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Knight S, Yang XQ, Jarvis GE. "Dem sey mi mad": a scoping review of the attitudes and beliefs of English-speaking Afro-Caribbeans about psychosis. Front Psychiatry 2024; 15:1385525. [PMID: 39224480 PMCID: PMC11366823 DOI: 10.3389/fpsyt.2024.1385525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 06/24/2024] [Indexed: 09/04/2024] Open
Abstract
Introduction The mental health disparities suffered by the English-speaking Afro-Caribbean diaspora living with psychosis in North America and the United Kingdom have been well described for decades, but the root causes of these disparities remain poorly understood. Part of the problem may be that the attitudes and beliefs of Caribbean communities regarding psychosis have never been systematically assessed. Such an inquiry could lay the foundation for changes to how psychiatric services for psychosis are implemented with migrant Caribbean communities. The ideal would be a re-design of services, or cultural adaptation of care, based on input from community members, patients, and their families, with the hope that disparities of care would be reduced or eliminated as clinicians co-create interventions that are more appropriate and acceptable to Caribbean people. To lay the groundwork of such an important endeavor, we investigated the shared attitudes, beliefs, experiences, practices, and traditions of English-speaking Afro-Caribbean people in relation to psychosis and psychiatric care. Methods We conducted a scoping review by searching Medline, PsychINFO and Scopus, reviewing 764 articles, and selecting 220 for thematic content analysis. Results We highlighted the heterogeneity in the Caribbean diaspora living in North America and the UK. Five principal themes emerged: (1) The enduring effects of colonialism on the psychiatric care of Afro-Caribbean migrants; (2) The effects of adaptation to migration on the experience of psychosis; (3) Pervasive cultural mistrust of psychiatry and mental health institutions; (4) A collective approach to life; and (5) The role of religion and spirituality in the understanding of psychosis. Conclusion Historical, sociocultural, and geopolitical themes characterize the English Afro-Caribbean experience of psychosis and inform culturally adapted clinical interventions for patients with psychosis and their families. Careful attention to these adaptations will reduce clinical bias and misdiagnosis, optimize adherence to treatment, engage patients and families in recovery, and ultimately, reduce treatment disparities while empowering Afro-Caribbean people and their communities. By bringing forward the themes in this chapter, individual clinicians will be given tools to change how they work with Caribbean people with psychosis in addition to laying the foundation for higher order changes in the mental health professions and society as a whole.
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Affiliation(s)
- Sommer Knight
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Xin Qiang Yang
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - G. Eric Jarvis
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Culture and Mental Health Research Unit, Institute of Community and Family Psychiatry, Jewish General Hospital, Montreal, QC, Canada
- Division of Social and Transcultural Psychiatry, McGill University, Montreal, QC, Canada
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Gibbon S, McPhail E, Mills G, McBride M, Storer R, Taylor N, McCarthy L. Uptake of COVID-19 vaccination in a medium secure psychiatric hospital population. BJPsych Open 2021; 7:e108. [PMID: 34059167 PMCID: PMC8167253 DOI: 10.1192/bjo.2021.924] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Patients in medium secure hospitals may be at particularly increased risk of coronavirus disease 2019 (COVID-19) infection and complications. We undertook a service evaluation involving all current in-patients within a single, English medium secure hospital to describe the uptake of the COVID-19 vaccine among this population. Data regarding capacity to consent to the vaccine, acceptance/refusal of this (and reasons for refusal) and demographics was retrospectively collected from the patients' clinical records and analysed. In total, 85 patients (92.4% of eligible patients) had capacity to decide if they wanted the COVID-19 vaccine. Of these 68 (80.0%) consented and 17 (20.0%) declined to consent. A similar proportion of patients aged under and over 40 years old consented to have the vaccine. Those from a Black Asian minority ethnic background were more likely to decline the vaccine than White British patients. The reasons for capacitous refusal appeared similar to those seen in the general population.
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Affiliation(s)
- Simon Gibbon
- East Midlands Centre for Forensic Mental Health, Nottinghamshire Healthcare NHS Foundation Trust, Arnold Lodge, UK
| | - Emma McPhail
- East Midlands Centre for Forensic Mental Health, Nottinghamshire Healthcare NHS Foundation Trust, Arnold Lodge, UK
| | - Georgina Mills
- East Midlands Centre for Forensic Mental Health, Nottinghamshire Healthcare NHS Foundation Trust, Arnold Lodge, UK
| | - Martin McBride
- East Midlands Centre for Forensic Mental Health, Nottinghamshire Healthcare NHS Foundation Trust, Arnold Lodge, UK
| | - Rebekah Storer
- East Midlands Centre for Forensic Mental Health, Nottinghamshire Healthcare NHS Foundation Trust, Arnold Lodge, UK
| | - Nicholas Taylor
- East Midlands Centre for Forensic Mental Health, Nottinghamshire Healthcare NHS Foundation Trust, Arnold Lodge, UK
| | - Lucy McCarthy
- East Midlands Centre for Forensic Mental Health, Nottinghamshire Healthcare NHS Foundation Trust, Arnold Lodge, UK
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Basrak N, Mulcrone N, Sharifuddin S, Ghumman Z, Bechan N, Mohamed E, Murray M, Rajendran H, Gunnigle S, Nolan M, Quane T, Terao M, Hoare T, Kirrane K, Kennedy HG, Davoren M. Risk of adverse outcome of COVID-19 among patients in secure psychiatric services: observational cohort study. BJPsych Open 2021; 7:e31. [PMID: 33427191 PMCID: PMC7804071 DOI: 10.1192/bjo.2020.169] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/16/2020] [Accepted: 12/22/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Secure forensic mental health services treat patients with high rates of treatment-resistant psychoses. High rates of obesity and medical comorbidities are common. Population-based studies have identified high-risk groups in the event of SARS-CoV-2 infection, including those with problems such as obesity, lung disease and immune-compromising conditions. Structured assessment tools exist to ascertain the risk of adverse outcome in the event of SARS-CoV-2 infection. AIMS To assess risk of adverse outcome in the event of SARS-CoV-2 infection in a complete population of forensic psychiatry patients using structured assessment tools. METHOD All patients of a national forensic mental health service (n = 141) were rated for risk of adverse outcome in the event of SARS-CoV-2 infection, using two structured tools, the COVID-Age tool and the COVID-Risk tool. RESULTS We found high rates of relevant physical comorbidities. Mean chronological age was 45.5 years (s.d. = 11.4, median 44.1), mean score on the COVID-Age tool was 59.1 years (s.d. = 19.4, median 58.0), mean difference was 13.6 years (s.d. = 15.6), paired t = 10.9, d.f. = 140, P < 0.001. Three patients (2.1%) were chronologically over 70 years of age, compared with 43 (30.5%) with a COVID-Age over 70 (χ2 = 6.99, d.f. = 1, P = 0.008, Fisher's exact test P = 0.027). CONCLUSIONS Patients in secure forensic psychiatric services represent a high-risk group for adverse outcomes in the event of SARS-COV-2 infection. Population-based guidance on self-isolation and other precautions based on chronological age may not be sufficient. There is an urgent need for better physical health research and treatment in this group.
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Affiliation(s)
- Natasa Basrak
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland
| | - Naoise Mulcrone
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland
| | - Sue Sharifuddin
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland
| | - Zeshan Ghumman
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland
| | - Nirvana Bechan
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland
| | - Enas Mohamed
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland
| | - Michael Murray
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland
| | - Hariharan Rajendran
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland
| | - Sean Gunnigle
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland
| | - Mark Nolan
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland; and DUNDRUM Centre for Forensic Excellence, Trinity College Dublin, Ireland
| | - Tim Quane
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland
| | - Masashi Terao
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland
| | - Tracey Hoare
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland
| | - Kevin Kirrane
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland
| | - Harry G. Kennedy
- National Forensic Mental Health Service, Central Mental Hospital, Dublin; and DUNDRUM Centre for Forensic Excellence, Trinity College Dublin, Ireland
| | - Mary Davoren
- National Forensic Mental Health Service, Central Mental Hospital, Dublin; and DUNDRUM Centre for Forensic Excellence, Trinity College Dublin, Ireland
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4
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Vinkers DJ, Van de Vorst M, Hoek HW, Van Os J. Social Defeat, Psychotic Symptoms, and Crime in Young Caribbean Immigrants to Rotterdam. Front Psychiatry 2021; 12:498096. [PMID: 33897475 PMCID: PMC8058196 DOI: 10.3389/fpsyt.2021.498096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 02/22/2021] [Indexed: 11/29/2022] Open
Abstract
Background: The negative experience of being excluded from the majority group (social defeat) may be associated with psychosis in immigrants. The social defeat hypothesis is supported by the high frequency of perceived discrimination and acculturation problems in psychotic immigrants. In addition, social defeat may lead to crime through social problems such as unemployment, school dropout, a broken family structure, or psychotic symptoms. Methods: We assessed the association between social defeat and acculturation on the one hand and broadly defined psychotic symptoms and crime on the other in Caribbean immigrants to Rotterdam who are aged 18-24 years. The municipality of Rotterdam provided data about Caribbean immigrants to Rotterdam. Acculturation, social defeat (perceived discrimination, sense of control, and evaluation of self and others), psychotic symptoms, and crime were assessed using online questionnaires. Results: Social defeat was associated with psychotic symptoms in women (β = 0.614, p < 0.001). This relation applied particularly to the negative self-perception domain of social defeat. Acculturation was associated with neither social defeat nor psychotic symptoms or crime and did not mediate the association between social defeat and psychosis. Conclusion: The social defeat hypothesis of psychosis may be gender-specific valid but does not extend to crime.
