‘Mentally disordered persons found in public places’ Diagnostic and social aspects of police referrals (Section 136)

Abstract

SynopsisA survey over 2 years of all Police Referrals (Section 136 of the Mental Health Act 1983) in an inner-city health district identified 163 cases, with a core group of repeat referrals. Previous psychiatric admissions, a diagnosis of schizophrenia, social deprivation, and a bias towards young men of Afro-Caribbean ethnicity were key features. The difficulty of obtaining clear data and uncertainties within the law rebound unfairly on patients, police and psychiatrists. Section 136, while not inappropriate diagnostically, can be seen as highlighting unmet social and medical needs in the context of community care. The requirement for coordinated resources, including acute in-patient services sufficient for deprived populations and legal provision for treatment beyond a hospital's boundaries, seems paramount.

Involuntary psychiatric attendances at an Australasian emergency department: A comparison of police and health‐care worker initiated presentations

“…The rates of police admissions after involuntary referral are similar to previous reported rates of admission in the USA 3–5 but is higher than the ‘all presentations’ rate of admission in the recent Victorian study 2 . Interestingly our police admission rate is lower than the 69% noted in the previous Australian study in this field, 6 and is much lower than an observational study of the use of similar legislation in the UK, where an 82.8% admission rate was noted 8 . This disparity in admission rates could be due to variable police practices between local commands regarding the application of mental health legislation, which would lead to an inconsistent prevalence of ‘true’ mental illness in the population of individuals to be involuntarily detained for mental health assessment.…”

“…2 Interestingly our police admission rate is lower than the 69% noted in the previous Australian study in this field, 6 and is much lower than an observational study of the use of similar legislation in the UK, where an 82.8% admission rate was noted. 8 This disparity in admission rates could be due to variable police practices between local commands regarding the application of mental health legislation, which would lead to an inconsistent prevalence of 'true' mental illness in the population of individuals to be involuntarily detained for mental health assessment. As a result it could be expected that a variation in admission rates could occur, even in the same mental health jurisdiction.…”

Ethnic differences in risk of compulsory psychiatric admission among representative cases of psychosis in London

“…This contrasts with lower rates of psychosis found among Irish people7 and conflicting results in Asian populations 2 8 9. Furthermore, high rates of hospital admission under the Mental Health Act 1983 have been reported for black Caribbean patients, particularly young men,10 11 12 13 both for compulsory admissions involving the police12 14 and for forensic orders 6 15. Independent of diagnosis, black Caribbean patients seem more likely to have contact with the police and forensic services,6 to be treated in intensive care facilities if detained under the act,16 and to have had a criminal conviction if they are young and male 17…”

“…Previous studies differ regarding whether the increased rate of compulsory admissions for black Caribbeans can be explained by an increased incidence of schizophrenia or other psychosis8 12 13 or whether it results from diagnostic bias14 or is an independent finding 6 13 16. Compulsory admission is more likely in patients who are living in temporary accommodation, in those not registered with a general practitioner, those attending a psychiatric outpatient department, and those with previous admissions 15.…”

Sociodemographic and clinical characteristics of psychiatric patients coercively brought to hospitals

“…Previous studies concerned with both involuntary admission and routes to a psychiatric emergency room have reported several factors as being related to a patient's motivation. These include demographic factors such as age and sex, 4,5,6,[9][10][11][12][13][14][15][16] and clinical factors such as diagnosis and symptoms. [9][10][11][12][17][18][19][20][21] In addition, we added two environmental factors: living arrangements and the presence of parental caregivers.…”