Detention Rates Research Articles

Decision-Making Behaviour under the Mental Health Act 1983 and Its Impact on Mental Health Tribunals: An English Perspective

In England and Wales, the Mental Health Act 1983 (MHA 1983) provides the legal framework which governs decisions made concerning the care and treatment of those suffering from mental disorders, where they may pose a risk to themselves or others. The perspective of the patient and the care provider may conflict and can be a source of tension and challenge within mental health law. Through access to a mental health tribunal, patients are offered the apparatus to review and challenge their detention. With detention rates under the mental health legislation rising exponentially, this is having a knock-on effect upon tribunal application numbers. As there is a legal requirement to review all cases of individuals detained under the MHA 1983, understanding the key drivers for this increase in detention is essential in order to understand how to better manage both detention rates and the upsurge in tribunal caseloads. With the increase in overall activity, mental health tribunal workloads present significant practical challenges and has downstream cost implications.

Trans-migrations: Agency and Confinement at the Limits of Sovereignty

Intersectional analyses of gender, sexuality, and migrations have been central to feminist and queer theorizations of the state in historical perspective. In the twenty-first century, mounting deportations and mass incarceration—mostly of brown and black men—have elicited growing scholarly concern about the intersections of gender, race, and increased state coercive power under neoliberalism, including the emerging field of detention studies. However, the increasing displacement of trans subjects in the Americas, and what their embodied experiences of migration tell us about the changing nature of state sovereignty at the border and beyond, remains undertheorized. Based on participant observation and interviews conducted with chicas trans at migrant shelters in Mexico, this study sheds light on how gender and geographical transitions shape each other, blurring distinctions of shelter and homelessness, motion and boundedness, and freedom and unfreedom. It reveals counterintuitive inversions and sites of confinement beyond the walls of strictly carceral facilities, even as rates of migrant detention and imprisonment have increased dramatically in both Mexico and the United States in the past few years. Drawing on these findings, I propose the notion of “confinement in motion,” a state that persists even when the subject is not traveling through space in an ordinary sense. I further argue that, while the requirements of global accumulation continuously set people in motion, migratory flows have not remained undisciplined but have been incorporated into contemporary global governance through a carceral regime of sovereignty that exceeds the state.

Approved Mental Health Professionals and Detention: An Exploration of Professional Differences and Simularities

The enactment of the Mental Health Act (MHA) 2007 introduced the role of the multidisciplinary Approved Mental Health Professional (AMHP) in England and Wales by amending The MHA 1983. The role can now be performed by a range of professionals including a psychologist, an occupational-therapist, a social worker or a mental-health/learning difficulties nurse. This amendment amongst other legal provisions replaced the earlier Approved Social Worker role. This is an exploratory qualitative research that aimed to identify if the decision-making relating to management and assessment of risk varied according to the professional background of the AMHP. The decision-making of 10 social work and 10 nursing AMHPs were examined through the use of an experimental vignette containing audio-visual and written materials in order for participants to reach a decision about whether or not to detain. Proposed detention rates between social work and nurse AMHPs were identical although variation was found across the whole sample in terms of the risks that were identified in the vignette. The paper concludes by arguing that these results suggest that differences in the way AMHPs reach decisions may well relate to a variety of individual differences rather than reflecting initial professional identity and training as so often argued in the literature.

Twenty Years after IIRIRA: The Rise of Immigrant Detention and its Effects on Latinx Communities across the Nation

This paper studies the dynamics of detention, deportation, and the criminalization of immigrants. We ground our analyses and discussion around the Illegal Immigration Reform and Immigrant Responsibility Act of 1996's (IIRIRA's) detention mandate, the role of special interest groups and federal policies. We argue that these special interest groups and major federal policies have come together to fuel the expansion of immigrant detention to unprecedented levels. Moreover, we aim to incite discussion on what this rapid growth in detention means for human rights, legislative representation and democracy in the United States. This study analyzes two main questions: What is the role of special interests in the criminalization of immigrants? And does the rapid increase in detention pose challenges or risks to democracy in the United States? Our study is grounded within the limited, yet growing literature on immigrant detention, government data, and “gray” literature produced by nonprofits and organizations working on immigration-related issues. We construct a unique dataset using this literature and congressional reports to assess what factors are associated with the rise of immigrant detention. A series of correlations and a time series regression analysis reveal that major restrictive federal immigration policies such as IIRIRA, along with the increasing federal immigration enforcement budget, have had a significant impact on immigrant detention rates. Based on these findings, we recommend three central policy actions. First, the paper recommends increased transparency and accountability on behalf of the Department of omeland Security, Immigration and Customs Enforcement, and on lobbying expenditures from for-profit detention corporations. Second, it argues for the repeal of mandatory detention laws. These mandatory laws have led to the further criminalization and marginalization of undocumented immigrants. And lastly, it argues that repeal of the Congressional bed mandate would allow for the number of detainees to mirror actual detention needs, rather than providing an incentive to detain. However, we anticipate that the demand for beds will increase even more given the current administration's push for the criminalization and increased arrests of undocumented individuals. The rhetoric used by the present administration further criminalizes immigrants. 1

