Pathways to care and ethnicity. 2: Source of referral and help-seeking

BackgroundPrevious research has found that African–Caribbean and Black African patients are likely to come into contact with mental health services via more negative routes, when compared with White patients. We sought to investigate pathways to mental health care and ethnicity in a sample of patients with a first episode of psychosis drawn from two UK centres.MethodWe included all White British, other White, African–Caribbean and Black African patients with a first episode of psychosis who made contact with psychiatric services over a 2-year period and were living in defined areas. Clinical, socio-demographic and pathways to care data were collected from patients, relatives and case notes.ResultsCompared with White British patients, general practitioner referral was less frequent for both African–Caribbean and Black African patients and referral by a criminal justice agency was more common. With the exception of criminal justice referrals for Black African patients, these findings remained significant after adjusting for potential confounders.ConclusionsThese findings suggest that factors are operating during a first episode of psychosis to increase the risk that the pathway to care for Black patients will involve non-health professionals.

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Pathways to care and ethnicity. 1: Sample characteristics and compulsory admission

The British Journal of Psychiatry ◽

10.1192/bjp.186.4.281 ◽

2005 ◽

Vol 186 (4) ◽

pp. 281-289 ◽

Cited By ~ 109

Author(s):

Craig Morgan ◽

Rosemarie Mallett ◽

Gerard Hutchinson ◽

Hemant Bagalkote ◽

Kevin Morgan ◽

...

Keyword(s):

Pathways To Care ◽

First Episode ◽

Compulsory Admission ◽

Sampling Frame ◽

Black African ◽

Epidemiological Sample ◽

African Caribbean ◽

Sample Characteristics ◽

African Patients ◽

The Uk

BackgroundMany studies have found high levels of compulsory admission to psychiatric hospital in the UK among African–Caribbean and Black African patients with a psychotic illness.AimsTo establish whether African–Caribbean and Black African ethnicity is associated with compulsory admission in an epidemiological sample of patients with a first episode of psychosis drawn from two UK centres.MethodAll patients with a first episode of psychosis who made contact with psychiatric services over a 2-year period and were living in defined areas were included in the (ÆSOP) study. For this analysis we included all White British, other White, African–Caribbean and Black African patients from the ÆSOP sampling frame. Clinical, socio-demographic and pathways to care data were collected from patients, relatives and case notes.ResultsAfrican–Caribbean patients were significantly more likely to be compulsorily admitted than White British patients, as were Black African patients. African–Caribbean men were the most likely to be compulsorily admitted.ConclusionsThese findings suggest that factors are operating at or prior to first presentation to increase the risk of compulsory admission among African–Caribbean and Black African patients.

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Improving outcomes: Factors influencing help-seeking behaviors in immigrants and ethnic minorities with first-episode psychosis

Die Psychiatrie ◽

10.1055/s-0038-1672286 ◽

2016 ◽

Vol 13 (03) ◽

pp. 152-157

Author(s):

A. O. Berg ◽

K. Leopold ◽

S. Zarafonitis-Müller ◽

M. Nerhus ◽

L. H. Stouten ◽

...

Keyword(s):

Mental Health ◽

Help Seeking ◽

Service Use ◽

First Episode Psychosis ◽

Pathways To Care ◽

First Episode ◽

Factors Influencing ◽

Increased Risk ◽

Episode Psychosis ◽

The Hague

Summary Background: Immigrants have increased risk of a poor recovery from first episode psychosis (FEP). Early treatment can improve prognosis, but having an immigrant background may influence pathways to care. Method: We present research of service use and factors influencing treatment outcome in immigrants with FEP. Service use was assessed in in-patients at an early intervention center in Berlin, Germany. Duration of untreated psychosis and beliefs about illness was assessed in a FEP study in Oslo, Norway and cognitive functioning in patients with FEP schizophrenia from the regular mental health services in The Hague, the Netherlands. The proportion of immigrants in Berlin and Oslo was at level with the local populations, while the proportion in The Hague appeared to be higher. Result: There were clear indications that mental health literacy, probably based in different cultural expectations, were lower in first generation immigrants (FGI). Findings regarding clinical insight were ambiguous. There were also indications that FGI had more cognitive problems, based in higher stress levels or in cognitive styles. Early psychosis services must take issues of immigration and ethnicity into consideration.

