reduced.Discussion: There are marked ethnic inequities not only between white British and black women, but also between white British and white other women in experiences of acute admission. Differences between groups in help-seeking behaviours in a crisis may contribute to explaining differences in rates of compulsory admission.

Acute Psychiatric Problems among Migrants Living in Switzerland- a Retrospective Study from a Swiss University Emergency Department

“…As in other studies, we confirm that immigrants have a high rate of compulsory presentation to mental health emergency departments [17,26,27]. In psychiatry, the main clinical examination tool is language, a fact that sometimes raises barriers in care provision.…”

Ethnic variations in compulsory detention and hospital admission for psychosis across four UK Early Intervention Services

“…One UK study [25] showed higher rates of detention in this group (non-FEP women). The group in this study is very heterogeneous, including Turkish, Polish and Irish patients.…”

“…These factors have been demonstrated as potentially accounting for some of the variation between ethnic groups in rates of being detained in previous studies [3,25,26]. Logistic regression analysis was conducted on the subgroup to explore if ethnic differences in rates persisted when adjustments were made for pathway to care and help-seeking behaviour.…”

Ethnicity as a predictor of detention under the Mental Health Act

“…Some studies have, however, found that the higher risk of detention amongst minority patients is considerably reduced or even eliminated if sociodemographic, clinical and care pathway differences are taken into account (Bebbington et al 1994;Cole et al 1995;Lawlor et al 2012).…”