HOUSEHOLD INCOMES AND EXPENDITURES: DOMESTIC REALITIES AND FOREIGN EXPERIENCE

Introduction. Household finances in Ukraine are unbalanced. Households are losing a significant part of their income due to inefficient allocation of available savings. This is the result of the drawbacks in the functioning of the Ukrainian stock market. Social transfers as a lion's share of domestic household income, are redistributed with a violation of targeting principles, and the detention rates of the population are formed. The size of state social guarantees and standards does not correspond to the average European values. Macroeconomic conditions for development of household finances, in particular the inflationary processes in economy are also unfavorable. The purposeof the article is to analyze foreign experience and domestic realities of formation and use of household finances, to carry out a comparative description of the obtained results. It is also aimed at developing a strategy for the comprehensive improvement of domestic household finances on the basis of the analyzed foreign experience. Methods. In the article research methods of analyzis, synthesis, grouping and generalization have been applied in analyzing of population income and expenditure, aggregate financial resources of households. Methods of induction, deduction and analogy have been used for forming a strategy of the comprehensive improvement of household finances. Results. The analysis indicated that the main sources of household incomes are income from employment, wages in particular and entrepreneurship. Moreover, the share of wage earnings is comparable to the foreign one, however, in the part of self-employment and entrepreneurial activity there is a discrepancy of 4-6% versus 10-18%. The share of social transfers in the income of domestic households varies from 20 to 27% and is quite comparable with foreign countries. Income from households in Ukraine is 0.8-1.0%, while in other countries it is 6-10%. The problem is that domestic households are not fully acquainted with the potential of the securities market. Domestic households, in comparison with foreign ones, receive significant financial assistance from relatives and other households, also from abroad. The prevailing part in the structure of household expenditure is directed towards consumption. The share of non-consumption expenditures of domestic households (8-10%) is lower than that of households in the EU (15-30%). Savings of domestic households (1.5-3%) are much less than savings of foreign households (10-15%) due to the crisis of the domestic banking system, distrust of the population to banking and non-bank financial and credit institutions. Conclusions. The strategy of comprehensive improvement of domestic household finances has been suggested. It consists of the general strategy and is applicable at the national level and at the level of individual households. The strategic tasks are stabilization and growth of economy; social responsibility of business; stock market development; increase of state social standards and guarantees.