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Affiliation(s)
- David J Vinkers
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | | | - Hans W Hoek
- Parnassia Psychiatric Institute, The Hague, Netherlands.,Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.,Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Jim Van Os
- Department of Psychiatry, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands.,Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, Netherlands.,Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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Claassen D, Ascoli M, Berhe T, Priebe S. Research on mental disorders and their care in immigrant populations: a review of publications from Germany, Italy and the UK. Eur Psychiatry 2020; 20:540-9. [PMID: 15963698 DOI: 10.1016/j.eurpsy.2005.02.010] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2004] [Accepted: 02/15/2005] [Indexed: 11/28/2022] Open
Abstract
AbstractObjectiveThe review aims to identify the extent and nature of research on mental disorders and their care in immigrant populations in three major European countries with high levels of immigration, i.e. Germany, Italy, United Kingdom (UK).MethodsPeer-reviewed publications on the subject from the three countries between 1996 and 2004 were analyzed. The research questions addressed, the methods used, and the results obtained were assessed.ResultsThirteen papers reporting empirical studies were found from Germany, four from Italy and 95 from the UK. Studies addressed a range of research questions and most frequently assessed rates of service utilization in different immigrant groups. The most consistent finding is a higher rate of hospital admissions for Afro-Caribbean patients in the UK. Many studies had serious methodological shortcomings with low sample sizes and unspecified inclusion criteria.DiscussionDespite large scale immigration in each of the three studied countries, the numbers of relevant research publications vary greatly with a relatively high level of empirical research in the UK. Possible reasons for this are a generally stronger culture of mental health service research and a higher number of researchers who are themselves from immigrant backgrounds in the UK.ConclusionOverall the evidence base to guide the development of mental health services for immigrant populations appears limited. Future research requires appropriate funding, should be of sufficient methodological quality and may benefit from collaboration across Europe.
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Affiliation(s)
- Dirk Claassen
- Unit for Social and Community Psychiatry, Queen Mary (University of London), Newham Centre for Mental Health, Glen Road, Plaistow, London E13 8SP, UK.
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Leshem R, Icht M, Bentzur R, Ben-David BM. Processing of Emotions in Speech in Forensic Patients With Schizophrenia: Impairments in Identification, Selective Attention, and Integration of Speech Channels. Front Psychiatry 2020; 11:601763. [PMID: 33281649 PMCID: PMC7691229 DOI: 10.3389/fpsyt.2020.601763] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 10/16/2020] [Indexed: 12/11/2022] Open
Abstract
Individuals with schizophrenia show deficits in recognition of emotions which may increase the risk of violence. This study explored how forensic patients with schizophrenia process spoken emotion by: (a) identifying emotions expressed in prosodic and semantic content separately, (b) selectively attending to one speech channel while ignoring the other, and (c) integrating the prosodic and the semantic channels, compared to non-clinical controls. Twenty-one forensic patients with schizophrenia and 21 matched controls listened to sentences conveying four emotions (anger, happiness, sadness, and neutrality) presented in semantic or prosodic channels, in different combinations. They were asked to rate how much they agreed that the sentences conveyed a predefined emotion, focusing on one channel or on the sentence as a whole. Forensic patients with schizophrenia performed with intact identification and integration of spoken emotions, but their ratings indicated reduced discrimination, larger failures of selective attention, and under-ratings of negative emotions, compared to controls. This finding doesn't support previous reports of an inclination to interpret social situations in a negative way among individuals with schizophrenia. Finally, current results may guide rehabilitation approaches matched to the pattern of auditory emotional processing presented by forensic patients with schizophrenia, improving social interactions and quality of life.
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Affiliation(s)
- Rotem Leshem
- Department of Criminology, Bar-Ilan University, Ramat Gan, Israel
| | - Michal Icht
- Department of Communication Disorders, Ariel University, Ariel, Israel
| | - Roni Bentzur
- Psychiatric Division, Sheba Medical Center, Tel Hashomer, Israel
| | - Boaz M Ben-David
- Baruch Ivcher School of Psychology, Interdisciplinary Center (IDC), Herzliya, Israel.,Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada.,Toronto Rehabilitation Institute, University Health Networks (UHN), Toronto, ON, Canada
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Weithmann G, Traub HJ, Flammer E, Völlm B. Comparison of offenders in forensic-psychiatric treatment or prison in Germany. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2019; 66:101502. [PMID: 31706400 DOI: 10.1016/j.ijlp.2019.101502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 08/23/2019] [Accepted: 09/08/2019] [Indexed: 06/10/2023]
Abstract
PURPOSE Arrangements for the management of mentally disordered offenders vary widely across countries, as do rates of imprisonment and detention in forensic-psychiatric settings of such individuals. This study aims to quantify the characteristics of offenders detained in forensic-psychiatric settings in Germany over a 15 year period from 1995 and compare these with those sentenced to imprisonment over the same period. METHODS Using official national statistical data, the index offences, demographic characteristics and criminal histories for all individuals convicted to forensic-psychiatric detention during the study period are described together with changes over time. This group was then compared with offenders convicted to a prison sentence of at least two years in the same time period for equivalent offences. RESULTS Relevant differences and similarities between the two treatment groups were identified. Compared to offenders in prison, those in forensic care were older, with a higher proportion of women and a lower proportion of those with foreign backgrounds. Significant previous offending and levels of diminished responsibility were present in both groups. CONCLUSIONS These findings provide data for future comparative research and indicate potential opportunities for earlier intervention to prevent trajectories into more serious offending, particularly in young people and those with mental disorder.
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Affiliation(s)
| | | | - Erich Flammer
- Zentrum für Psychiatrie, Weißenau-Ravensburg, Germany
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8
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Tully J, Cappai A, Lally J, Fotiadou M. Follow-up study of 6.5 years of admissions to a UK female medium secure forensic psychiatry unit. BJPsych Bull 2019; 43:54-57. [PMID: 30257727 PMCID: PMC6472308 DOI: 10.1192/bjb.2018.77] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aims and methodWe aimed to examine clinical and risk outcomes at follow-up, and reoffending and readmission rates, for a sample of 50 admissions to a female medium secure unit (MSU). Demographic, clinical risk assessment (HCR-20 and HoNOS-Secure) and quality of life data were collected using validated measures for all admissions to a female MSU ward in London, UK, between April 2008 and November 2014. RESULTS: All clinical and risk assessment scale scores had improved at follow-up. Quality of life compared favourably to community samples and was good for physical, social and environmental factors and acceptable for psychological health. Twenty-six per cent had at least one readmission, while 17.5% reoffended in the period studied. A longer duration of admission and use of restrictions on discharge was associated with reduced reoffending, but not readmission.Clinical implicationsAdmission is associated with improvement on clinical risk assessment at follow-up. Longer hospital admissions and use of restrictions on discharge may be necessary to prevent reoffending in this group.Declaration of interestNone.
