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Published in: Social Psychiatry and Psychiatric Epidemiology 10/2006

01-10-2006 | ORIGINAL PAPER

Ethnic Differences in Mental Health Service Use Among Patients with Psychotic Disorders

Authors: Dr. Rajesh Mohan, MRCPsych, Dr. Paul McCrone, PhD, Dr. George Szmukler, FRCPsych, Dr. Nadia Micali, MRCPsych, Sarah Afuwape, C Psychol, Prof. Graham Thornicroft, FRCPsych

Published in: Social Psychiatry and Psychiatric Epidemiology | Issue 10/2006

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Abstract

Background

There are concerns that ethnic minority patients are over-represented in inpatient mental health settings, but under-utilise community services. This study aims to compare the use of community mental health services between African-Caribbean and White patients with psychosis, before and after the introduction of new community services, and to investigate their impact on inpatient treatment.

Methods

The sample was drawn from epidemiologically representative patients with psychotic disorders living in two catchment areas in South London, one of which was developing intensive community treatments. Service utilisation was measured at baseline and at 2-year follow-up using the Client Service Receipt Interview (CSRI). The mean number of contacts with specific services was compared between the two groups over time.

Results

A total of 92 White and 48 African-Caribbean patients were compared. The latter were more likely to be younger (P = 0.004), have shorter illness duration (P < 0.001), and had more detentions under the Mental Health Act (P = 0.003). No significant differences were seen in use of community services over time. However, intensive treatment led to a significant reduction in hospital days for African Caribbean patients compared to White patients in the intensive sector and all patients in the standard sector.