Review of Mental Health Act must address excessive detention rates

British Journal of Healthcare ManagementVol. 23, No. 11 CommentReview of Mental Health Act must address excessive detention ratesAlistair QuaileAlistair QuaileSearch for more papers by this authorAlistair QuailePublished Online:15 Nov 2017https://doi.org/10.12968/bjhc.2017.23.11.513AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View articleReferences BBC News. Ministers lose Mental Health vote. [Online]. 2007. [Cited on 25 Oct 2017]. Available from: http://news.bbc.co.uk/1/hi/uk_politics/6374547.stm Google Scholar Department of Health. Thousands of new roles to be created in mental health workforce plan. London: The Stationery Office; 2017 Aug 30 [cited 2017 Oct 18]. Available from https://publichealthmatters.blog.gov.uk/2017/08/30/moving-forward-with-the-prevention-of-mental-health-problems/ Google Scholar Health Education England. Stepping forward to 2020/21: The mental health workforce plan for England. Leeds: Health Education England; 2017 [cited 2017 Oct 18]. Available from https://www.hee.nhs.uk/sites/default/files/documents/CCS0717505185-1_FYFV%20Mental%20health%20workforce%20plan%20for%20England_v5%283%29.pdf Google Scholar Independent Police Complaints Commission. Mental health and police custody [Internet]. Sale: IPCC; 2017 [cited 2017 Oct 19]. Available from https://www.ipcc.gov.uk/page/mental-health-police-custody Google Scholar May T. Theresa May's Conservative conference speech, full text [Internet]. London: The Spectator; 2017 Oct 4 [cited 2017 Oct 18]. Available from https://blogs.spectator.co.uk/2017/10/theresa-mays-conservative-conference-speech-full-text/ Google Scholar Mental Health Taskforce. The Five Year Forward View for Mental Health. Leeds: NHS England; 2016. Google Scholar NHS Digital. Inpatients formally detained in hospitals under the Mental Health Act 1983, and patients subject to supervised community treatment. Uses of the Mental Health Act: Annual Statistics, 2015/16. London: Health and Social Care Information Centre; 2016. Google Scholar Royal College of Nursing. RCN responds to Mental Health Workforce Plan. London: RCN; 2017 [cited 2017 Oct 18]. Available from https://tinyurl.com/yavm3ulq Google Scholar Wessely S. The Prime Minister Has Asked Me To Lead A Review Of The Mental Health Inequality In Britain - Here's Why. London: The Huffington Post; 2017 Oct 6 [cited 2017 Oct 19]. Available from http://www.huffingtonpost.co.uk/professor-sir-simon-wessely/mental-health-act_b_18192476.html Google Scholar FiguresReferencesRelatedDetails 2 November 2017Volume 23Issue 11ISSN (print): 1358-0574ISSN (online): 1759-7382 Metrics History Published online 15 November 2017 Published in print 2 November 2017 Information© MA Healthcare LimitedPDF download

Rethinking Bail Reform

The monetary bail procedures the criminal justice system employs for detaining defendants before trial, when they are cloaked with the presumption of innocence, have come under increasing criticism of late. Legal scholars and social scientists alike are uniform in their belief that monetary bail systems are expensive, unjust, and do little to further public safety or to ensure a defendant’s return to court. Burgeoning scientific research has led to the creation of evidence-based risk assessment tools designed to predict a defendant’s recidivism risk and to reduce detention rates for defendants being held on bonds they cannot afford. But, thus far, the consensus approach to achieving bail reform has focused on litigation-based, one-size-fits-all solutions that are limited in scope. This Article calls into question the notion that litigation is the sole and superior approach for achieving bail reform. It discusses the history of the American bail system and surveys current scholarly critiques of the system of money bond, as well as recent and pending lawsuits challenging standard bail schedules and the imposition of money bonds in cases of non-violent misdemeanors. The Article then focuses on the limitations of bail reform litigation and the obstacles to achieving reform through the courts. Using specific examples where reform has been achieved outside of litigation, the Article also discusses possible extra-judicial alternatives for holistic bail reform, including community bail funds, travel assistance programs, and legislative amendments. It concludes that, while litigation may be an effective tool for eliminating monetary bonds in certain jurisdictions, the better and more comprehensive approach for bail reform is one that employs both judicial and extra-judicial strategies.

Compulsory admissions in southwest Greece 2010-2011: A descriptive report.

Compulsory admissions represent a significant proportion of psychiatric hospitalizations. A wide variation seems to exist internationally regarding legal frameworks, administrative procedures, detention rates and clinical practice. The aim of the present study is to describe qualitative and quantitative features of compulsory admissions in a large administrative area in southwest Greece, in order to identify targets for future research and possible remediation. Involuntary assessments and admissions in the Department of Psychiatry of the University Hospital of Patras were retrospectively assessed, during a 12-month period, for demographic features and data regarding legal procedures. Diagnoses following compulsory first assessment and at discharge were recorded for the patients who were admitted in our department. During the period of observation, 218 compulsory assessments were made, corresponding to 190 patients and resulting in 183 compulsory admissions. Thirty five cases (16.1%) were assessed as not justifying hospitalization and corresponded mainly to the diagnoses of alcohol and/or substance abuse or dependence. Involuntary hospitalizations represented 44.9% of all psychiatric admissions in our department. Diagnosis at first assessment was most frequently psychosis (68.4%). Diagnoses at discharge were most often schizophrenia (52.8%) and bipolar disorder (21.3%). A history of multiple hospitalizations (>5) was observed in 17 (15.8%) patients, whereas 46 patients (42.6%) were hospitalized for the first time, and 13 (11.7%) exhibited their first psychotic episode. Of the 108 patients who were admitted in our department, 88 (81.5%) declared that they did not wish to attend the court hearing, 7 (6.5%) were not able to attend due to severe health condition, and only 13 (12.0%) actually presented in court. Concluding, current situation regarding legal procedures, involuntary admissions and mental health care in Greece is rather far from satisfying. Future directions should include the systematic recording of mental health care parameters, such as compulsory hospitalizations, as well as efforts to improve these parameters and the existing legal framework and procedures.

