Ethnic variations in pathways to acute care and compulsory detention for women experiencing a mental health crisis.
BACKGROUND
Much recent debate on excess rates of compulsory detention and coercive routes to care has focused on young black men; evidence is less clear regarding ethnic variations among women and factors that may mediate these.


OBJECTIVE
To explore ethnic variations in compulsory detentions of women, and to explore the potential role of immediate pathways to admission and clinician-rated reasons for admission as mediators of these differences.


METHODS
All women admitted to an acute psychiatric inpatient ward or a women's crisis house in four London boroughs during a 12-week period were included. Data were collected regarding their pathways to care, clinician-rated reasons for admission, hospital stays, and social and clinical characteristics.


RESULTS
Two hundred and eighty seven (287) women from white British, white other, black Caribbean, black African and black other groups were included. Adjusting for social and clinical characteristics, all groups of black patients and white other patients were significantly more likely to have been compulsorily admitted than white British patients; white British patients were more likely than other groups to be admitted to a crisis house and more likely than all the black groups to be admitted because of perceived suicide risk. Immediate pathways to care differed: white other, black African and black other groups were less likely to have referred themselves in a crisis and more likely to have been in contact with the police. When adjustment was made for differences in pathways to care, the ethnic differences in compulsory admission were considerably reduced.


CONCLUSIONS
There are marked ethnic inequities not only between white British and black women, but also between white British and white other women in experiences of acute admission. Differences between groups in help-seeking behaviours in a crisis may contribute to explaining differences in rates of compulsory admission.
University College London, London, UK.
Caroline
C
Lawlor
Sonia
S
Johnson
Laura
L
Cole
Louise M
LM
Howard
D003068:Coercion; D003134:Commitment of Persons with Psychiatric Disorders; D004637:Emergency Services, Psychiatric; D005006:Ethnicity; D005260:Female; D017144:Focus Groups; D006801:Humans; D007407:Interviews as Topic; D008131:London; D001523:Mental Disorders / Q000208:ethnology*; D010343:Patient Admission / Q000706:statistics & numerical data