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Affiliation(s)
- John Tully
- Department of Forensic and Neurodevelopmental Sciences,Institute of Psychiatry, Psychology and Neuroscience, Kings College London
| | | | - John Lally
- Department of Psychosis Studies,Institute of Psychiatry, Psychology and Neuroscience, Kings College Londonand Department of Psychiatry,Royal College of Surgeons in Ireland
| | - Maria Fotiadou
- South London and Maudsley Foundation Trust Forensic Services
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9
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Ethnic variations in compulsory detention under the Mental Health Act: a systematic review and meta-analysis of international data. Lancet Psychiatry 2019; 6:305-317. [PMID: 30846354 PMCID: PMC6494977 DOI: 10.1016/s2215-0366(19)30027-6] [Citation(s) in RCA: 109] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 01/07/2019] [Accepted: 01/11/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Evidence suggests that black, Asian and minority ethnic (BAME) groups have an increased risk of involuntary psychiatric care. However, to our knowledge, there is no published meta-analysis that brings together both international and UK literature and allows for comparison of the two. This study examined compulsory detention in BAME and migrant groups in the UK and internationally, and aimed to expand upon existing systematic reviews and meta-analyses of the rates of detention for BAME populations. METHODS For this systematic review and meta-analysis, we searched five databases (PsychINFO, MEDLINE, Cochrane Controlled Register of Trials, Embase, and CINAHL) for quantitative studies comparing involuntary admission, readmission, and inpatient bed days between BAME or migrant groups and majority or native groups, published between inception and Dec 3, 2018. We extracted data on study characteristics, patient-level data on diagnosis, age, sex, ethnicity, marital status, and occupational status, and our outcomes of interest (involuntary admission to hospital, readmission to hospital, and inpatient bed days) for meta-analysis. We used a random-effects model to compare disparate outcome measures. We assessed explanations offered for the differences between minority and majority groups for the strength of the evidence supporting them. This study is prospectively registered with PROSPERO, number CRD42017078137. FINDINGS Our search identified 9511 studies for title and abstract screening, from which we identified 296 potentially relevant full-text articles. Of these, 67 met the inclusion criteria and were reviewed in depth. We added four studies after reference and citation searches, meaning 71 studies in total were included. 1 953 135 participants were included in the studies. Black Caribbean patients were significantly more likely to be compulsorily admitted to hospital compared with those in white ethnic groups (odds ratio 2·53, 95% CI 2·03-3·16, p<0·0001). Black African patients also had significantly increased odds of being compulsorily admitted to hospital compared with white ethnic groups (2·27, 1·62-3·19, p<0·0001), as did, to a lesser extent, south Asian patients (1·33, 1·07-1·65, p=0·0091). Black Caribbean patients were also significantly more likely to be readmitted to hospital compared with white ethnic groups (2·30, 1·22-4·34, p=0·0102). Migrant groups were significantly more likely to be compulsorily admitted to hospital compared with native groups (1·50, 1·21-1·87, p=0·0003). The most common explanations for the increased risk of detainment in BAME populations included increased prevalence of psychosis, increased perceived risk of violence, increased police contact, absence of or mistrust of general practitioners, and ethnic disadvantages. INTERPRETATION BAME and migrant groups are at a greater risk of psychiatric detention than are majority groups, although there is variation across ethnic groups. Attempts to explain increased detention in ethnic groups should avoid amalgamation and instead carry out culturally-specific, hypothesis-driven studies to examine the numerous contributors to varying rates of detention. FUNDING University College London Hospitals National Institute for Health Research (NIHR) Biomedical Research Centre, NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, King's College London, and NIHR Collaboration for Leadership in Applied Health Research and Care North Thames at Bart's Health NHS Trust.
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10
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Dixon J. Narratives of illness and offending: mentally disordered offenders' views on their offending. SOCIOLOGY OF HEALTH & ILLNESS 2018; 40:1053-1068. [PMID: 29667209 DOI: 10.1111/1467-9566.12740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Narratives have been used in both the sociology of health and illness and in criminology to examine how groups of people present themselves in moral terms. This article focuses on the narratives of offenders with mental health problems in England subject to section 37/41 of the Mental Health Act 1983 to examine how they justified offending prior to admission. Participants presented illness in a variety of different ways indicating a range of moral positions towards offending. In line with previous research a first group used mental illness to excuse offending and saw themselves as achieving moral reform through treatment. A second group also used illness to excuse offending, but did so inconsistently, seeking to mitigate responsibility whilst distancing themselves from treatment obligations. A third group portrayed themselves as dishonourable both due to their category of offence and the type of illness experienced. A final group rejected both labels of illness and offending, seeking to portray themselves as consistently moral.
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Affiliation(s)
- Jeremy Dixon
- Department of Social and Policy Sciences, University of Bath, UK
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11
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Bhui K, Bhugra D. Mental illness in Black and Asian ethnic minorities: pathways to care and outcomes. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.8.1.26] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
A substantial body of research indicates that, for people from Black and Asian ethnic minorities, access to, utilisation of and treatments prescribed by mental health services differ from those for White people (Lloyd & Moodley, 1992; for a review see Bhui, 1997). Pathways to mental health care are important, and the widely varying pathways taken in various societies may reflect many factors: the attractiveness and cultural appropriateness of services; attitudes towards services; previous experiences; and culturally defined lay referral systems (Goldberg, 1999). Contact with mental health care services may be imposed on the individual, but people who choose to engage with services usually do so only if they think that their changed state of functioning is health-related and potentially remediable through these services. In such cases, they will contact whoever they perceive to be the most appropriate carer, and these carers are often not part of a national health care network.
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Dein K, Williams PS, Dein S. Ethnic bias in the application of the Mental Health Act 1983. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.bp.107.003582] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
There is evidence pointing to a bias in the application of the Mental Health Act 1983 (which is in force in England and Wales). One study found that Black people on in-patient units were four times more likely to have been compulsorily admitted than White people. Furthermore, it has been shown that compulsory admissions to secure units are 2.9–5.6 times higher for Black than for White patients. Any understanding of this bias necessitates an examination of the attitudes of mental health professionals towards Africans and African–Caribbeans. Here we discuss possible contributory factors and examine a number of initiatives that have been instituted in order to tackle this problem.
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13
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Denzel AD, Harte JM, van den Bergh M, Scherder EJA. Ethnic variations regarding clinical profiles and symptom representation in prisoners with psychotic disorders. BJPsych Open 2018; 4:18-28. [PMID: 29388907 PMCID: PMC6020278 DOI: 10.1192/bjo.2017.3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Black and minority ethnic (BME) groups are known to have higher prevalences of psychotic disorders and are over-represented in western penitentiaries and forensic psychiatric institutions. Research from regular mental healthcare settings suggests that they could show different and more severe psychotic symptoms. Aims To explore ethnic variations in severity of symptomatology of BME and non-BME detainees with psychotic disorders. METHOD In this study, 824 patients with psychotic disorders from seven different ethnic groups, imprisoned in a penitentiary psychiatric centre in the Netherlands, were compared on symptom severity and symptom representation using the BPRS-E clinical interview. Data were analysed by means of a multilevel analysis. RESULTS BME patients with psychotic disorders are over-represented in forensic psychiatry, and symptom profiles of prisoners with psychotic disorders vary by ethnicity. Additionally, severity levels of overall psychopathology differ between ethnic groups: patients with an ethnic majority status show more severe levels of psychopathology compared with BME patients. CONCLUSIONS There are differences in symptom severity and symptom profiles between BME patients and non-BME patients. Disregarding these differences could have an adverse effect on the outcome of the treatment. Possible explanations and clinical impact are discussed. Declaration of interest None.
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Affiliation(s)
- A Dorina Denzel
- Department of Clinical Neuropsychology,VU University,Amsterdam,van der Boechorststraat 1,1081 BT Amsterdam,the Netherlands
| | - Joke M Harte
- Netherlands Institute for the Study of Crime and Law Enforcement,(NSCR);Department of Criminology,VU University Amsterdam,de Boelelaan 1105,Initium (1A-46),1081 HV Amsterdam,the Netherlands
| | - Mattis van den Bergh
- Department of Methodology and Statistics,Tilburg University,P.O. Box 90153,5000 LE Tilburg,the Netherlands
| | - Erik J A Scherder
- Professor,Department of Clinical Neuropsychology,VU University,Amsterdam,van der Boechorststraat 1,1081 BT Amsterdam,the Netherlands
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14
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Ventriglio A, Bellomo A, Vitrani G, Stella E, Gentile A, Bhugra D. Migration, violence, and the role of psychiatry in Italy. Int Rev Psychiatry 2017; 29:327-333. [PMID: 28805124 DOI: 10.1080/09540261.2017.1343532] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Immigration to Italy has been increasing exponentially in the last decades due to the international political changes and conflicts in the Middle East. The relationship between immigration and crimes is a debated issue, and violent radicalization of second or third generations of migrants is under increased scrutiny. Consequently, many politicians and political parties use nationalist and xenophobic language. Inevitably, this will have an impact on reactions of the larger population, as well as that of migrants. Psychiatry can have a major role in dealing with immigrants' health needs, and also assessing risk and preventing violent behaviours due to mental disorders. It is possible to prevent some radicalization by employing strategies of education, leading to better integration of immigrants in the community (based on education, housing, work, etc.). However, often specialist services for migrants are lacking, and mental healthcare professionals may remain poorly trained. Italy is one of the major countries in Southern Europe with a large number of illegal and legal migrants; thereby, creating a major pressure on the resources. It is important to understand the links between globalization, migration, and violence in Italy, in order to prevent future radicalization. It is also useful for psychiatrists to act as advocates for migrants to help reduce xenophobia and discrimination supported by some national cultural and political movements. Ethno-psychiatric facilities should be promoted, as well as policies of support, integration, and prevention should be employed to promote legal migration through the European countries.