The Unintended Impact of Pretrial Detention on Case Outcomes: Evidence from New York City Arraignments

In the United States, over 400,000 individuals are in jail daily waiting for their criminal cases to be resolved. The majority of detainees are held because they cannot post bail. We estimate the impact of being detained pretrial on the likelihood of being convicted and sentence length using data on nearly a million criminal cases in New York City. Causal effects are identified using variation across arraignment judges in their propensities to detain defendants. We find that being detained increases the probability of conviction by 13 percentage points for felony defendants. Although pretrial detention lowers the probability of rearrest while cases are being adjudicated, this reduction in criminal activity is mostly offset by an increase in recidivism within 2 years after disposition. Higher pretrial detention rates among minority defendants explain 40 percent of the black-white gap in rates of being sentenced to prison and 28 percent of the Hispanic-white gap. Excessive bail shall not be required, nor excessive fines imposed, nor cruel and unusual punishments inflicted. (US Constitution, Eighth Amendment)

Referrals and outcomes of assessment for compulsory admission under the mental health act 1983 in Norfolk, England

IntroductionA significant number of people are not detained in hospital following assessment under the Mental Health Act 1983 (MHA) for possible detention. However, since amendments in 2007, some studies show an increase in total patient detentions. There is currently a lack of published research describing both outcomes and their affecting variables.ObjectivesTo determine rates, outcomes and affecting variables of MHA assessments in Norfolk, 2001–2011.MethodsThis observational study involved data collection from all 11,509 referrals for detention assessment under the MHA. Data was collected by Norfolk Social Services from 2001–2011 including age, gender and marital status.ResultsFollowing assessment, 6903 (60.0%) were admitted; of those, 1157 (16.8%) were voluntary and 5746 (83.2%) were detained; 4606 (40%) were not admitted. Admission rates for males (50.4%) and females (49.5%) were similar. Detention rates increased with age: 37.6% of < 18s; 47.1% of 18–64s and 61.4% of 65+. A greater proportion of married (57.5%) and widowed patients (58.2%) were detained, compared with patients who were single (48%). Accommodation status showed 52% of those living with other were detained versus 43.9% of those with no fixed abode.ConclusionsThe finding that a higher proportion of married than single people, and of those living with others versus living alone, were detained following assessment is unexpected but significant and needs further investigation.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Chavism and Criminal Policy in Venezuela, 1999-2014

For a long time, the Venezuelan democracy was an exception in South America due to a party system that was based on what was known as the ‘Punto Fijo Pact’. At the start of the 1980s a series of economic, social and political events began to occur, which caused this ‘exceptionalism’ to stagger and disrupt the institutionality of the traditional Venezuelan democratic State. The events led to a deep national crisis and the birth of a new political era. By the end of the 1990s, there had been a significant shift towards left-wing governance. Hugo Chávez Frías subsequently won the presidential elections in 1998. This paper analyzes some aspects of the criminal policies that were implemented during the reign of left-wing leader Chávez till his death in 2013 and thereafter by Chavist party president elect, Nicolás Maduro during 2013-2014. Four stages can be identified in the behavior of incarceration rates. The first stage, from 1999 to 2000, was characterized by the lowest recordings of incarceration rates and the lowest measured percentage of preventive detention in Venezuela in thirty years. The second stage, from 2001 to 2005, saw a slight increase in the incarceration rate which then remained stable. The third stage, from 2006 to 2012, and the fourth stage, from 2013 to 2014, are characterized by sustained increases in preventive detention, incarceration and murder rates.

