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Ethnicity and the Mental Health Act 1983\ud

By Swaran P. Singh, Nan Greenwood, Sarah White and Rachel Churchill

Abstract

Background Black and minority ethnic (BME) patients are disproportionately detained under the Mental Health Act 1983. There has been no systematic exploration of differences within and between ethnic groups, nor of the explanations put forward for this excess. \ud Aims To systematically review detention and ethnicity, with meta-analyses of detention rates for BME groups, and to explore the explanations offered for ethnic differences in detention rates. \ud \ud Method Literature search and meta-analysis. Explanations offered were categorised, supporting literature was accessed and the strength of the evidence evaluated. \ud \ud Results In all, 49 studies met inclusion criteria; of these, 19 were included in the meta-analyses. Compared with White patients, Black patients were 3.83 times, BME patients 3.35 times and Asian patients 2.06 times more likely to be detained. The most common explanations related to misdiagnosis and discrimination against BME patients, higher incidence of psychosis and differences in illness expression. Many explanations, including that of racism within mental health services, were not supported by clear evidence. \ud \ud Conclusions Although BME status predicts psychiatric detention in the UK, most explanations offered for the excess detention of BME patients are largely unsupported. \ud \u

Topics: HT, RA
Publisher: Royal College of Psychiatrists
Year: 2007
OAI identifier: oai:wrap.warwick.ac.uk:3760

