Management of compulsorily admitted patients to a high security unit

Ideology, Camouflage or Contingency? Racism in British Psychiatry

"...Are we so sure that the racist form of intolerance results chiefly from the wrong ideas of this or that group of people about the dependence of cultural evolution on organic evolution? Might not these ideas be simply ideological camouflage for more concrete oppositions based on a desire to subjugate other groups and maintain a posi tion of power?"

Ethnicity and access to an inner city home treatment service: a case-control study

There is strong evidence suggesting ethnic variations in mental health service use and disproportionate numbers of people of black ethnic origin being admitted to hospital. The objective of this study was to establish whether people of black ethnic origin had equal access to home treatment in a mental health crisis. Using a case-control design, we selected a random sample of 240 inpatient episodes and compared them with a sample of 77 home treatment episodes over a 12-month period (1 April 2008-31 March 2009). We found no difference in the proportion of people of black ethnic origin being home treated in comparison to receiving an inpatient admission, although they experienced longer hospital admissions than people of other ethnic origin. Diagnosis, housing status and source of referral were found to be significant in influencing the choice of intervention in our multivariate analysis. People of black ethnic origin were found to use home treatment to the same extent as other ethnic groups in a mental health crisis, but further research is required for the early discharge function of home treatment teams to evaluate whether this aspect of care is experienced differently by different ethnic groups.

Multicultural mental health services: projects for minority ethnic communities in England

Black and minority ethnic (BME) communities form 7.8% of the total population of the U.K. Many of these communities face a variety of disadvantages when they access, or are forced to access, statutory mental health services under the National Health Service. Efforts have been made to address these problems by developing projects both within statutory mental health services and in the non-governmental ('voluntary') sector. This article describes some of these projects located in England, drawing out the themes and models that underlie their approaches, and discusses the lessons that can be learned from the U.K. experience.

Ethnicity and its relevance in a seven-year admission cohort to an English national adolescent medium secure health service unit

BACKGROUND

There is some research which variously suggests that adults from some ethnic minority groups in the UK may be disproportionately likely to attract certain psychiatric diagnoses, and, in turn, to be admitted to inpatient facilities and compulsorily detained there; there are concerns too about over-representation in the criminal justice system. Little such work has been done with adolescents.

AIMS

To determine the proportion of young people from ethnic minorities admitted to one UK specialist medium secure hospital unit for adolescents and describe their diagnoses.

METHODS

Data were extracted from the case records of all 61 young people admitted to this unit at any time between 1 April 1995 and 31 March 2002.

RESULTS

Inpatients from ethnic minority backgrounds were significantly over-represented when compared with National Census data. This was mainly accounted for by inpatients from Black African (11%) and Black Caribbean backgrounds (8%). There were, however, no within unit differences in final diagnoses between the ethnic groups.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Our findings confirm both a high overall proportion of young people from ethnic minorities using a national medium secure hospital service and considerable ethnic diversity within that. They are discussed in the context of one relevant national government initiative for improving responses to minority groups.

African and African Caribbean users' perceptions of inpatient services

It has been suggested that well-documented differences in African and African Caribbean people's contact with mental health services may stem from the organization, processes and practices of services themselves. This article presents the findings of a qualitative study which explored the inpatient experiences of a sample of African and African Caribbean people. Although some positive experiences were described, in the main, participants' accounts revolved around a sense of loss of control and around experiences of overt and implicit racism. Underpinning these experiences were relationships with staff that were perceived to be unhelpful. On the basis of both the positive and negative experiences described, we draw conclusions about the changes required to ensure that inpatient services more effectively meet the needs of this group.

The essential elements of culturally sensitive psychiatric services

The recent re-structuring of the British National Health Service (NHS) involving a greater emphasis on community treatment has not specifically taken account of the unequal access to mental health services experienced by black people. The greater use amongst black people of compulsory orders, police involvement and reliance on psychotropic medication, although well established, has not influenced policy or led to a strategy to ensure that services appropriately meet the needs of the culturally diverse population in this country. We present the literature on service utilisation by black people and emphasise potential solutions in areas with which black people are dissatisfied. The service structures, ideology and mechanisms presented form the foundations of good practice.

Psychiatric diagnosis and racial bias: empirical and interpretative approaches

Understanding of psychiatric illness among Britain's Black and ethnic minority population has shifted from an emphasis on cultural difference to one on racism within psychiatric theory and practice. In spite of this apparent turn, the explanations put forward remain within an empirical framework of methodological individualism, reflecting the background and training of British psychiatrists themselves. How racism may be actually demonstrated in individual clinical practice remains elusive. The standard hypotheses are examined here through a conventional clinical vignette study: this suggests medical education does not in itself now involve any specific racist psychiatric assumptions. Fuller understanding of the exercise of social power within this particular domain requires not only more complex interactive studies, preferably derived from a variety of clinical and social contexts, but a more developed interpretation of psychiatric practice and ideology within the social system.

Schizophrenia in British Afro-Caribbeans: two debates confused?

The concept and aetiology of schizophrenia remain controversial issues. Epidemiological studies reveal considerable variations in rates of diagnosed cases between groups. British Afro-Caribbeans show high rates. At the same time, their psychiatric experience is marked by a high level of conflict with the psychiatric services. The two debates--that surrounding the concept of schizophrenia, and that concerning the psychiatric experiences of British Afro-Caribbeans--need to be separated so that each receives appropriate consideration. Studies based on the experiences of people diagnosed as schizophrenic may confuse rather than advance the first debate if due care is not paid to the reliability of the diagnosis. The second debate has consequences for the development of psychiatric services. Further unaddressed questions referring to the mental health of ethnic minorities are suggested.