The Pre-Cautionary Culture: Interpassivity and Radical Prevention in the Making of Canada's Remand Crisis

There is a remand crisis in Canada. Pre-trial detention rates have nearly tripled in the past thirty years and today, of the 25,208 adults detained in Canada’s provincial and territorial jails, over half are remand prisoners (54.5%) (Porter & Caverley, 2011; Dauvergne, 2012). These trends cannot be attributed to rising crime rates nor the absence of legislation governing the use of pre-trial detention. Both the crime rate and the violent crime rate have been on a steady decline for over the last 20 years (Boyce, Cotter & Perreault, 2014). Further, the legal framework guiding bail in Canada, as established by the Criminal Code (S. 515) and the Canadian Charter of Rights and Freedoms (S.11(e)), mandates the presumption of release, absent conditions, unless the Crown can show just cause as to why conditional bail or the detention of the accused is justified (Meyers & Dhillon, 2013). It would seem that the remand problem in Canada may be arising from the abstract nature of the federal legislation being translated into practice in an ad hoc manner across the provinces and territories (The Canadian Civil Liberties Association, 2014).

Does a home treatment acute relapse prevention strategy reduce admissions for people with mania in bipolar affective disorder?

Aims and method To assess whether a home treatment team acute relapse prevention (ARP) strategy reduces admissions to hospital with mania. A retrospective design was used to analyse records for manic admissions since 2002. The number and length of admissions and detentions pre- and post-ARP were determined and rates of admissions and detentions calculated from this.Results We found reductions in admission and detention rates following the introduction of the ARP: 0.3 fewer admissions per person per year (95% bootstrap CI 0.09–0.62) and 0.25 fewer detentions per person per year (95% bootstrap CI 0.0–0.48). Wilcoxon signed-rank tests gave P<0.0001.Clinical implications A person-centred care plan such as the ARP which enables quick action in response to relapse-warning signs of mania appears to reduce rates of admission to hospital. The ARP could be used anywhere in the UK and fits with current mental health policy.

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

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.

Using Ethnographic Methods to Strengthen Quantitative Data – Explaining Juvenile Detention Rates in Three Australian States

Those advocating mixed methods research have long believed that ethnographic methods can strengthen quantitative data. This paper explores some practical and philosophical issues through considering a study that seeks to explain differences in detention rates between children’s courts in three Australian states (Tasmania, Victoria and New South Wales), primarily through observing sentencing hearings. It starts by considering whether the lower rate in Victoria indicates that magistrates are more lenient or, alternatively, that young people commit fewer offences in this state. The paper demonstrates, through comparing cases with similar features, that Victoria is more tolerant. Qualitative research can also suggest ways of developing a quantitative analysis by identifying significant potential differences within states and between decision makers. The paper also considers the strengths and limitations of court culture as an explanatory causal variable, and the alternative approach to comparison suggested by the interpretive tradition.

The Impact of a Risk Assessment Instrument on Juvenile Detention Decision-making: A Check on “Perceptual Shorthand” and “Going Rates”?

This study assesses the impact of a juvenile detention risk assessment instrument (RAI) on decision-making in five New Jersey counties. It uses a pretest–posttest design, drawing on a sample of decisions matched across time periods using propensity scores (N = 1,432). It suggests that the RAI, supported by other reforms, lowers overall rates of detention. Though evidence is not strong, findings suggest the RAI may have reduced reliance on “perceptual shorthand” variables reflected in the juvenile’s age and the time of day of the decision. There is stronger evidence that the RAI increased reliance on the specific factors contained within its risk score. There is also evidence that RAI reduced disparities in detention rates across counties, perhaps by diminishing the importance of “going rates” for detention, rooted in local courtroom workgroups.

The Impact of Gender on the Processing of Probation Violations and Contempt: A Study of One Juvenile Court

There is substantial evidence to suggest that in at least some contexts juvenile court judges are circumventing the proscription contained in the Juvenile Justice and Delinquency Prevention Act (“JJDPA”), which prohibits the secure confinement of status offenders, by securely detaining status offenders for contempt. Some evidence also indicates that gender may influence whether a juvenile is detained as a result of violating a valid court order. This study seeks to expand existing research by examining what happens to court order violators beyond detention and by explicitly comparing the treatment of court order violators with the treatment of probation violators in terms of detention, adjudication and confinement to shed light on how gender influences these decision points. While high rates of detention and commitment were uncovered, these results do not suggest that females were more likely to experience these consequences than males.