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Affiliation(s)
- Antonio Ventriglio
- a Department of Clinical and Experimental Medicine, Section of Psychiatry , University of Foggia , Foggia , Italy
| | - Antonello Bellomo
- a Department of Clinical and Experimental Medicine, Section of Psychiatry , University of Foggia , Foggia , Italy
| | - Giovanna Vitrani
- a Department of Clinical and Experimental Medicine, Section of Psychiatry , University of Foggia , Foggia , Italy
| | - Eleonora Stella
- a Department of Clinical and Experimental Medicine, Section of Psychiatry , University of Foggia , Foggia , Italy
| | - Alessandro Gentile
- a Department of Clinical and Experimental Medicine, Section of Psychiatry , University of Foggia , Foggia , Italy
| | - Dinesh Bhugra
- b Institute of Psychiatry, Psychology & Neuroscience , King's College London , London , UK
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Jani S, Johnson RS, Banu S, Shah A. Cross-cultural bias in the diagnosis of borderline personality disorder. Bull Menninger Clin 2017; 80:146-65. [PMID: 27294587 DOI: 10.1521/bumc.2016.80.2.146] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Borderline personality disorder (BPD) is an internationally recognized disorder, although it is slightly varied in its nosology in the International Classification of Diseases, 10th Revision (ICD-10), the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), and the Chinese Classification of Mental Disorders (CCMD). While it is recognized by genetic and neurobiological patterns, instability of affect, impaired interpersonal relationships, and unstable sense of self, its manifestation is extremely varied based on environmental factors, particularly culture. Several studies of the manifestation of BPD between and across countries, particularly in immigrant populations, identify variations in symptom prevalence based on culture. These findings reveal a need for more unified dimensional-based categorization of BPD to reduce cross-cultural bias and improve identification.
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Affiliation(s)
- Suni Jani
- Fellow, Child and Adolescent Psychiatry, Massachusetts General Hospital/McLean Hospital, Harvard Medical School, Boston, Massachusetts
| | - R Scott Johnson
- Fellow, Forensic Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
| | - Sophia Banu
- Associate professor of psychiatry, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Asim Shah
- Associate professor of psychiatry, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
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Shaikh U, Qamar I, Jafry F, Hassan M, Shagufta S, Odhejo YI, Ahmed S. Patients with Borderline Personality Disorder in Emergency Departments. Front Psychiatry 2017; 8:136. [PMID: 28824467 PMCID: PMC5543278 DOI: 10.3389/fpsyt.2017.00136] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 07/13/2017] [Indexed: 11/13/2022] Open
Abstract
Borderline personality disorder (BPD) patients, when in crisis, are frequent visitors of emergency departments (EDs). When these patients exhibit symptoms such as aggressiveness, impulsivity, intense anxiety, severe depression, self-harm, and suicidal attempts or gestures, diagnosis, and treatment of the BPD becomes challenging for ED doctors. This review will, therefore, outline advice to physicians and health-care providers who face this challenging patient population in the EDs. Crisis intervention should be the first objective of clinicians when dealing with BPD in the emergency. For the patients with agitation, symptom-specific pharmacotherapy is usually recommended, while for non-agitated patients, short but intensive psychotherapy especially dialectical behavior therapy (DBT) has a positive effect. Although various psychotherapies, either alone or integrated, are preferred modes of treatment for this group of patients, the effects of psychotherapies on BPD outcomes are small to medium. Proper risk management along with developing a positive attitude and empathy toward these patients will help them in normalizing in an emergency setting after which treatment course can be decided.
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Affiliation(s)
- Untara Shaikh
- Liaquat University of Medical & Health Sciences, Jamshoro, Pakistan
| | - Iqra Qamar
- Nassau University Medical Center, East Meadow, NY, United States
| | | | | | | | | | - Saeed Ahmed
- Kings County Hospital Center, Brooklyn, NY, United States
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Gajwani R, Parsons H, Birchwood M, Singh SP. Ethnicity and detention: are Black and minority ethnic (BME) groups disproportionately detained under the Mental Health Act 2007? Soc Psychiatry Psychiatr Epidemiol 2016; 51:703-11. [PMID: 26886264 PMCID: PMC4846695 DOI: 10.1007/s00127-016-1181-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 01/17/2016] [Indexed: 12/05/2022]
Abstract
PURPOSE There is substantial evidence to suggest that Black and minority ethnic (BME) patients are disproportionately detained under the Mental Health Act (MHA). We examined ethnic differences in patients assessed for detention and explored the effect of ethnicity after controlling for confounders. METHODS A prospective study of all MHA assessments conducted in 1 year (April 2009-March 2010) within Birmingham and Solihull Mental Health Foundation Trust, UK. Proportion of assessments and detentions within denominator population of service users and regional populations were calculated. Multiple regression analysis was conducted to determine which variables were associated with the outcome of MHA assessment and the role of ethnicity. RESULTS Of the 1115 assessments, 709 led to detentions (63.58 %). BME ethnic groups were statistically more likely to be assessed and detained under the MHA as compared to Whites, both in the service user and the ethnic population estimates in Birmingham, UK. MHA detention was predicted by having a serious mental illness, the presence of risk, older age and living alone. Ethnicity was not associated with detention under the MHA with age, diagnosis, risk and level of social support accounted for. CONCLUSION The BME 'disproportionality' in detention rates seems to be due to higher rates of mental illness, greater risk and poorer levels of social support rather than ethnicity per se.
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Affiliation(s)
- Ruchika Gajwani
- Institute of Health and Wellbeing, Yorkhill Hospital, University of Glasgow, Caledonia House, Glasgow, G3 8SJ, UK.
| | - Helen Parsons
- Cancer Research, Warwick Medical School, Coventry, CV4 7AL, UK
| | - Max Birchwood
- Mental Health and Wellbeing, Warwick Medical School, Coventry, CV4 7AL, UK
| | - Swaran P Singh
- Mental Health and Wellbeing, Warwick Medical School, Coventry, CV4 7AL, UK.
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Abstract
AbstractObjectives: To determine whether Irish Travellers are over-represented amongst transfers from prison to psychiatric hospital. If so, to determine whether this represents an excess over the proportion of Irish Travellers committed to prison.Method: Irish Travellers admitted to the National Forensic Psychiatry service were identified from a case register over three years 1997-1999. New prison committals were sampled and interviewed as part of the routine committal screening to identify ethnicity.Results: Irish Travellers accounted for 3.4% of forensic psychiatric admissions compared to 0.38% of the adult population. Travellers transferred from prison to psychiatric hospital had more learning disability and less severe mental illness than other groups, while black and other ethnic minorities had a higher proportion of severe mental illness. Travellers accounted for 6% (95% CI 3-11) of 154 male committals and 4% (95% CI 2-12) of 70 female committals. The estimated annualised prison committal rate was 2.8% (95% CI 2.4-3.3) of all adult male Travellers in Ireland and 1% for female Travellers (95% CI 0.8-1.3). Male Travellers had a relative risk of imprisonment compared to the settled community of 17.4 (95% CI 2.3-131.4), the relative risk for female Travellers was 12.9 (95% CI 1.7-96.7). Imprisoned Travellers had greater rates of drugs and alcohol problems than other prisoners (Relative risk 1.46, 95% C11.11-1.90).Conclusion: There is gross over-representation of Travellers in forensic psychiatric admissions. This reflects the excess of Travellers amongst prison committals.
