Ethnic inequalities in involuntary admission under the Mental Health Act: An exploration of mediation effects of clinical care prior to the first admission

Fonseca de Freitas, Daniela, Walker, Susan, Nyikavaranda, Patrick, Downs, Johnny, Patel, Rashmi, Khondoker, Mizanur ORCID: https://orcid.org/0000-0002-1801-1635, Bhui, Kamaldeep and Hayes, Richard D. (2023) Ethnic inequalities in involuntary admission under the Mental Health Act: An exploration of mediation effects of clinical care prior to the first admission. The British Journal of Psychiatry, 222 (1). pp. 27-36. ISSN 0007-1250

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Abstract

Background Studies show ethnic inequalities in rates of involuntary admission and types of clinical care (such as psychological therapies). However, few studies have investigated if there is a relationship between clinical care practices and ethnic inequalities in involuntary admission. Aims: This study investigated the impact of ethnicity and clinical care on involuntary admission and the potential mediation effects of prior clinical care. Method: In this retrospective cohort study, we used data from the electronic records of the South London and Maudsley NHS Foundation Trust and identified patients with a first hospital admission between January 2008 and May 2021. Logistic regression and mediation analyses were used to investigate the association between ethnicity and involuntary admission, and whether clinical care, in the 12 months preceding admission, mediates the association. Results: Compared with White British people, higher odds of involuntary admission were observed among 10 of 14 minority ethnic groups; with more than twice the odds observed among people of Asian Chinese, of Asian Bangladeshi and of any Black background. There were some ethnic differences in clinical care prior to admission, but these had a minimal impact on the inequalities in involuntary admission. More out-patient appointments and home treatment were associated with higher odds of involuntary admission, whereas psychological therapies and having a care plan were associated with reduced odds of involuntary admission. Conclusions: Ethnic inequalities in involuntary admission persist after accounting for potential mediating effects of several types and frequencies of clinical care. Promoting access to psychological therapies and ensuring that care plans are in place may reduce involuntary admissions.

Item Type: Article
Additional Information: Funding: This work utilised the Clinical Record Interactive Search (CRIS) platform, funded and developed by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London. Additionally, this work was supported by the Lankelly Chase Foundation, which is funding the emerging work of the Synergi Collaborative Centre (a 5-year national initiative to build a knowledge hub on ethnic inequalities and multiple disadvantages in severe mental illness in the UK). The funders of the study had no role in study design, data collection, data analysis, data interpretation, writing of the manuscript or in the decision to submit it for publication.
Uncontrolled Keywords: community mental healthcare,ethnicity,health inequities detention,involuntary hospital admission,psychiatry and mental health,sdg 3 - good health and well-being ,/dk/atira/pure/subjectarea/asjc/2700/2738
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups: Faculty of Science > Research Groups > Norwich Epidemiology Centre
Faculty of Medicine and Health Sciences > Research Groups > Norwich Epidemiology Centre
Faculty of Medicine and Health Sciences > Research Groups > Epidemiology and Public Health
Faculty of Medicine and Health Sciences > Research Groups > Public Health and Health Services Research (former - to 2023)
Faculty of Medicine and Health Sciences > Research Centres > Population Health
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Depositing User: LivePure Connector
Date Deposited: 21 Sep 2022 17:30
Last Modified: 19 Oct 2023 03:25
URI: https://ueaeprints.uea.ac.uk/id/eprint/88570
DOI: 10.1192/bjp.2022.141

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