Conclusions

Intensive community treatments reduced inpatient days in African Caribbean patients. Further effort is needed to improve the cultural sensitivity of community mental health services.
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Literature
1.
go back to reference Department of Health (2003) Inside outside: improving mental health services for black and minority ethnic communities in England. NIMHE, London Department of Health (2003) Inside outside: improving mental health services for black and minority ethnic communities in England. NIMHE, London
2.
go back to reference Goater N, King M, Cole E, et al. (1999) Ethnicity and outcome of psychosis. Br J Psychiatry 175:34–42PubMed Goater N, King M, Cole E, et al. (1999) Ethnicity and outcome of psychosis. Br J Psychiatry 175:34–42PubMed
3.
go back to reference Audini B, Lelliott P (2002) Age, gender and ethnicity of those detained under Part II of the Mental Health Act 1983. Br J Psychiatry 180:222–226PubMedCrossRef Audini B, Lelliott P (2002) Age, gender and ethnicity of those detained under Part II of the Mental Health Act 1983. Br J Psychiatry 180:222–226PubMedCrossRef
4.
go back to reference Commander MJ, O’Dell SM, Surtees PG, et al. (2003) Characteristics of patients and patterns of psychiatric service use in ethnic minorities. Int J Soc Psychiatry 49:216–224PubMedCrossRef Commander MJ, O’Dell SM, Surtees PG, et al. (2003) Characteristics of patients and patterns of psychiatric service use in ethnic minorities. Int J Soc Psychiatry 49:216–224PubMedCrossRef
5.
go back to reference Bhui K, Stansfeld S, Hull S, et al. (2003) Ethnic variations in pathways to and use of specialist mental health services in the UK. Systematic review. Br J Psychiatry 182:105–116PubMedCrossRef Bhui K, Stansfeld S, Hull S, et al. (2003) Ethnic variations in pathways to and use of specialist mental health services in the UK. Systematic review. Br J Psychiatry 182:105–116PubMedCrossRef
6.
go back to reference Takei N, Persaud R, Woodruff P, et al. (1998) First episodes of psychosis in Afro-Caribbean and White people. An 18 year follow-up study. Br J Psychiatry 172:147–153PubMed Takei N, Persaud R, Woodruff P, et al. (1998) First episodes of psychosis in Afro-Caribbean and White people. An 18 year follow-up study. Br J Psychiatry 172:147–153PubMed
7.
go back to reference Maden A, Friendship C, McClintock T, et al. (1999) Outcome of admission to a medium secure psychiatric unit. 2. Role of ethnic origin. Br J Psychiatry 175:317–321PubMed Maden A, Friendship C, McClintock T, et al. (1999) Outcome of admission to a medium secure psychiatric unit. 2. Role of ethnic origin. Br J Psychiatry 175:317–321PubMed
8.
go back to reference Leese M, Thornicroft G, Shaw J, Thomas S, Mohan R, Harty M, Dolan M (2006) Ethnic differences among patients in high secure psychiatric hospitals in England. Br J Psychiatry 188:300–385CrossRef Leese M, Thornicroft G, Shaw J, Thomas S, Mohan R, Harty M, Dolan M (2006) Ethnic differences among patients in high secure psychiatric hospitals in England. Br J Psychiatry 188:300–385CrossRef
9.
go back to reference Lay B, Lauber C, Rossler W (2005) Are immigrants at a disadvantage in psychiatric in-patient care? Acta Psychiatr Scand 111:358–366PubMedCrossRef Lay B, Lauber C, Rossler W (2005) Are immigrants at a disadvantage in psychiatric in-patient care? Acta Psychiatr Scand 111:358–366PubMedCrossRef
10.
go back to reference Bhui K, Sashidharan SP (2003) Should there be separate psychiatric services for ethnic minority groups? Br J Psychiatry 182:10–12PubMedCrossRef Bhui K, Sashidharan SP (2003) Should there be separate psychiatric services for ethnic minority groups? Br J Psychiatry 182:10–12PubMedCrossRef
11.
go back to reference Narrow WE, Regier DA, Norquist G, et al. (2000) Mental health service use by Americans with severe mental illnesses. Soc Psychiatry Psychiatr Epidemiol 35(4):147–155PubMedCrossRef Narrow WE, Regier DA, Norquist G, et al. (2000) Mental health service use by Americans with severe mental illnesses. Soc Psychiatry Psychiatr Epidemiol 35(4):147–155PubMedCrossRef
12.
go back to reference McCrone P, Thornicroft G, Phelan M, et al. (1998) Utilisation and costs of community mental health. Br J Psychiatry 173:391–398PubMed McCrone P, Thornicroft G, Phelan M, et al. (1998) Utilisation and costs of community mental health. Br J Psychiatry 173:391–398PubMed