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Bhui K, Ullrich S, Coid JW. Which pathways to psychiatric care lead to earlier treatment and a shorter duration of first-episode psychosis? BMC Psychiatry 2014; 14:72. [PMID: 24620939 PMCID: PMC3984674 DOI: 10.1186/1471-244x-14-72] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 03/05/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The pathways to care in a first onset psychosis are diverse and may influence the chances of early treatment and therefore the duration of untreated psychosis. We test which pathways to care are associated with a delay in receiving treatment and a longer duration of untreated psychosis (DUP). METHODS In a population based survey, we interviewed 480 people with first episode psychosis aged 18 to 64 years over a 2-year period. Information from structured interview and case files provided DSM-IV diagnostic, clinical, and demographic information. Consecutive contacts in the care pathway were mapped using the World Health Organisation's Encounter Form. Using information from all sources, DUP was defined as time from symptom onset to first treatment with antipsychotic medication. RESULTS The most common first contacts were primary care physicians (35.2%), emergency rooms in general hospital settings (21.3%), and criminal justice agencies (25.4%). In multivariate regression models, compared to DUP for those first in contact with primary care, DUP was shortest for first encounters with psychiatric emergency clinics (RR = 0.4, 95% CI: 0.23-0.71) and longest for first encounters with criminal justice agencies (RR = 1.61, 95% CI: 1-2.58). Older age was associated with a longer DUP (RR = 1.01 per year, 95% CI: 1-1.04). A shorter DUP was associated with a diagnosis of mania and affective psychoses-NOS compared with schizophrenia (RR = 0.22, 95% CI: 0.14-0.35; RR = 0.18, 95% CI: 0.06-0.54, respectively), for Black compared with White ethnicity (RR = 0.52, 95% CI: 0.34-0.82), and for each close person in the social network (RR = 0.9, 95% CI: 0.84-0.96). CONCLUSIONS To further reduce DUP, better links are needed between primary care, emergency rooms, criminal justice and psychiatric services.
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Affiliation(s)
- Kamaldeep Bhui
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London EC1M 6BQ, UK
| | - Simone Ullrich
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London EC1M 6BQ, UK
| | - Jeremy W Coid
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London EC1M 6BQ, UK
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Vinkers DJ, Selten JP, Hoek HW, Rinne T. Psychotic disorders are more common in ethnic minority than in Dutch native defendants. Soc Psychiatry Psychiatr Epidemiol 2013; 48:1399-404. [PMID: 23543339 DOI: 10.1007/s00127-012-0629-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 11/19/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE The prevalence of psychotic disorders among prisoners from racial or ethnic minority groups remains uncertain. We therefore compared the frequency of psychotic disorder in ethnic minority and Dutch native defendants using the nationwide database of elaborate pre-trial reports. METHODS Analysis of a nationwide database of pre-trial reported defendants in the Netherlands between 2000 and 2006 (n = 12,752). RESULTS A diagnosis of a psychotic disorder was more common in ethnic minority than in Dutch native defendants (21.1 vs. 10.2%). The odds ratio of this diagnosis, adjusted for age, gender, IQ below 85 and abuse of cannabis or hard drugs, was 2.6 (95% CI 2.2-3.0). This odds ratio was highest for African defendants (OR = 5.2; 95% CI 3.7-7.4). CONCLUSIONS Psychotic disorders were more common among pre-trial reported defendants from ethnic minorities than among their Dutch native counterparts.
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Affiliation(s)
- David J Vinkers
- Netherlands Institute for Forensic Psychiatry and Psychology, Noordsingel 113, 3035 EM, Rotterdam, The Netherlands.
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Flora N, Barbaree H, Simpson AIF, Noh S, McKenzie K. Pathways to forensic mental health care in Toronto: a comparison of European, African-Caribbean, and other ethnoracial groups in Toronto. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2012; 57:414-21. [PMID: 22762296 DOI: 10.1177/070674371205700704] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To describe pathways taken to care by a sample of patients in a secure forensic unit who have been found not criminally responsible or unfit to stand trial, and to investigate the pathways taken by patients within 3 ethnoracial subgroups of origin: European, African or Caribbean, and Other. METHOD Fifty patients from secure forensic units were interviewed using the Encounter Form developed for pathways mapping undertaken in the World Health Organization field trials. Differences in the types of caregivers seen, the total number of caregivers seen, and the time taken to reach forensic psychiatric services were compared across the 3 ethnoracial groupings. RESULTS Most people committed their index offence after they had already had contact with general mental health services. Few significant differences were observed in the pathways to secure forensic units across the European, African-Caribbean, and Other ethnoracial groups. CONCLUSIONS These findings suggest that improvements in general mental health services may be a key to decreasing the use of forensic psychiatric services. Further research is required to explore factors that may predict and prevent offending. Larger studies are needed to examine ethnoracial differences in pathways to care.
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Affiliation(s)
- Nina Flora
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Abstract
SUMMARYBackground — By the mid-1960s, the importance of socio-economic status for schizophrenia had been demonstrated in terms of differences between social-class groups in prevalence and incidence rates, illness course and outcome, and treatment experience. In the causation – selection debate, however, opinion had swung in favour of the selection hypothesis. Aims — To reassess evidence on the social-class distribution of schizophrenia in Britain, and to compare this body of research with population-based studies of schizophrenia risk in socially disadvantaged ethnic minorities. Method — Systematic review of medical and psychological data-bases. Results — Epidemiological research, while confirming the importance of premorbid social decline, has also provided support for the environmental ‘breeder’ hypothesis. High psychosis rates have been confirmed in ethnic minori-ties; in particular among Afro-Caribbean and other Black immigrants whose low social status cannot be accounted for by selective downward social drift or segregation. Conclusions — There are striking parallels, both in the epidemiology of schizophrenia and in social characteristics, between the lower-class indigenous groups highlighted by earlier psychiatric surveys and African-Caribbean populations in Britain's inner cities today. These similarities underline the need for a broader perspective in the search for environmental risk factors.Declaration of Interest: none.
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Affiliation(s)
- Brian Cooper
- Section of Old Age Psychiatry, Institute of Psychiatry, London, United Kingdom.
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Chinn D, Hall I, Ali A, Hassell H, Patkas I. Psychiatric in-Patients Away From Home: Accounts by People With Intellectual Disabilities in Specialist Hospitals Outside Their Home Localities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2010. [DOI: 10.1111/j.1468-3148.2010.00572.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Thornicroft G, Farrelly S, Birchwood M, Marshall M, Szmukler G, Waheed W, Byford S, Dunn G, Henderson C, Lester H, Leese M, Rose D, Sutherby K. CRIMSON [CRisis plan IMpact: Subjective and Objective coercion and eNgagement] protocol: a randomised controlled trial of joint crisis plans to reduce compulsory treatment of people with psychosis. Trials 2010; 11:102. [PMID: 21054847 PMCID: PMC2992058 DOI: 10.1186/1745-6215-11-102] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Accepted: 11/05/2010] [Indexed: 11/24/2022] Open
Abstract
Background The use of compulsory treatment under the Mental Health Act (MHA) has continued to rise in the UK and in other countries. The Joint Crisis Plan (JCP) is a statement of service users' wishes for treatment in the event of a future mental health crisis. It is developed with the clinical team and an independent facilitator. A recent pilot RCT showed a reduction in the use of the MHA amongst service users with a JCP. The JCP is the only intervention that has been shown to reduce compulsory treatment in this way. The CRIMSON trial aims to determine if JCPs, compared with treatment as usual, are effective in reducing the use of the MHA in a range of treatment settings across the UK. Methods/Design This is a 3 centre, individual-level, single-blind, randomised controlled trial of the JCP compared with treatment as usual for people with a history of relapsing psychotic illness in Birmingham, London and Lancashire/Manchester. 540 service users will be recruited across the three sites. Eligible service users will be adults with a diagnosis of a psychotic disorder (including bipolar disorder), treated in the community under the Care Programme Approach with at least one admission to a psychiatric inpatient ward in the previous two years. Current inpatients and those subject to a community treatment order will be excluded to avoid any potential perceived pressure to participate. Research assessments will be conducted at baseline and 18 months. Following the baseline assessment, eligible service users will be randomly allocated to either develop a Joint Crisis Plan or continue with treatment as usual. Outcome will be assessed at 18 months with assessors blind to treatment allocation. The primary outcome is the proportion of service users treated or otherwise detained under an order of the Mental Health Act (MHA) during the follow-up period, compared across randomisation groups. Secondary outcomes include overall costs, service user engagement, perceived coercion and therapeutic relationships. Sub-analyses will explore the effectiveness of the JCP in reducing use of the MHA specifically for Black Caribbean and Black African service users (combined). Qualitative investigations with staff and service users will explore the acceptability of the JCPs. Discussion JCPs offer a potential solution to the rise of compulsory treatment for individuals with psychotic disorders and, if shown to be effective in this trial, they are likely to be of interest to mental health service providers worldwide. Trial registration Current Controlled Trials ISRCTN11501328
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Affiliation(s)
- Graham Thornicroft
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK.