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Criminal justice pathways to psychiatric care for psychosis

The British Journal of Psychiatry ◽

10.1192/bjp.bp.114.153882 ◽

2015 ◽

Vol 207 (6) ◽

pp. 523-529 ◽

Cited By ~ 12

Author(s):

Kamaldeep Bhui ◽

Simone Ullrich ◽

Constantinos Kallis ◽

Jeremy W. Coid

Keyword(s):

Criminal Justice ◽

Drug Use ◽

Psychiatric Care ◽

Care Pathway ◽

Population Based ◽

First Episode ◽

Black African ◽

Black Caribbean ◽

African Patients ◽

First Contact

BackgroundSome patients are at higher risk of contact with criminal justice agencies when experiencing a first episode of psychosis.AimsTo investigate whether violence explains criminal justice pathways (CJPs) for psychosis in general, and ethnic vulnerability to CJPs.MethodTwo-year population-based survey of people presenting with a first-episode of psychosis. A total of 481 patients provided information on pathways to psychiatric care. The main outcome was a CJP at first contact compared with other services on the care pathway.ResultsCJPs were more common if there was violence at first presentation (odds ratio (OR) = 4.23, 95% CI 2.74–6.54, P<0.001), drug use in the previous year (OR = 2.28, 95% CI 1.50–3.48, P<0.001) and for high psychopathy scores (OR = 2.54, 95% CI 1.43–4.53, P = 0.002). Compared with White British, CJPs were more common among Black Caribbean (OR = 2.97, 95% CI 1.54–5.72, P<0.001) and Black African patients (OR = 1.95, 95% CI 1.02–3.72, P = 0.01). Violence mediated 30.2% of the association for Black Caribbeans, but was not a mediator for Black African patients. These findings were sustained after adjustment for age, marital status, gender and employment.ConclusionsCJPs were more common in violent presentations, for greater psychopathy levels and drug use. Violence presentations did not fully explain ethnic vulnerability to CJPs.

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The pathways to mental health care of first-episode psychosis patients: a systematic review

Psychological Medicine ◽

10.1017/s0033291710000371 ◽

2010 ◽

Vol 40 (10) ◽

pp. 1585-1597 ◽

Cited By ~ 92

Author(s):

K. K. Anderson ◽

R. Fuhrer ◽

A. K. Malla

Keyword(s):

Mental Health ◽

First Episode Psychosis ◽

Pathways To Care ◽

First Episode ◽

Psychotic Episode ◽

First Psychotic Episode ◽

Episode Psychosis ◽

First Contact ◽

Pathway To Care ◽

Delay In Treatment

BackgroundAlthough there is agreement on the association between delay in treatment of psychosis and outcome, less is known regarding the pathways to care of patients suffering from a first psychotic episode. Pathways are complex, involve a diverse range of contacts, and are likely to influence delay in treatment. We conducted a systematic review on the nature and determinants of the pathway to care of patients experiencing a first psychotic episode.MethodWe searched four databases (Medline, HealthStar, EMBASE, PsycINFO) to identify articles published between 1985 and 2009. We manually searched reference lists and relevant journals and used forward citation searching to identify additional articles. Studies were included if they used an observational design to assess the pathways to care of patients with first-episode psychosis (FEP).ResultsIncluded studies (n=30) explored the first contact in the pathway and/or the referral source that led to treatment. In 13 of 21 studies, the first contact for the largest proportion of patients was a physician. However, in nine of 22 studies, the referral source for the greatest proportion of patients was emergency services. We did not find consistent results across the studies that explored the sex, socio-economic, and/or ethnic determinants of the pathway, or the impact of the pathway to care on treatment delay.ConclusionsAdditional research is needed to understand the help-seeking behavior of patients experiencing a first-episode of psychosis, service response to such contacts, and the determinants of the pathways to mental health care, to inform the provision of mental health services.

