Abstract
BackgroundSubstantial ethnic variations have been found in incidence, pathways to care and outcomes in psychosis. It is unknown whether these remain as marked in the presence of specialist Early Intervention Services (EIS) for psychosis. We present the first UK study exploring ethnic differences in compulsory detention and hospitalization rates for EIS patients. We investigated whether the excess rates of compulsory admission for people from Black groups have persisted following nationwide introduction of EIS. We also explored variations in compulsory admission for other ethnic groups, and differences by gender and diagnosis.MethodsFour inner-city London EIS teams gathered data from first-presentation psychosis patients between 2004–2009 using the MiData audit tool. Clinical, sociodemographic and pathways to care data were recorded regarding adult patients from eight different ethnic groups at entry to EIS and one year later.ResultsBlack African EIS service users had odds of being detained and of being hospitalised three times greater than White British patients, even after adjustment for confounders. This was most marked in Black African women (seven to eight times greater odds than White British women). A post-hoc analysis showed that pathways to care and help-seeking behaviour partially explained these differences.ConclusionThese findings suggest EIS input in its current form has little impact on higher admission and detention rates in certain Black and minority groups. There is a need to tackle these differences and engage patients earlier, focusing on the needs of men and women from the most persistently affected groups.
Highlights
Substantial ethnic variations have been found in incidence, pathways to care and outcomes in psychosis
For the analyses reported in this paper, only service users from the following self-ascribed ethnic groups were included: White British White Other (White service users with no parents born in the UK, includes White Irish) Mixed Black/White South Asian (Bangladeshi, Indian, Pakistani, Sri Lankan origin) Other Asian Black British (Black service users born in the UK) Black Caribbean (Black and born in the Caribbean) Black African (Black and born in Africa)
Those from other ethnic groups were excluded from the study as they belonged to ethnic groups represented in numbers too small to provide sufficient statistical power
Summary
Substantial ethnic variations have been found in incidence, pathways to care and outcomes in psychosis It is unknown whether these remain as marked in the presence of specialist Early Intervention Services (EIS) for psychosis. We present the first UK study exploring ethnic differences in compulsory detention and hospitalization rates for EIS patients. A greater risk of adverse pathways to, and contacts with, psychiatric services has been shown in BME patients [3,4] a source of concern to Importantly, significant differences in rates of compulsory detention and hospitalization have been demonstrated in studies of first-episode psychosis (FEP) populations, in the UK and beyond. Though results have shown some variation, the largest and most robust of these studies indicated that Black Caribbean men were 3.5 times more likely to be detained than their White British counterparts [3]. With regards to hospital admission, international studies have shown varied results [6,7,8]
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