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Almeida J, Graça O, Vieira F, Almeida N, Santos JC. Characteristics of offenders deemed not guilty by reason of insanity in Portugal. MEDICINE, SCIENCE, AND THE LAW 2010; 50:136-139. [PMID: 21133264 DOI: 10.1258/msl.2010.100003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
In Portugal, offenders found not guilty by reason of insanity (NGRI), may be given a restricted order to a special hospital as an alternative to prison. In European countries there is a recognized need for data concerning this special population. The aim of the present study was to examine the characteristics of all the NGRI subjects (n = 274) detained in the country in a descriptive and retrospective survey conducted in January 2009. Offence committed, demographic factors, diagnosis at admission, background of substance abuse and diagnostic stability were recorded. Schizophrenia was the commonest diagnosis (51.5%). Mean population age was 42.6 years, with only 6.2% women. Homicide was the most common offense (41.2%). A background of substance abuse was found in 42.3% of subjects. There were significant differences in the schizophrenia and mental retardation patient groups when compared individually with the other diagnoses concerning homicide and arson as the offence. Mean duration of inpatient stay did not differ significantly between diagnoses. The findings also point to poor follow-up of the NGRI patients after admission.
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Affiliation(s)
- Jaime Almeida
- Department of Psychiatry and Mental Health, Hospital S. Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, 1600 Lisbon, Portugal.
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McGilloway A, Hall RE, Lee T, Bhui KS. A systematic review of personality disorder, race and ethnicity: prevalence, aetiology and treatment. BMC Psychiatry 2010; 10:33. [PMID: 20459788 PMCID: PMC2882360 DOI: 10.1186/1471-244x-10-33] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Accepted: 05/11/2010] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Although psychoses and ethnicity are well researched, the importance of culture, race and ethnicity has been overlooked in Personality Disorders (PD) research. This study aimed to review the published literature on ethnic variations of prevalence, aetiology and treatment of PD. METHOD A systematic review of studies of PD and race, culture and ethnicity including a narrative synthesis of observational data and meta-analyses of prevalence data with tests for heterogeneity. RESULTS There were few studies with original data on personality disorder and ethnicity. Studies varied in their classification of ethnic group, and few studies defined a specific type of personality disorder. Overall, meta-analyses revealed significant differences in prevalence between black and white groups (OR 0.476, CIs 0.248 - 0.915, p = 0.026) but no differences between Asian or Hispanic groups compared with white groups. Meta-regression analyses found that heterogeneity was explained by some study characteristics: a lower prevalence of PD was reported among black compared with white patients in UK studies, studies using case-note diagnoses rather than structured diagnostic interviews, studies of borderline PD compared with the other PD, studies in secure and inpatient compared with community settings, and among subjects with co-morbid disorders compared to the rest. The evidence base on aetiology and treatment was small. CONCLUSION There is some evidence of ethnic variations in prevalence of personality disorder but methodological characteristics are likely to account for some of the variation. The findings may indicate neglect of PD diagnosis among ethnic groups, or a true lower prevalence amongst black patients. Further studies are required using more precise cultural and ethnic groups.
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Affiliation(s)
- Angela McGilloway
- Barts and The London School of Medicine and Dentistry, Turner Street, London E1 2AD, UK
| | - Ruth E Hall
- Barts and The London School of Medicine and Dentistry, Turner Street, London E1 2AD, UK
| | - Tennyson Lee
- East London Foundation Trust, Trust headquarters, Eastone, 22 Commercial Street, London, E1 6LP, UK
| | - Kamaldeep S Bhui
- Centre for Psychiatry, Barts & The London School of Medicine & Dentistry, Old Anatomy Building, Charterhouse Square, London, EC1M 6BQ, UK,The Centre for Applied Research and Evaluation International Foundation (Careif), Centre for Psychiatry, Barts & The London School of Medicine & Dentistry, Old Anatomy Building, Charterhouse Square, London, EC1M 6BQ, UK,East London Foundation Trust, Trust headquarters, Eastone, 22 Commercial Street, London, E1 6LP, UK
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Vinkers DJ, de Vries SC, van Baars AWB, Mulder CL. Ethnicity and dangerousness criteria for court ordered admission to a psychiatric hospital. Soc Psychiatry Psychiatr Epidemiol 2010; 45:221-4. [PMID: 19396576 DOI: 10.1007/s00127-009-0058-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2008] [Accepted: 04/14/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Black and minority ethnic (BME) populations are disproportionately detained in psychiatric hospitals. AIM To examine the dangerousness criteria for compulsory court ordered admission to a psychiatric hospital in White and BME persons. METHOD We examined the psychiatric examinations for court ordered compulsory admissions in 506 White and 299 BME persons from October 2004 until January 2008 in Rotterdam, the Netherlands. The White and BME groups are compared using Chi-square tests and in case of significant differences with logistic regression models adjusted for age, gender, mental disorders and socio-economic background. RESULTS In BME persons, violence towards others and neglect of relatives were more often reasons to request court order admission as compared with Whites (39.8 vs. 25.3%, P < 0.001, respectively, 6.4 vs. 2.4%, P = 0.01). This remained true after adjustment for age, gender, mental disorders and socio-economic background [OR 1.56 (95% CI 1.12-2.18), P = 0.01, respectively; OR 3.08 (95% CI 1.31-7.26), P = 0.01]. The other reasons for a request of court order admission had a similar prevalence in both groups (suicide or self-harm, social decline, severe self-neglect, arousal of aggression of others, danger to the mental health of others, and the general safety of persons and goods). CONCLUSION Violence towards others and neglect of relatives are more often a reason to request court ordered admission in BME than in White persons. BME patients are more often perceived as potentially dangerous to others.
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Affiliation(s)
- D J Vinkers
- O3 Research Centre, Mental Health Care Rijnmond, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands.
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Sheldon K, Krishnan G. The clinical and risk characteristics of patients admitted to a secure hospital‐based Dangerous and Severe Personality Disorder unit. ACTA ACUST UNITED AC 2009. [DOI: 10.1108/14636646200900019] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Fazel S, Grann M, Långström N. What is the role of epidemiology for forensic psychiatry? CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2009; 19:281-285. [PMID: 19343701 DOI: 10.1002/cbm.727] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Gabrielsen G, Kramp P. Forensic psychiatric patients among immigrants in Denmark--diagnoses and criminality. Nord J Psychiatry 2009; 63:140-7. [PMID: 19034801 DOI: 10.1080/08039480802423014] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The purpose of this study is to analyse a sample of immigrant forensic psychiatric patients and to compare them with Danish patients. Of the 326 forensic patients in Copenhagen, 111 were immigrants or descendants of immigrants. The sample was broken down according to area of origin, age, gender and ethnic status. The data have been analysed by Poisson regression with the background population as an offset variable. Of the patients of non-Danish ethnicity, a significantly higher ratio was diagnosed with schizophrenia and a lower ratio was diagnosed with personality disorders compared with Danes. Iranians accounted for a higher ratio than did other minority groups, whereas patients from Western Europe/USA were not different from Danes. The higher ratio of forensic schizophrenic patients of non-Danish ethnicity cannot be explained by social factors or substance abuse. Migration increases the age-adjusted risk (ARR) of becoming schizophrenic (ARR=2.7). We found the ARR of becoming a male forensic schizophrenic patient among immigrants/descendants to be 2.8, i.e. the same as that caused by migration as such. Violence and schizophrenia are associated, and this explains the fact that the ratio of immigrants/descendants having committed violence exceeds that of Danes. Non-violent crimes are more equally distributed among ethnic groups and seem to be associated with common criminogenic factors. Arson is mainly committed by older schizophrenic patients of Danish ethnicity. The risk of an individual immigrant and Danish schizophrenic patient exhibiting criminal behaviour is the same. Schizophrenia is a criminogenic factor in violence, but not in non-violent crimes. The differences between the various ethnic groups could be related to selection caused by both immigration and emigration.
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Affiliation(s)
- Gorm Gabrielsen
- Center for Statistics, Copenhagen Business School, Frederiksberg, Denmark
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Pascual JC, Malagón A, Córcoles D, Ginés JM, Soler J, García-Ribera C, Pérez V, Bulbena A. Immigrants and borderline personality disorder at a psychiatric emergency service. Br J Psychiatry 2008; 193:471-6. [PMID: 19043150 DOI: 10.1192/bjp.bp.107.038208] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Several studies have suggested that immigrants have higher rates of psychiatric emergency service use and a higher risk of mental disorders such as schizophrenia than indigenous populations. AIMS To compare the likelihood that immigrants (immigrant group) v. indigenous population (indigenous group) will be diagnosed with borderline personality disorder in a psychiatric emergency service and to determine differences according to area of origin. METHOD A total of 11 578 consecutive admissions over a 4-year period at a tertiary psychiatric emergency service were reviewed. The collected data included socio-demographic and clinical variables and the Severity of Psychiatric Illness rating score. Psychiatric diagnosis was limited to information available in the emergency room given that a structured interview is not usually feasible in this setting. The diagnosis of borderline personality disorder was based on DSM-IV criteria. Immigrants were divided into five groups according to region of origin: North Africa, sub-Saharan Africa, South America, Asia and Western countries. RESULTS Multivariate statistical logistic regression analysis showed that all subgroups of immigrants had a lower likelihood of being diagnosed with borderline personality disorder than the indigenous population independently of age and gender. Furthermore, the rates of borderline personality disorder diagnosis were considerably lower in Asian and sub-Saharan subgroups than in South American, North African, Western or native subgroups. CONCLUSIONS Our results showed that in the psychiatric emergency service borderline personality disorder was diagnosed less frequently in the immigrant group v. the indigenous group. Our results do not support the concept of migration as a risk factor for borderline personality disorder.