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  1. (2001). A review of explanations for the excess of psychosis among the Afro-Caribbean population in England. doi
  2. (1983). A systematic review of research relating to the Mental Health Act doi
  3. (2003). Adapted from Bhui et al
  4. (1998). An association Secondary evidence: Callan & Littlewood
  5. (1990). An association Secondary evidence: Harrison et al (1984) as above Lewis et al
  6. (2004). An association Secondary evidence: None Webber & Huxley
  7. (1990). Are British psychiatrists racist? doi
  8. (1980). as above Owens et al
  9. (2003). Asian patients may fear disgrace or being unable to find a marriage partner. Primary evidence: None Secondary evidence: None
  10. (2004). Attitudes of mental health professionals and lay-people towards involuntary admission and treatment in England and Germany - a questionnaire analysis. European Psychiatry, doi
  11. (2005). Compulsory admission and treatment in schizophrenia: a study of ethical attitudes in four European countries. Soc Psychiatry Psychiatr Epidemiol, doi
  12. (1999). Dissatisfaction with admission process.
  13. (1992). Disturbed behaviour does not account for the excess. Primary evidence: There remained a significant association between ethnicity and compulsory detention, even after adjusting for disturbed behaviour.
  14. (2002). Does racial discrimination cause mental illness? doi
  15. (1997). Ethnic differences in satisfaction with mental health services among representative people with psychosis in south London: PRiSM study 4. doi
  16. (1999). Ethnicity and outcome of psychosis. doi
  17. (2002). Explanation Alienation with services/Dissatisfaction /Negative perception of services/Mistrust Audini & Lelliott
  18. (1999). Explanation: Attitudes to mental illness and perception of roles of services Goater et al
  19. (2002). Explanation: Black patients have greater contact with the police Audini & Lelliott
  20. (1997). Explanation: Black people’s ‘social life’ takes place more often in public Koffman et al
  21. (1999). Explanation: Different explanatory models of illness Commander et al
  22. (1999). Explanation: Different expression of illness - more challenging behaviour/violence Goater et al
  23. (1997). Explanation: Differing cultural norms of behaviour Browne
  24. (1994). Explanation: Ethnic disadvantage due to societal racism McGovern et al
  25. (1995). Explanation: Higher prevalence/ diagnosis of psychosis/schizophrenia amongst Black patients Anderson & Parrott
  26. (1998). Explanation: Less compliance with medication Singh et al
  27. (1992). Explanation: Misdiagnosis, under-recognition of psychiatric disturbance, lower likelihood of referral to specialist services Crowley & Simmons
  28. (1998). Explanation: Racial stereotyping, labelling and discrimination including differential management of patients Takei et al
  29. (1992). Explanation: Services not be meeting the needs of ethnic minorities
  30. (1983). gender and ethnicity of those detained under Part II of the Mental Health Act doi
  31. (1988). How many beds? A survey of needs for treatment and care in an in-patient unit. doi
  32. (1977). Inception rates for all diagnostic categories except reactive depression and paranoid states were significantly higher among West Africans than West Indians than the British.
  33. (1994). Incidence of psychotic illness in London:comparison of ethnic groups. doi
  34. (1994). Inner London collaborative audit of admissions in two health districts. II: Ethnicity and the use of the Mental Health Act. doi
  35. (2001). Institutional racism in British psychiatry. doi
  36. (2001). Is there a racial bias in clinicians' perceptions of the dangerousness of psychiatric patients? A review of the literature. doi
  37. Littlewood & Lipsedge (1981b) – Concluded the excess diagnosis of schizophrenia might be accounted for at least partially by the occurrence of acute psychotic reactions which are diagnosed as schizophrenia.
  38. (1996). Mental health and ethnic minorities: A review of the literature and implications for services.
  39. (2003). Misdiagnosis of Asian patients as having a physical illness.
  40. (2004). Negative pathways to psychiatric care and ethnicity: the bridge between social science and psychiatry. Social Science and Medicine, doi
  41. (1995). No primary evidence about satisfaction was provided.
  42. (1999). Outcome of psychosis in people of African-Caribbean family origin. Population-based first-episode study. doi
  43. (1995). Pathways to care for patients with a first episode of psychosis. A comparison of ethnic groups. doi
  44. (1992). Patient dissatisfaction shaped by previous experience leading to later presentation.
  45. (1991). Perception of psychiatric services as racist, coercive and inappropriate to their needs.
  46. (1992). Perception of services as inaccessible.
  47. (1995). Perception of services as un-therapeutic, with delayed help-seeking.
  48. (1991). Police involvement leading to a cycle of disengagement Primary evidence: None Secondary evidence: None Turner et al (1992) Police behaviour – e.g. ‘stop and search’.
  49. (1999). Primary evidence: An association Secondary evidence: None Owens et al
  50. (1991). Primary evidence: An association Secondary evidence: None Singh et al
  51. (1999). Primary evidence: An association Secondary evidence: Perkins & Moodley