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Differing patterns of brain structural abnormalities between black and white patients with their first episode of psychosis

Psychological Medicine ◽

10.1017/s0033291709991565 ◽

2009 ◽

Vol 40 (7) ◽

pp. 1137-1147 ◽

Cited By ~ 8

Author(s):

K. D. Morgan ◽

P. Dazzan ◽

C. Morgan ◽

J. Lappin ◽

G. Hutchinson ◽

...

Keyword(s):

Grey Matter ◽

First Episode Psychosis ◽

First Episode ◽

Grey Matter Volume ◽

Black African ◽

Caribbean Black ◽

Matter Volume ◽

Episode Psychosis ◽

African Caribbean ◽

African Patients

BackgroundAfrican-Caribbean and black African people living in the UK are reported to have a higher incidence of diagnosed psychosis compared with white British people. It has been argued that this may be a consequence of misdiagnosis. If this is true they might be less likely to show the patterns of structural brain abnormalities reported in white British patients. The aim of this study therefore was to investigate whether there are differences in the prevalence of structural brain abnormalities in white and black first-episode psychosis patients.MethodWe obtained dual-echo (proton density/T2-weighted) images from a sample of 75 first-episode psychosis patients and 68 healthy controls. We used high resolution magnetic resonance imaging and voxel-based methods of image analysis. Two separate analyses were conducted: (1) 34 white British patients were compared with 33 white British controls; (2) 41 African-Caribbean and black African patients were compared with 35 African-Caribbean and black African controls.ResultsWhite British patients and African-Caribbean/black African patients had ventricular enlargement and increased lenticular nucleus volume compared with their respective ethnic controls. The African-Caribbean/black African patients also showed reduced global grey matter and increased lingual gyrus grey-matter volume. The white British patients had no regional or global grey-matter loss compared with their normal ethnic counterparts but showed increased grey matter in the left superior temporal lobe and right parahippocampal gyrus.ConclusionsWe found no evidence in support of our hypothesis. Indeed, the finding of reduced global grey-matter volume in the African-Caribbean/black African patients but not in the white British patients was contrary to our prediction.

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Systematic review of pathways to care in the U.S. for Black individuals with early psychosis

npj Schizophrenia ◽

10.1038/s41537-021-00185-w ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Oladunni Oluwoye ◽

Beshaun Davis ◽

Franchesca S. Kuhney ◽

Deidre M. Anglin

Keyword(s):

Systematic Review ◽

Substance Use ◽

Racial Differences ◽

Help Seeking ◽

Family Members ◽

Pathways To Care ◽

First Episode ◽

Prodromal Phase ◽

Black Populations ◽

Pathway To Care

AbstractThe pathway to receiving specialty care for first episode psychosis (FEP) among Black youth in the US has received little attention despite documented challenges that negatively impact engagement in care and clinical outcomes. We conducted a systematic review of US-based research, reporting findings related to the pathway experiences of Black individuals with FEP and their family members. A systematic search of PubMed, PsycInfo, and Embase/Medline was performed with no date restrictions up to April 2021. Included studies had samples with at least 75% Black individuals and/or their family members or explicitly examined racial differences. Of the 80 abstracts screened, 28 peer-reviewed articles met the inclusion criteria. Studies were categorized into three categories: premordid and prodromal phase, help-seeking experiences, and the duration of untreated psychosis (DUP). Compounding factors such as trauma, substance use, and structural barriers that occur during the premorbid and prodromal contribute to delays in treatment initiation and highlight the limited use of services for traumatic childhood experiences (e.g., sexual abuse). Studies focused on help-seeking experiences demonstrated the limited use of mental health services and the potentially traumatic entry to services (e.g., law enforcement), which is associated with a longer DUP. Although the majority of studies focused on help-seeking experiences and predictors of DUP, findings suggests that for Black populations, there is a link between trauma and substance use in the pathway to care that impacts the severity of symptoms, initiation of treatment, and DUP. The present review also identifies the need for more representative studies of Black individuals with FEP.

