title: Social exclusion and risk of emergency compulsory admission. A case-control study.
abstract: BACKGROUND
  Emergency detentions under section 4 of the Mental Health Act 1983 are more frequent in socially deprived areas of England and Wales. However, it is not clear whether individual socio-economic disadvantage increases likelihood of emergency detention. Therefore, this study tests the hypothesis that a higher proportion of people who are socially excluded will be admitted to hospital under section 4 than those who are not.
  
  
  METHODS
  A total of 300 mental health act assessments in two London boroughs with different rates of section 4 admissions were studied by retrospective case note review in a case-control design. An index of social exclusion was created and piloted for this study.
  
  
  RESULTS
  The logistic regression analysis discovered four risk factors for section 4 admissions: presenting with a risk to self or others at the mental health act assessment, bi-polar affective disorder, non-White British ethnicity and low social support. There were no significant differences between the two boroughs on these variables. Risk factors for any compulsory admission were: presenting with a risk, psychosis and non-White British ethnicity.
  
  
  CONCLUSIONS
  This study found low social support to be the only social exclusion indicator that increases likelihood of admission under section 4. While individual-level variables explain some of the variation in section 4 rates, it is likely that, as indicated by other studies, different configurations of mental health services affect rates to a greater degree.
authors.affiliation: Institute of Psychiatry, Kings College London, London, UK. m.webber@iop.kcl.ac.uk
authors.forename: Martin
authors.initials: M
authors.lastname: Webber
authors.forename: Peter
authors.initials: P
authors.lastname: Huxley
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D016022:Case-Control Studies; D003134:Commitment of Persons with Psychiatric Disorders / Q000706:statistics & numerical data*; D003617:Dangerous Behavior; D004630:Emergencies; D005006:Ethnicity / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011610:Psychosocial Deprivation; D012059:Rejection, Psychology; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012918:Social Alienation / Q000523:psychology*; D012944:Social Support; D012959:Socioeconomic Factors; D014505:Urban Population / Q000706:statistics & numerical data*