Abstract
ObjectivesCompared with the majority population, those from minority ethnic groups in the UK are more likely to be admitted compulsorily during a first episode of psychosis (FEP). We investigated whether these disparities in pathways in to care continue.MethodsWe analysed data from two first episode psychosis studies, conducted in the same geographical area in south London 15 years apart: the Aetiology and Ethnicity in Schizophrenia and Other Psychosis (AESOP) and the Clinical Record Interactive Search-First Episode Psychosis (CRIS-FEP) studies. The inclusion/exclusion criteria for case ascertainment for first episode psychosis were identical across the two studies. We performed multivariable logistic regression to estimate odds of compulsory admission by ethnic group, controlling for confounders.ParticipantsTwo hundred sixty-six patients with first episode psychosis, aged 18–64 years, who presented to mental health services in south London in 1997–1999 and 446 with FEP who presented in 2010–2012.ResultsWhen the two samples were compared, ethnic differences in compulsory admission appear to have remained the same for black African patients, i.e. three times higher than white British in both samples: AESOP (adj. OR = 3.96; 95% CI = 1.80–8.71) vs. CRIS-FEP (adj. OR = 3.12; 95% CI = 1.52–6.35). Black Caribbean patients were three times more likely to be compulsorily admitted in AESOP (adj. OR = 3.20; 95% CI = 1.56–6.54). This was lower in the CRIS-FEP sample (adj. OR = 1.68; 95% CI = 0.71–3.98) and did not meet conventional levels for statistical significance.ConclusionEthnicity is strongly associated with compulsory admissions at first presentation for psychosis with evidence of heterogeneity across groups, which deserves further research.
Highlights
With the passage of time, some ethnic minority groups and their succeeding generations are more integrated into UK society than others
Patients in the Clinical Records Interactive Search (CRIS)-first episode of psychosis (FEP) study were more likely to be educated to university level, live with family, and to have housing tenure of ‘Other’, i.e. refugee/homeless hostel, than patients in the AESOP study
In analyses of study time point (AESOP vs. CRIS-FEP) and compulsory admission, we found that the CRIS-FEP sample was less likely to compulsorily detained (n = 544), OR = 0.72; 95% CI = 0.61–0.84 and adj
Summary
With the passage of time, some ethnic minority groups and their succeeding generations are more integrated into UK society than others. Mental health service provision has changed in recent times, psychiatric hospital beds have substantially reduced [3, 4] and new services such as early intervention for psychosis in the community have been introduced [5]. Given these changes, it is unclear to what extent ethnicity. Several studies have shown that compulsory admissions during a first episode psychosis are more likely among minority ethnic group patients [6,7,8], relative to white British patients This evidence is strong for the black ethnic group patients, with odds ratios ranging from twofold to fourfold [6, 9]. In the UK for example, the government published a report on reducing the inequality in detention rates in the white paper ‘Delivering Race Equality in Mental Health Care’ [16]
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