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Pathways to Care for Patients with a First Episode of Psychosis

The British Journal of Psychiatry ◽

10.1192/bjp.167.6.770 ◽

1995 ◽

Vol 167 (6) ◽

pp. 770-776 ◽

Cited By ~ 121

Author(s):

Eleanor Cole ◽

Gerard Leavey ◽

Michael King ◽

Eric Johnson-Sabine ◽

Amanda Hoar

Keyword(s):

Help Seeking ◽

Minority Groups ◽

Important Variable ◽

Psychiatric Services ◽

Pathways To Care ◽

First Episode ◽

Compulsory Admission ◽

Chronic Patients ◽

Black Patients ◽

First Contact

BackgroundIt is reported that patients from ethnic minority groups, in particular Afro-Caribbeans, are more likely to enter less desirable pathways to psychiatric care. We aimed to determine whether ethnicity significantly affected time to presentation, type of first contact, rates of compulsory admission and police and primary care involvement, in patients with their first episode of psychosis.MethodAs part of a prospective epidemiological study, patients and their carers were interviewed using a semi-structured questionnaire to trace the various persons and agencies seen en route to their first contact with psychiatric services.ResultsWhile compulsory admission was more likely for Black patients, the excess was less striking than in previous studies. Black patients were no more likely than other patients to have police involvement. The most important factors in avoiding an adverse pathway were having a supportive family member or friend and the presence of a general practitioner to assist in gaining access to psychiatric services.ConclusionsThe routes to psychiatric services for first onset patients are different to those for chronic patients. Variables associated with social support were more important than ethnicity in determining pathways to care. Police involvement and compulsory admissions were strongly associated with the absence of GP involvement and the absence of help-seeking by a friend or relative. It may be that ethnicity becomes an important variable after the patient has come into contact with psychiatric services.

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Duration of untreated psychosis and ethnicity in the ÆSOP first-onset psychosis study

Psychological Medicine ◽

10.1017/s0033291705006604 ◽

2005 ◽

Vol 36 (2) ◽

pp. 239-247 ◽

Cited By ~ 52

Author(s):

CRAIG MORGAN ◽

PAUL FEARON ◽

GERARD HUTCHINSON ◽

KWAME McKENZIE ◽

JULIA M. LAPPIN ◽

...

Keyword(s):

Mental Illness ◽

Study Data ◽

First Episode ◽

Duration Of Untreated Psychosis ◽

Treatment Delays ◽

Black African ◽

Black Patients ◽

Catchment Areas ◽

African Patients ◽

First Contact

Background. There is a common assumption that Black patients with a psychotic mental illness experience longer treatment delays during a first episode. We sought to investigate this issue in a large cohort of patients with a first episode of psychosis.Method. All patients with a first episode of psychosis presenting to secondary mental health services within tightly defined catchment areas in south-east London and Nottingham over a 2-year period were included in the study. Data relating to duration of untreated psychosis (DUP) and clinical and sociodemographic characteristics were collected from patients, relatives and case-notes.Results. There was no evidence that African-Caribbean or Black African patients experienced longer periods of untreated psychosis than White British patients prior to first contact with services. There was evidence that Black African patients experienced shorter periods of untreated psychosis than White British patients.Conclusions. Contrary to what is commonly assumed, our study suggests that Black patients with a psychotic mental illness do not experience longer treatment delays prior to first contact with services than White British patients. This suggests that strategies to reduce treatment delays targeted specifically at Black patients will be of limited value.

