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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References
Department of Health (2003) Inside outside: improving mental health services for black and minority ethnic communities in England. NIMHE, London
Goater N, King M, Cole E, et al. (1999) Ethnicity and outcome of psychosis. Br J Psychiatry 175:34–42
Audini B, Lelliott P (2002) Age, gender and ethnicity of those detained under Part II of the Mental Health Act 1983. Br J Psychiatry 180:222–226
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 49:216–224
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 182:105–116
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 172:147–153
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 175:317–321
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 188:300–385
Lay B, Lauber C, Rossler W (2005) Are immigrants at a disadvantage in psychiatric in-patient care? Acta Psychiatr Scand 111:358–366
Bhui K, Sashidharan SP (2003) Should there be separate psychiatric services for ethnic minority groups? Br J Psychiatry 182:10–12
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):147–155
McCrone P, Thornicroft G, Phelan M, et al. (1998) Utilisation and costs of community mental health. Br J Psychiatry 173:391–398
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 48:764–770
World Health Organisation (1992) SCAN: schedules for clinical assessments in neuropsychiatry. WHO, Geneva
Thornicroft G, Strathdee G, Phelan M, et al. (1998) Rationale and design. PRiSM Psychosis Study. Br J Psychiatry 173:363–370
Becker T, Holloway F, McCrone P, et al. (1998) Evolving service interventions in Nunhead and Norwood. PRiSM Psychosis Study. 2. Br J Psychiatry 173:371–375
Beecham J, Knapp M (1992) Costing psychiatric interventions. In: Thornicroft G, Brewin C, Wing J (eds) Measuring mental health needs. Gaskell, London
Overall J, Gorham D (1962) Brief psychiatric rating scale. Psychol Rep 10:799–812
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 157:848–852
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
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 167:589–595
Endicott J, Spitzer RL, Fleiss JL (1976) The Global Assessment Scale. A procedure for measuring overall severity of psychiatric disturbance. Arch Gen Psychiatry 33:766–771
Office of Population Censuses, Survey (1991) The 1991 census. Small Area Statistics. HMSO, London
Thompson SG, Barber JA (2000) How should cost data in pragmatic randomised trials be analysed? BMJ 320:1197–1200
Mooney C, Duval R (1993) Bootstrapping: a non-parametric approach to statistical inference. Sage, London
UK700 Group (1999) Intensive versus standard case management for severe psychotic illness: a randomised trial. Lancet 353:2185–2189
Marshall M, Gray A, Lockwood A, Green R (2000) Case management for people with severe mental disorders. Cochrane Database Syst Rev;(2):CD000050
Raine R, Lewis L, Sensky T, et al. (2000) Patient determinants of mental health interventions in primary care. Br J Gen Pract 50:620–625
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 167:770–776
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 54:1264–1270
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 171:238–241
Goldberg RW, Seybolt DC, Lehman A (2002) Reliable self-report of health service use by individuals with serious mental illness. Psychiatr Serv 53:879–881
McCrone P, Menezes PR, Johnson S, et al. (2000) Service use and costs of people with dual diagnosis in South London. Acta Psychiatr Scand 101:464–472
Marshall M, Bond G, Stein LI, et al. (1999) PRiSM Psychosis Study. Design limitations, questionable conclusions. Br J Psychiatry 175:501–503
Thornicroft G, Becker T, Holloway F, et al. (1999) Community mental health teams: evidence or belief? Br J Psychiatry 175:508–513
Minas H (2001) Service responses to cultural diversity. In: Thornicroft G, Szmukler G (eds) Textbook of community psychiatry. Oxford University Press, Oxford
Acknowledgements
The authors gratefully acknowledge the helpful comments and suggestions from Dr Morven Leese on the methodology and analysis of the data.
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Declaration of interest:
This study was funded by the Bethlem and Maudsley NHS Trustees.
Appendix 1
Appendix 1
Service use categories
Category | Description |
---|---|
Psychiatrist | Appointment with psychiatrist |
Emergency clinic | Contact with emergency hospital services |
Day care | Day hospital and day care services |
CPN | Community psychiatric nurse |
Occupational therapist | Occupational therapy appointments |
Psychologist | Psychology appointments |
General health care | General practitioner and other general health care |
Social services | Social worker and other social care services |
Allied services | Educational, employment and legal services |
Informal care | All informal care |
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Mohan, R., McCrone, P., Szmukler, G. et al. Ethnic Differences in Mental Health Service Use Among Patients with Psychotic Disorders. Soc Psychiat Epidemiol 41, 771–776 (2006). https://doi.org/10.1007/s00127-006-0094-7
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DOI: https://doi.org/10.1007/s00127-006-0094-7