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Affiliation(s)
- J C Pascual
- Department of Psychiatry, Sta. Creu i St. Pau Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Bauer A, Rosca P, Grinshpoon A, Khawaled R, Mester R, Yoffe R, Ponizovsky AM. Trends in involuntary psychiatric hospitalization in Israel 1991-2000. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2007; 30:60-70. [PMID: 17141875 DOI: 10.1016/j.ijlp.2006.02.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2005] [Revised: 11/21/2005] [Accepted: 02/24/2006] [Indexed: 05/12/2023]
Abstract
BACKGROUND Though information about involuntary psychiatric hospitalizations (IPH) is crucial for the planning of Israel's National Mental Health Care Policy, very few studies have been carried out to date on this subject. AIMS To identify trends in first IPH to all inpatient psychiatric settings in Israel. METHOD The sample included all admissions of adults (18 years and older) over the ten-year period, 1991-2000, according to the registration of such admissions in the National Psychiatric Case Registry. RESULTS A 2.4-fold increase was found in first IPH over the decade studied. The typical profile of the involuntarily admitted patient was that of a native-born Jewish male, aged 18-24 or 65 and older, single, with less than 8 years of education, and with a diagnosis of schizophrenia or delusional psychosis. CONCLUSIONS These findings suggest the need for improving the interfaces between hospital and community services, and for preparing specific guidelines to extend the use of involuntary ambulatory treatment orders. Further study is needed to explore the respective roles of involuntary inpatient and outpatient treatment.
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Affiliation(s)
- Arie Bauer
- Forensic Psychiatry Unit, Mental Health Services, Ministry of Health, Jerusalem, Israel
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Affiliation(s)
- Lorraine Childs
- Medlicott Academic Unit, Christchurch, New Zealand
- Medlicott Academic Unit, Regional Forensic Psychiatric Service, Canterbury District Health Board, Hillmorton Hospital Prvt. Bag 4733, Christchurch, New Zealand
| | - Philip Brinded
- Medlicott Academic Unit, Christchurch, New Zealand
- Medlicott Academic Unit, Regional Forensic Psychiatric Service, Canterbury District Health Board, Hillmorton Hospital Prvt. Bag 4733, Christchurch, New Zealand
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Leese M, Thornicroft G, Shaw J, Thomas S, Mohan R, Harty MA, Dolan M. Ethnic differences among patients in high-security psychiatric hospitals in England. Br J Psychiatry 2006; 188:380-5. [PMID: 16582066 DOI: 10.1192/bjp.188.4.380] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Black (Black Caribbean and Black African) patients are over-represented in admissions to general adult and medium-security psychiatric services in England. AIMS To describe the sociodemographic, clinical and offence characteristics of patients in high-security psychiatric hospitals (HSPHs) in England, and to compare admission rates and unmet needs by ethnic group. METHOD A total of 1255 in-patients were interviewed, and their legal status, socio-demographic characteristics and individual treatment needs were assessed. RESULTS Black patients in HSPHs are over-represented by 8.2 times (range 3.2-24.4,95% CI 7.1-9.3), are more often male (P=0.037), and are more often diagnosed with a mental illness and less often diagnosed with a personality disorder or learning disability (P<0.001) than White patients. Unmet needs were significantly less common among White than among Black patients (mean values of 2.22 v. 2.62, difference=0.40,95% CI 0.06-0.73). CONCLUSIONS Compared with the proportion of Black patients in the general population in their region of origin, a much higher proportion of Black patients were admitted to HSPHs, and fewer of their needs were met.
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Affiliation(s)
- Morven Leese
- Section of Community Psychiatry (PRiSM), Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, UK
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Morgan C, Mallett R, Hutchinson G, Leff J. Negative pathways to psychiatric care and ethnicity: the bridge between social science and psychiatry. Soc Sci Med 2004; 58:739-52. [PMID: 14672590 DOI: 10.1016/s0277-9536(03)00233-8] [Citation(s) in RCA: 109] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
It has been consistently reported that the African-Caribbean population in the UK are more likely than their White counterparts to access psychiatric services via the police and under compulsion. The reasons for these differences are poorly understood. This paper comprises two main parts. The first provides a comprehensive review of research in this area, arguing the current lack of understanding stems from a number of methodological limitations that characterise the research to date. The issue of ethnic variations in pathways to psychiatric care has been studied almost exclusively within a medical epidemiological framework, and the potential insights offered by sociological and anthropological research in the fields of illness behaviour and health service use have been ignored. This has important implications as the failure of research to move beyond enumerating differences in sources of referral to psychiatric services and rates of compulsory admission means no recommendations for policy or service reform have been developed from the research. The second part of the paper sets out the foundations for future research, arguing that the pathway to care has to be studied as a social process subject to a wide range of influences, including the cultural context within which illness is experienced. It is further argued that Kleinman's (Patients and healers in the context of culture: an exploration of the borderland between anthropology, medicine and psychiatry, University of California Press, Los Angeles, 1980) Health Care System model offers a particularly valuable preliminary framework for organising and interpreting future research. It is only through gaining a more qualitative understanding of the processes at work in shaping different responses to mental illness and interactions with mental health services that the patterns observed in quantitative studies can be fully understood. This further reflects the need for a bridge between the social sciences and psychiatry if services are to be developed to respond to the increasing diversity of modern societies.
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Affiliation(s)
- Craig Morgan
- Department of Social Policy and Social Work, University of Oxford, Barnett House, 32 Wellington Square, Oxford OX1 2ER, UK.
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Gudjonsson GH, Rabe-Hesketh S, Szmukler G. Management of psychiatric in-patient violence: patient ethnicity and use of medication, restraint and seclusion. Br J Psychiatry 2004; 184:258-62. [PMID: 14990525 DOI: 10.1192/bjp.184.3.258] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Significant ethnic differences have been found previously on a forensic unit in the management of psychiatric patients after a violent incident. AIMS To study the management of violent incidents on all general wards in a large psychiatric hospital in South London. The main question is whether there are differences in the management of Black patients involved in violent incidents compared with White patients and, if so, what are the factors leading to it? METHOD All recorded violent incidents (1515 in total) on 14 general wards over three years (1994, 1996, 1998) were analysed using mixed logistic regression to estimate the odds ratio that the corresponding management decision (emergency medication, physical restraint, seclusion) was taken for Black patients compared with White patients after controlling for covariates and unobserved heterogeneity between subjects. RESULTS Black patients were more likely than White patients to be given emergency medication and to be secluded after a violent incident, but not to be physically restrained. However, differences disappeared when the odds ratios were adjusted for other variables. CONCLUSIONS Racial 'stereotyping' was unlikely to have played a major direct role in determining nurses' responses.
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Affiliation(s)
- Gisli H Gudjonsson
- Denis Hill Unit, South London and Maudsley NHS Trust, Institute of Psychiatry, London.
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Davison S. Specialist forensic mental health services. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2004; 14 Suppl 1:S19-24. [PMID: 16575811 DOI: 10.1002/cbm.604] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
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Abstract
There is now a body of research that has shown that the attitudes of nurses towards substance misuse in the mentally ill are generally suboptimal and this has an impact on the quality of nursing care provided. Despite this, to date there have been no published studies that have examined the attitudes of forensic nurses towards substance misusing forensic service users. Sixty-three multiethnic registered forensic psychiatric nurses based on an inpatient unit in outer London were surveyed using the Substance Abuse Attitude Survey (SAAS). This has five subscores: Treatment Intervention, Treatment Optimism, Permissiveness, Non-Moralism and Non-Stereotypes. Only Permissiveness scores were at an optimum level and equivalent to other community mental health workers. The Treatment Intervention and Treatment Optimism subscores were well below those of a multidisciplinary group of community mental health workers. Three other findings were of note. Firstly, women had higher Non-Moralism scores than men. Secondly, staff nurses had higher Non-Stereotypes scores than other grades. Finally, Black nurses had higher Treatment Optimism scores than non-Black colleagues. In conclusion, the attitudes of forensic nurses towards substance misuse in forensic clients are more suboptimal than other groups of community mental health workers. Our findings also indicate that gender, staff grading and ethnicity are associated with suboptimal scores.
