Routes to psychiatric inpatient care in an Inner London Borough

Abstract

A study is reported in which pathways to psychiatric inpatient care were investigated in an Inner London Borough. Data were collected on a series of 52 consecutive admissions of adults to the psychiatric wards serving the area. The most striking feature of the results was the variety of routes taken to inpatient care, combined with a high level of police involvement (23.1% of admissions) and low level of referral from General Practitioners (15.4% of admissions). Significant age differences in routes to care were found: those under 30 years were usually brought to hospital by the police or presented directly to psychiatric emergency services; those over 30 typically came via medical/surgical hospital services, domiciliary psychiatric services or psychiatric outpatients. There were no differences in the routes taken by Afro-Caribbean and white people or by men and women. Higher proportions of Afro-Caribbeans received a diagnosis of schizophrenia, considered themselves to have nothing wrong with them and were compulsorily detained. Higher proportions of whites were diagnosed as depressed and considered themselves to have physical problems rather than psychiatric ones. However, results clearly indicated that it was ethnic status rather than diagnostic category that accounted for the higher rates of compulsory detention of Afro-Caribbean people. The implications of the findings for service development and delivery are considered.

Pathways to the First Contact with Specialist Mental Health Care

“…These findings are at variance with previous research that tended to show that ethnicity influenced the duration of help-seeking and the pathways taken to reach care. Moodley and Perkins [27] did not find any difference in the routes to psychiatric admission in a consecutive series of Afro-Caribbean and White patients in an Inner London Borough. However, a number of recent studies have questioned such conclusions.…”

Is there racial bias in clinicians' perceptions of the dangerousness of psychiatric patients? A review of the literature

“…Similarly, in an audit of 60 consecutive compulsory admissions to hospital, Moodley & Perkins (1991), found that although their sample of black patients were more likely than white patients to be given a diagnosis of psychosis, that this could not account for differences in compulsory admission rates. In this study, the best predictor of risk of compulsory admission was found to be ethnicity alone.…”

The Essential Elements of Culturally Sensitive Psychiatric Services

“…The recent changes in practice regarding the prescription of high doses of neuroleptics are to be welcomed (Sims, 1994). Perhaps it is similarly time to challenge views about medication amongst Black people who are known in Britain to receive major tranquillizers and antidepressants more frequently than White patients, more often as a depot, at higher doses, and less often psychotherapy or counselling (Littlewood & Lipsedge, 1989;Moodley & Perkins, 1991;Lloyd & Moodley, 1992). Black users' complaints about medication may be a result of excessive medication in the face of poorer communicative relationships lending themselves to pursue a biological approach.…”