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Pathways to care among psychiatric outpatients in a tertiary mental health institution in Singapore

International Journal of Social Psychiatry ◽

10.1177/0020764018784632 ◽

2018 ◽

Vol 64 (6) ◽

pp. 554-562 ◽

Cited By ~ 3

Author(s):

Anitha Jeyagurunathan ◽

Edimansyah Abdin ◽

Saleha Shafie ◽

Peizhi Wang ◽

Sherilyn Chang ◽

...

Keyword(s):

Mental Health ◽

Primary Care ◽

Multinomial Logistic Regression ◽

Mental Illnesses ◽

Pathways To Care ◽

Linear Regression Models ◽

Specialist Care ◽

Duration Of Untreated Illness ◽

First Contact ◽

Pathway To Care

Background: Pathways to care studies in Singapore are of high interest given the cultural diversity and various sources of help available for those with mental illnesses, ranging from the more traditional to tertiary-level mental health care services. Aim: The current study aimed to explore the associations of patients’ socio-demographic characteristics with pathways to first contact and duration of untreated mental illness. Method: A total of 402 participants were recruited through convenience sampling. A pathway to care form was used to gather systematic information about the sources of care utilized by participants before approaching a mental health professional. Data were analysed using multinomial logistic regression and multiple linear regression models to assess the associations. Results: Majority of participants reported primary care (36.0%) as their first point of contact, followed by non-formal sources of help (33.8%), specialist care (21.8%), police/court (4.0%), websites/media (3.3%) and religious/traditional treatment (1.3%). Those belonging to Malay and Indian ethnicity (vs Chinese) were more likely to make first contact with non-formal sources of help than primary care. Those who received a diagnosis of any mood or anxiety disorder (vs schizophrenia and related psychoses) were less likely to make first contact with specialist care or non-formal sources of help than primary care. Those who were separated/divorced/widowed were significantly associated with higher duration of untreated illness compared to those who were single. Participants whose family/relative initiated the first contact were significantly associated with a shorter duration of untreated illness compared to those who initiated first contact on their own. Conclusion: Findings suggest the determinants of the pathways to first contact and duration of untreated illness included diagnosis, ethnicity, marital status and family initiating the first contact. The pathways adopted by these participants need to be kept in mind for planning mental health programmes.

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Excess mortality in mental health service users during the COVID-19 pandemic described by ethnic group: South London and Maudsley data

10.1101/2020.07.13.20152710 ◽

2020 ◽

Cited By ~ 1

Author(s):

Robert Stewart ◽

Matthew Broadbent ◽

Jayati Das-Munshi

Keyword(s):

Mental Health ◽

Mental Health Service ◽

Health Service ◽

Ethnic Group ◽

Ethnic Groups ◽

Excess Mortality ◽

Premature Mortality ◽

Service Users ◽

Black African ◽

African Caribbean

The COVID-19 pandemic in the UK was accompanied by excess all-cause mortality at a national level, only part of which was accounted for by known infections. Excess mortality has previously been described in people who had received care from the South London and Maudsley NHS Foundation Trust (SLaM), a large mental health service provider for 1.2m residents in south London. The SLaM Clinical Record Interactive Search (CRIS) data resource receives 24-hourly updates from its full electronic health record, including regularly sourced national mortality on all past and present SLaM service users. The SLaM urban catchment has high levels of deprivation and is ethnically diverse, so the objective of the descriptive analyses reported in this manuscript was to compare mortality in SLaM service users from 16th March to 15th May 2020 to that for the same period in 2019 within specific ethnic groups: i) White British, ii) Other White, iii) Black African/Caribbean, iv) South Asian, v) Other, and vi) missing/not stated. For Black African/Caribbean patients (the largest minority ethnic group) this ratio was 3.33, compared to 2.47 for White British patients. Considering premature mortality (restricting to deaths below age 70), these ratios were 2.74 and 1.96 respectively. Ratios were also high for those from Other ethnic groups (2.63 for all mortality, 3.07 for premature mortality).

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