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Affiliation(s)
- J H Foster
- Department of Health and Social Sciences, Middlesex University, Enfield Campus, Queensway, Enfield, Middlesex, UK.
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Bhui K, Stansfeld S, Hull S, Priebe S, Mole F, Feder G. Ethnic variations in pathways to and use of specialist mental health services in the UK. Systematic review. Br J Psychiatry 2003; 182:105-16. [PMID: 12562737 DOI: 10.1192/bjp.182.2.105] [Citation(s) in RCA: 271] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Inequalities of service use across ethnic groups are important to policy makers, service providers and service users. AIMS To identify ethnic variations in pathways to specialist mental health care, continuity of contact, voluntary and compulsory psychiatric in-patient admissions; to assess the methodological strength of the findings. METHOD A systematic review of all quantitative studies comparing use of mental health services by more than one ethnic group in the UK. Narrative analysis supplemented by meta-analysis, where appropriate. RESULTS Most studies compared Black and White patients, finding higher rates of in-patient admission among Black patients. The pooled odds ratio for compulsory admission, Black patients compared with White patients, was 4.31 (95% CI 3.33-5.58). Black patients had more complex pathways to specialist care, with some evidence of ethnic variations in primary care assessments. CONCLUSIONS There is strong evidence of variation between ethnic groups for voluntary and compulsory admissions, and some evidence of variation in pathways to specialist care.
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Affiliation(s)
- Kamaldeep Bhui
- Department of Psychiatry, Barts and the London, Queen Mary's School of Medicine and Dentistry, UK.
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Dimond C, Butwell M. Children admitted to high security (special) hospital. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2003; 13:278-293. [PMID: 14654864 DOI: 10.1002/cbm.551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
INTRODUCTION The Special Hospitals in England provide psychiatric treatment in high security. The aim of this study was to examine the demographics and background characteristics of children admitted to high security hospitals in England, using the special hospital case register. METHOD Forty-six children (the subject group) were admitted to a high security hospital under the MHA (1983) classification of disorder of mental illness and/or psychopathic disorder between 1983 and 1999, 33 (72%) of whom were male. A comparison group of adults was matched on sex, legal classification of detention and MHA 1983 classification of disorder. RESULTS The children were admitted for a similar range of offences to those of the comparison group. However, the children had received convictions for criminal damage and violence at a significantly earlier age, they were more likely to have experienced a change in caregiver during their childhood, been placed in a children's home and were less likely to be living with a family member on their 16th birthday. Children admitted to special hospital experience a lot of disruption in their childhood and are extremely high users of multi-agency services as they grow up. DISCUSSION Issues are raised regarding how to provide a developmentally sensitive service for children who require high security care.
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Affiliation(s)
- Claire Dimond
- CAMHS, Lanesborough Wing, St George's Hospital, London SW17 0QT
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Coid J, Petruckevitch A, Bebbington P, Brugha T, Bhugra D, Jenkins R, Farrell M, Lewis G, Singleton N. Ethnic differences in prisoners. 1: criminality and psychiatric morbidity. Br J Psychiatry 2002; 181:473-80. [PMID: 12456516 DOI: 10.1192/bjp.181.6.473] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND In England and Wales, persons of African-Caribbean origin are more likely to be both imprisoned and admitted to secure hospitals. AIMS To estimate population-based rates of imprisonment in different ethnic groups, and compare criminal behaviour and psychiatric morbidity. METHOD We examined Home Office data on all persons in prison, and carried out a two-stage cross-sectional survey of 3142 remanded and sentenced, male and female, prisoners in all penal establishments in England and Wales in 1997. RESULTS We confirmed high rates of imprisonment for Black people and lower rates for South Asians. Different patterns of offending and lower prevalence of psychiatric morbidity were observed in Black prisoners. CONCLUSIONS Despite increased risks of imprisonment, African-Caribbeans show less psychiatric morbidity than White prisoners. This contrasts with the excess of African-Caribbeans in secure hospitals, an inconsistency possibly in part due to the effects of ethnic groups on admission procedures.
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Affiliation(s)
- Jeremy Coid
- Department of Psychological Medicine, St Bartholomew's Hospital, London.
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Coid J, Petruckevitch A, Bebbington P, Brugha T, Bhugra D, Jenkins R, Farrell M, Lewis G, Singleton N. Ethnic differences in prisoners. 2: risk factors and psychiatric service use. Br J Psychiatry 2002; 181:481-7. [PMID: 12456517 DOI: 10.1192/bjp.181.6.481] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The high rates of psychiatric morbidity in prisoners vary between ethnic groups. AIMS To compare early environmental risks, stressful daily living experiences and reported use of psychiatric services in prisoners from different ethnic groups. METHOD Cross-sectional survey of 3142 prisoners in all penal establishments in England and Wales in 1997. RESULTS Fewer Black and South Asian male prisoners reported childhood traumas and conduct disorder, and fewer Black prisoners experienced stressful prison experiences, than White prisoners. Fewer Black women had received previous psychiatric treatment, and fewer Black men had their psychiatric problems identified in prison. Black prisoners were less likely to have received psychiatric treatment than Whites. CONCLUSIONS The lower prevalence of psychiatric morbidity observed in Black prisoners corresponds with reduced exposure to risk factors. Higher rates of imprisonment might be explained by higher rates of conduct disorder, adolescent-onset criminality and disadvantage within the criminal justice system.
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Affiliation(s)
- Jeremy Coid
- Department of Psychological Medicine, St Bartholomew's Hospital, London.
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Walsh E, Leese M, Taylor P, Johnston I, Burns T, Creed F, Higgit A, Murray R. Psychosis in high-security and general psychiatric services: report from the UK700 and special hospitals' treatment resistant schizophrenia groups. Br J Psychiatry 2002; 180:351-7. [PMID: 11925359 DOI: 10.1192/bjp.180.4.351] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Serious violence is an unusual but significant correlate of psychosis, and leads to the need for specialist secure psychiatric services. Most such service users have previously used general psychiatric services. AIMS To examine diagnostic and socio-demographic differences between high-security psychiatric service users from their peers in community services. METHOD Two groups of patients with psychosis were compared: a national sample of high-security hospital residents, and a sample of patients in contact with general psychiatric services. RESULTS Schizophrenia was the almost invariable diagnosis for all special hospital patients. White patients in the community sample were significantly more likely to have affective components to their illness compared with African-Caribbean patients; unlike those in special hospitals. There was a small excess in the proportion of African-Caribbean patients in the special hospital group, controlling for diagnosis, gender and locality. Men were overrepresented in this group. CONCLUSIONS Among patients with psychosis, having a diagnosis of schizophrenia and being male increase the likelihood of special hospital admission. Suggestions that ethnic minority patients are much more likely to have engaged in serious violence and need high-security placement were not borne out.
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Affiliation(s)
- Elizabeth Walsh
- Institute of Psychiatry, London. St George's Hospital Medical School, London, UK
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Coid J, Kahtan N, Gault S, Cook A, Jarman B. Medium secure forensic psychiatry services: comparison of seven English health regions. Br J Psychiatry 2001; 178:55-61. [PMID: 11136211 DOI: 10.1192/bjp.178.1.55] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Regional medium secure developments have proceeded unevenly, with wide variations in resources to deliver services. AIMS To compare patients admitted to seven (pre-reorganisation) regional services and styles of service delivery. METHOD A record survey of a complete sample of 2608 patients admitted on 3403 occasions between 1 January 1988 and 31 December 1994. RESULTS Services differed according to location of patients before admission, their legal basis for detention, criminal and antisocial behaviour, diagnosis, security needs and length of stay. Regions with more resources and lower demand provided a wider range of services. Thames services were relatively under-provided during the study period, with North East Thames substantially reliant on admissions to private hospitals. CONCLUSIONS Uncoordinated development led to under-provision despite high demand. Certain regions prioritised offender patients and did not support local psychiatric services. New standards are required for service specification and resource allocation to redress inequality. Traditional performance measures were of limited usefulness in comparing services.
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Affiliation(s)
- J Coid
- Forensic Psychiatry Research Unit, St Bartholomew's Hospital, London, UK
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Sarkar SP. Ethnic differences in forensic hospitalisation. Br J Psychiatry 2000; 177:566. [PMID: 11102340 DOI: 10.1192/bjp.177.6.566-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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