High rates of police detention among recently released HIV-infected prisoners in Ukraine: Implications for health outcomes

BackgroundUkraine's HIV epidemic, primarily affecting people who inject drugs (PWID), is expanding and transitioning despite free opioid substitution therapy (OST) and antiretroviral therapy (ART), two effective ways to reduce HIV transmission. Police detention of PWID not resulting in a formal charge or imprisonment is common, but its prevalence and impact on health are not known. MethodHIV-infected individuals (N=97) released from prison within one year were recruited and surveyed in two HIV-endemic Ukrainian cities about post-release police detention experiences. Data on the frequency of police detention, related adverse events, and impact on OST and ART continuity were collected, and correlates of detention were examined using logistic regression. ResultsDetention responses were available for 94 (96.9%) participants, of which 55 (58.5%) reported police detentions (mean=9.4 per person-year). For those detained while prescribed OST (N=28) and ART (N=27), medication interruption was common (67.9% and 70.4%, respectively); 23 of 27 participants prescribed OST (85.2%) were detained en route to/from OST treatment. Significant independent correlates of detention without charges included post-release ART prescription (AOR 4.98, p=0.021), current high-risk injection practices (AOR 5.03, p=0.011), male gender (AOR 10.88, p=0.010), and lower lifetime months of imprisonment (AOR 0.99, p=0.031). ConclusionsHIV-infected individuals recently released from prison in Ukraine experience frequent police detentions, resulting in withdrawal symptoms, confiscation of syringes, and interruptions of essential medications, including ART and OST. Structural changes are urgently needed to reduce police detentions in order to control HIV transmission and improve both individual and public health.

The role of ethnicity and diagnosis in rates of adolescent psychiatric admission and compulsory detention: a longitudinal case-note study

To explore whether ethnic variations in psychiatric admission and detention reported for adults also apply to adolescents and to establish the influence of diagnosis. A longitudinal, case-note study over a 10-year period. An adolescent inpatient psychiatric unit in London. All adolescents admitted to the unit. Rates of admission and detention under the Mental Health Act, according to catchment area population. Young Black people were nearly six times more likely than the White group to be admitted with psychosis but showed no increase in admission for non-psychotic conditions. Young people in the Other group were over three times more likely to be admitted with psychosis but showed only a modest increase in admission with non-psychotic conditions. Young Asians were over twice as likely to be admitted with psychosis but were only one-third as likely to be admitted with non-psychotic conditions. Young people with psychosis in the Black and Other groups were around three times more likely to have been detained, but there were no significant differences for non-psychotic conditions. Significant ethnic variation was found in the rates of admission and detention for adolescents. However, diagnosis was also an important consideration and must be taken into account when examining for evidence of ethnic bias in the use of mental health services by young people. Further investigation is required to establish whether adolescent care pathways are providing a safe and appropriate level of inpatient care for all ethnic groups.

THERACOM: a systematic review of the evidence base for interventions to improve Therapeutic Communications between black and minority ethnic populations and staff in specialist mental health services

BackgroundBlack and Minority Ethnic (BME) groups in receipt of specialist mental health care have reported higher rates of detention under the mental health act, less use of psychological therapies, and more dissatisfaction. Although many explanations have been put forward to explain this, a failure of therapeutic communications may explain poorer satisfaction, disengagement from services and ethnic variations in access to less coercive care. Interventions that improve therapeutic communications may offer new approaches to tackle ethnic inequalities in experiences and outcomes.MethodsThe THERACOM project is an HTA-funded evidence synthesis review of interventions to improve therapeutic communications between black and minority ethnic patients in contact with specialist mental health services and staff providing those services. This article sets out the protocol methods for a necessarily broad review topic, including appropriate search strategies, dilemmas for classifying different types of therapeutic communications and expectations of the types of interventions to improve them. The review methods will accommodate unexpected types of study and interventions. The findings will be reported in 2013, including a synthesis of the quantitative and grey literature.DiscussionA particular methodological challenge is to identify and rate the quality of many different study types, for example, randomised controlled trials, observational quantitative studies, qualitative studies and case studies, which comprise the full range of hierarchies of evidence. We discuss the preliminary methodological challenges and some solutions. (PROSPERO registration number: CRD42011001661).