  52. (1994). Primary evidence: High detention rate can be explained by strong interaction between diagnosis and challenging behaviour, but not ethnicity. No interaction between ethnicity and challenging behaviour.
  53. (1986). Primary evidence: None Secondary evidence: Bean
  54. (1994). Primary evidence: None Secondary evidence: Bebbington et al
  55. (1987). Primary evidence: None Secondary evidence: Burke
  56. (1999). Primary evidence: None Secondary evidence: Burnett et al
  57. (2004). Primary evidence: None Secondary evidence: Cochrane
  58. (1994). Primary evidence: None Secondary evidence: Commander et al (1997a) – as above McGovern et al
  59. (1990). Primary evidence: None Secondary evidence: Cope & Ndegwa
  60. (1992). Primary evidence: None Secondary evidence: Dean et al
  61. (1990). Primary evidence: None Secondary evidence: Dunn & Fahy
  62. (2004). Primary evidence: None Secondary evidence: Fernando
  63. (1989). Primary evidence: None Secondary evidence: Francis et al
  64. (1999). Primary evidence: None Secondary evidence: Goldberg
  65. (1989). Primary evidence: None Secondary evidence: Harrison et al
  66. (1987). Primary evidence: None Secondary evidence: Hitch & Clegg
  67. (1997). Primary evidence: None Secondary evidence: Koffman et al
  68. (1994). Primary evidence: None Secondary evidence: Lewis et al
  69. (1991). Primary evidence: None Secondary evidence: Littlewood
  70. (1994). Primary evidence: None Secondary evidence: None Bebbington et al
  71. (1990). Primary evidence: None Secondary evidence: None Bowl & Barnes
  72. (1992). Primary evidence: None Secondary evidence: None Crowley & Simmons
  73. (1992). Primary evidence: None Secondary evidence: None Davies et al
  74. Primary evidence: None Secondary evidence: None Law-Min et al (2003) Asian patients may delay seeking help by going to traditional healers.
  75. (1994). Primary evidence: None Secondary evidence: None McGovern et al
  76. (1991). Primary evidence: None Secondary evidence: None Owens et al
  77. (1998). Primary evidence: None Secondary evidence: None Singh et al
  78. (1999). Primary evidence: None Secondary evidence: Odell et al
  79. (2002). Primary evidence: None Secondary evidence: Wall et al
  80. (1994). Primary evidence: None Secondary evidence: Wilson & McCarthy
  81. (1996). Psychotic illness in ethnic minorities: clarification from the 1991 census. doi
  82. (2006). Race and Mental Illness: There is More to race than Racism. doi
  83. (2002). Racism and mental health prejudice and suffering: Kingsley Publishers, doi
  84. (1991). Racism in psychiatry and insensitivity to cultural differences.
  85. (1999). Racism in psychiatry necessitates reappraisal of general procedures and Eurocentric theories. doi
  86. (1988). Reference to a conference presentation was unavailable. Takei et al
  87. (2000). Reform of the Mental Health Act. Health or safety? doi
  88. (2002). Relation between racial discrimination, social class, and health among ethnic minority groups. doi
  89. (1997). Secondary evidence: None Browne
  90. (1999). Secondary evidence: None Commander et al
  91. (1996). Secondary evidence: None Law-Min et al (2003) Primary evidence: None Secondary evidence: Lloyd & St Louis
  92. (1991). Secondary evidence: None Moodley & Perkins
  93. Secondary evidence: None Morgan et al (2005) Perceived risk and diagnosis do not account for the excess. Primary evidence: Higher detention rates could not be explained by perceived risk or diagnosis.
  94. (2001). Secondary evidence: None Riordan et al (2004) Primary evidence: None Secondary evidence: Sharpley et al
  95. (2001). Social Factors and Schizophrenia and Afro-Carribbeans.
  96. (1998). Specific prejudice against Afro-Caribbeans with schizophrenia but not those with manic depression.
  97. (1995). Study site Sample source Sample size n= MHA sections
  98. (1992). suggest that this might be an explanation but no evidence provided. Law-Min et al (2003) due to differences in social support.
  99. (2001). Survey of patients from an inner-London health authority in medium secure psychiatric care. doi
  100. (2005). Systematic review of publication bias in studies on publication bias. doi
  101. (2001). Systematic reviews in health care: Investigating and dealing with publication bias and other biases in meta-analysis. doi
  102. (1999). The first contact of patients with schizophrenia with psychiatric services: social factors and pathways to care in a multi-ethnic population. doi
  103. (2004). The imposition of restricted hospital orders: Potential effects of ethnic origin. doi
  104. (1991). The risk of schizophrenia was greater in those of Afro-Caribbean ethnicity, irrespective of age, gender or place of birth.
  105. (1986). the Royal College of Psychiatrists, doi
  106. (1997). There were no differences in satisfaction with services between Black and other first episode schizophrenic patients but there were some differences between their relatives. This was an association.
  107. (1995). Urgent psychiatric transfers from prison in England and Wales: A prison perspective. Criminal Behaviour and Mental Health,
  108. (1995). Variables associated with social support were more important than ethnicity in determining pathways to care.
  109. (1981). When compulsorily admitted patients were compared with voluntary ones, there was an association between living alone, being friendless and having had no contact with a relative over the last 6 months. However, these authors did not look at ethnicity.

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