13.
go back to reference McGuffin P, Farmer A, Harvey I (1991) A polydiagnostic application of operational criteria in studies of psychotic illness; Development and reliability of the OPCRIT system. Arch Gen Psychiatry 48:764–770PubMed McGuffin P, Farmer A, Harvey I (1991) A polydiagnostic application of operational criteria in studies of psychotic illness; Development and reliability of the OPCRIT system. Arch Gen Psychiatry 48:764–770PubMed
14.
go back to reference World Health Organisation (1992) SCAN: schedules for clinical assessments in neuropsychiatry. WHO, Geneva World Health Organisation (1992) SCAN: schedules for clinical assessments in neuropsychiatry. WHO, Geneva
15.
go back to reference Thornicroft G, Strathdee G, Phelan M, et al. (1998) Rationale and design. PRiSM Psychosis Study. Br J Psychiatry 173:363–370PubMed Thornicroft G, Strathdee G, Phelan M, et al. (1998) Rationale and design. PRiSM Psychosis Study. Br J Psychiatry 173:363–370PubMed
16.
go back to reference Becker T, Holloway F, McCrone P, et al. (1998) Evolving service interventions in Nunhead and Norwood. PRiSM Psychosis Study. 2. Br J Psychiatry 173:371–375PubMed Becker T, Holloway F, McCrone P, et al. (1998) Evolving service interventions in Nunhead and Norwood. PRiSM Psychosis Study. 2. Br J Psychiatry 173:371–375PubMed
17.
go back to reference Beecham J, Knapp M (1992) Costing psychiatric interventions. In: Thornicroft G, Brewin C, Wing J (eds) Measuring mental health needs. Gaskell, London Beecham J, Knapp M (1992) Costing psychiatric interventions. In: Thornicroft G, Brewin C, Wing J (eds) Measuring mental health needs. Gaskell, London
18.
go back to reference Overall J, Gorham D (1962) Brief psychiatric rating scale. Psychol Rep 10:799–812CrossRef Overall J, Gorham D (1962) Brief psychiatric rating scale. Psychol Rep 10:799–812CrossRef
19.
go back to reference Leff J, O’Driscoll C, Dayson D, et al. (1990) The TAPS Project. 5: the structure of social network data obtained from long stay patients. Br J Psychiatry 157:848–852PubMed Leff J, O’Driscoll C, Dayson D, et al. (1990) The TAPS Project. 5: the structure of social network data obtained from long stay patients. Br J Psychiatry 157:848–852PubMed
20.
go back to reference Oliver J (1991) The social care directive: development of a quality of life profile for use on community service for the mentally ill. Soc Work Soc Sci Rev 3:5–45 Oliver J (1991) The social care directive: development of a quality of life profile for use on community service for the mentally ill. Soc Work Soc Sci Rev 3:5–45
21.
go back to reference Phelan M, Slade M, Thornicroft G, et al. (1995) The Camberwell Assessment of Need (CAN): the validity and reliability of an instrument to assess the needs of people with severe mental illness. Br J Psychiatry 167:589–595PubMed Phelan M, Slade M, Thornicroft G, et al. (1995) The Camberwell Assessment of Need (CAN): the validity and reliability of an instrument to assess the needs of people with severe mental illness. Br J Psychiatry 167:589–595PubMed
22.
go back to reference Endicott J, Spitzer RL, Fleiss JL (1976) The Global Assessment Scale. A procedure for measuring overall severity of psychiatric disturbance. Arch Gen Psychiatry 33:766–771PubMed Endicott J, Spitzer RL, Fleiss JL (1976) The Global Assessment Scale. A procedure for measuring overall severity of psychiatric disturbance. Arch Gen Psychiatry 33:766–771PubMed
23.
go back to reference Office of Population Censuses, Survey (1991) The 1991 census. Small Area Statistics. HMSO, London Office of Population Censuses, Survey (1991) The 1991 census. Small Area Statistics. HMSO, London
24.
go back to reference Thompson SG, Barber JA (2000) How should cost data in pragmatic randomised trials be analysed? BMJ 320:1197–1200PubMedCrossRef Thompson SG, Barber JA (2000) How should cost data in pragmatic randomised trials be analysed? BMJ 320:1197–1200PubMedCrossRef
25.
go back to reference Mooney C, Duval R (1993) Bootstrapping: a non-parametric approach to statistical inference. Sage, London Mooney C, Duval R (1993) Bootstrapping: a non-parametric approach to statistical inference. Sage, London
26.
go back to reference UK700 Group (1999) Intensive versus standard case management for severe psychotic illness: a randomised trial. Lancet 353:2185–2189CrossRef UK700 Group (1999) Intensive versus standard case management for severe psychotic illness: a randomised trial. Lancet 353:2185–2189CrossRef
27.
go back to reference Marshall M, Gray A, Lockwood A, Green R (2000) Case management for people with severe mental disorders. Cochrane Database Syst Rev;(2):CD000050 Marshall M, Gray A, Lockwood A, Green R (2000) Case management for people with severe mental disorders. Cochrane Database Syst Rev;(2):CD000050
28.
go back to reference Raine R, Lewis L, Sensky T, et al. (2000) Patient determinants of mental health interventions in primary care. Br J Gen Pract 50:620–625PubMed Raine R, Lewis L, Sensky T, et al. (2000) Patient determinants of mental health interventions in primary care. Br J Gen Pract 50:620–625PubMed
29.
go back to reference Cole E, Leavey G, King M, et al. (1995) Pathways to care for patients with a first episode of psychosis. A comparison of ethnic groups. Br J Psychiatry 167:770–776PubMed Cole E, Leavey G, King M, et al. (1995) Pathways to care for patients with a first episode of psychosis. A comparison of ethnic groups. Br J Psychiatry 167:770–776PubMed
30.
go back to reference Barrio C, Yamada AM, Hough RL, et al. (2003) Ethnic disparities in use of public mental health case management services among patients with schizophrenia. Psychiatr Serv 54:1264–1270PubMedCrossRef Barrio C, Yamada AM, Hough RL, et al. (2003) Ethnic disparities in use of public mental health case management services among patients with schizophrenia. Psychiatr Serv 54:1264–1270PubMedCrossRef
31.
go back to reference Koffman J, Fulop NJ, Pashley D, et al. (1997) Ethnicity and use of acute psychiatric beds: one-day survey in north and south Thames regions. Br J Psychiatry 171:238–241PubMed Koffman J, Fulop NJ, Pashley D, et al. (1997) Ethnicity and use of acute psychiatric beds: one-day survey in north and south Thames regions. Br J Psychiatry 171:238–241PubMed
32.
go back to reference Goldberg RW, Seybolt DC, Lehman A (2002) Reliable self-report of health service use by individuals with serious mental illness. Psychiatr Serv 53:879–881PubMedCrossRef Goldberg RW, Seybolt DC, Lehman A (2002) Reliable self-report of health service use by individuals with serious mental illness. Psychiatr Serv 53:879–881PubMedCrossRef
33.
go back to reference McCrone P, Menezes PR, Johnson S, et al. (2000) Service use and costs of people with dual diagnosis in South London. Acta Psychiatr Scand 101:464–472PubMedCrossRef McCrone P, Menezes PR, Johnson S, et al. (2000) Service use and costs of people with dual diagnosis in South London. Acta Psychiatr Scand 101:464–472PubMedCrossRef
34.
go back to reference Marshall M, Bond G, Stein LI, et al. (1999) PRiSM Psychosis Study. Design limitations, questionable conclusions. Br J Psychiatry 175:501–503PubMedCrossRef Marshall M, Bond G, Stein LI, et al. (1999) PRiSM Psychosis Study. Design limitations, questionable conclusions. Br J Psychiatry 175:501–503PubMedCrossRef
35.
go back to reference Thornicroft G, Becker T, Holloway F, et al. (1999) Community mental health teams: evidence or belief? Br J Psychiatry 175:508–513PubMed Thornicroft G, Becker T, Holloway F, et al. (1999) Community mental health teams: evidence or belief? Br J Psychiatry 175:508–513PubMed
36.
go back to reference Minas H (2001) Service responses to cultural diversity. In: Thornicroft G, Szmukler G (eds) Textbook of community psychiatry. Oxford University Press, Oxford Minas H (2001) Service responses to cultural diversity. In: Thornicroft G, Szmukler G (eds) Textbook of community psychiatry. Oxford University Press, Oxford
Metadata
Title
Ethnic Differences in Mental Health Service Use Among Patients with Psychotic Disorders
Authors
Dr. Rajesh Mohan, MRCPsych
Dr. Paul McCrone, PhD
Dr. George Szmukler, FRCPsych
Dr. Nadia Micali, MRCPsych
Sarah Afuwape, C Psychol
Prof. Graham Thornicroft, FRCPsych
Publication date
01-10-2006
Publisher
Steinkopff-Verlag
Published in
Social Psychiatry and Psychiatric Epidemiology / Issue 10/2006
Print ISSN: 0933-7954
Electronic ISSN: 1433-9285
DOI
https://doi.org/10.1007/s00127-006-0094-7

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