Effects of ethnic density on the risk of compulsory psychiatric admission for individuals attending secondary care mental health services: evidence from a large-scale study in England

Background Black, Asian and minority ethnicity groups may experience better health outcomes when living in areas of high own-group ethnic density – the so-called ‘ethnic density’ hypothesis. We tested this hypothesis for the treatment outcome of compulsory admission. Methods Data from the 2010–2011 Mental Health Minimum Dataset (N = 1 053 617) was linked to the 2011 Census and 2010 Index of Multiple Deprivation. Own-group ethnic density was calculated by dividing the number of residents per ethnic group for each lower layer super output area (LSOA) in the Census by the LSOA total population. Multilevel modelling estimated the effect of own-group ethnic density on the risk of compulsory admission by ethnic group (White British, White other, Black, Asian and mixed), accounting for patient characteristics (age and gender), area-level deprivation and population density. Results Asian and White British patients experienced a reduced risk of compulsory admission when living in the areas of high own-group ethnic density [odds ratios (OR) 0.97, 95% credible interval (CI) 0.95–0.99 and 0.94, 95% CI 0.93–0.95, respectively], whereas White minority patients were at increased risk when living in neighbourhoods of higher own-group ethnic concentration (OR 1.18, 95% CI 1.11–1.26). Higher levels of own-group ethnic density were associated with an increased risk of compulsory admission for mixed-ethnicity patients, but only when deprivation and population density were excluded from the model. Neighbourhood-level concentration of own-group ethnicity for Black patients did not influence the risk of compulsory admission. Conclusions We found only minimal support for the ethnic density hypothesis for the treatment outcome of compulsory admission to under the Mental Health Act.

ADMITTING A MENTALLY ILL PERSON INCAPABLE OF INDEPENDENT EXISTENCE TO A PSYCHIATRIC HOSPITAL WITHOUT CONSENT – GLOSS TO THE DECISION OF THE SUPREME COURT

The conditions for compulsory admission to a psychiatric hospital under Art. 29 of the Mental Health Act apply only to the person to be admitted, they lack the element of protection of third parties (as opposed to admission under Articles 23 and 24 of this Act). Due to the fact that any admission without consent to a psychiatric hospital constitutes an interference with fundamental human rights (the right to freedom and to decide about one’s life), the provisions authorizing such admission must be strictly interpreted. Art. 29 provides for two groups of reasons for admission without consent: 1) counteracting the deterioration of health and 2) its improvement. Due to the fact that placement in a psychiatric hospital is the most onerous way of treating the patient, the guardianship court is obliged to consider whether less drastic methods of therapy will not be effective in such a case.

Compulsory admissions of patients with mental disorders: State of the art on ethical and legislative aspects in 40 European countries

Background. Compulsory admission procedures of patients with mental disorders vary between countries in Europe. The Ethics Committee of the European Psychiatric Association (EPA) launched a survey on involuntary admission procedures of patients with mental disorders in 40 countries to gather information from all National Psychiatric Associations that are members of the EPA to develop recommendations for improving involuntary admission processes and promote voluntary care. Methods. The survey focused on legislation of involuntary admissions and key actors involved in the admission procedure as well as most common reasons for involuntary admissions. Results. We analyzed the survey categorical data in themes, which highlight that both medical and legal actors are involved in involuntary admission procedures. Conclusions. We conclude that legal reasons for compulsory admission should be reworded in order to remove stigmatization of the patient, that raising awareness about involuntary admission procedures and patient rights with both patients and family advocacy groups is paramount, that communication about procedures should be widely available in lay-language for the general population, and that training sessions and guidance should be available for legal and medical practitioners. Finally, people working in the field need to be constantly aware about the ethical challenges surrounding compulsory admissions.

Migrant status and risk of compulsory admission at first diagnosis of psychotic disorder: a population-based cohort study in Sweden

Background Minority ethnic and migrant groups face an elevated risk of compulsory admission for mental illness. There are overlapping cultural, socio-demographic, and structural explanations for this risk that require further investigation. Methods By linking Swedish national register data, we established a cohort of persons first diagnosed with a psychotic disorder between 2001 and 2016. We used multilevel mixed-effects logistic modelling to investigate variation in compulsory admission at first diagnosis of psychosis across migrant and Swedish-born groups with individual and neighbourhood-level covariates. Results Our cohort included 12 000 individuals, with 1298 (10.8%) admitted compulsorily. In an unadjusted model, being a migrant [odds ratio (OR) 1.48; 95% confidence interval (CI) 1.26–1.73] or child of a migrant (OR 1.27; 95% CI 1.10–1.47) increased risk of compulsory admission. However after multivariable modelling, region-of-origin provided a better fit to the data than migrant status; excess risk of compulsory admission was elevated for individuals from sub-Saharan African (OR 1.94; 95% CI 1.51–2.49), Middle Eastern and North African (OR 1.46; 95% CI 1.17–1.81), non-Nordic European (OR 1.27; 95% CI 1.01–1.61), and mixed Swedish-Nordic backgrounds (OR 1.33; 95% CI 1.03–1.72). Risk of compulsory admission was greater in more densely populated neighbourhoods [OR per standard deviation (s.d.) increase in the exposure: 1.12, 95% CI 1.06–1.18], an effect that appeared to be driven by own-region migrant density (OR per s.d. increase in exposure: 1.12; 95% CI 1.02–1.24). Conclusions Inequalities in the risk of compulsory admission by migrant status, region-of-origin, urban living and own-region migrant density highlight discernible factors which raise barriers to equitable care and provide potential targets for intervention.

Mental health and COVID-19: is the virus racist?

SummaryCOVID-19 has changed our lives and it appears to be especially harmful for some groups more than others. Black and Asian ethnic minorities are at particular risk and have reported greater mortality and intensive care needs. Mental illnesses are more common among Black and ethnic minorities, as are crisis care pathways including compulsory admission. This editorial sets out what might underlie these two phenomena, explaining how societal structures and disadvantage generate and can escalate inequalities in crises.

Factors associated with prolonged psychiatric intensive care unit admission at Somdet Chaophraya Institute of Psychiatry, Thailand

Aim: Our objective is to determine factors associated with prolonged psychiatric intensive care unit (PICU) admission at Somdet Chaophraya Institute of Psychiatry (SCIP).<br/> Method: We reviewed the medical records of patients admitted to the PICU between 1 July 2016 and 31 December 2016 meeting PICU admission criteria. We defined prolonged admission as PICU clinical stay of longer than five days. We then performed univariate binary logistic regression analysis to analyse the association between factors and prolonged PICU admission. Factors with p-value <0.25 were then included in backward stepwise multiple logistic regression analysis.<br/> Results: We included 293 cases then excluded 42 of them using our exclusion criteria (30 were discharged by other means and 12 cases were due to inability to obtain essential information). Of 251 studied cases, 112 cases (44.6%) had prolonged PICU admission. Univariate logistic regression analysis found that a history of prior PICU admission, compulsory admission, treatment with electroconvulsive therapy (ECT), and primary diagnosis were associated with prolonged PICU admission with p-value <0.25. Using multiple logistic regression analysis, factors associated with prolonged PICU admission were: compulsory admission (adjusted odds ratio 2.45, 95% CI 1.06–5.69 when adjusted with treatment with ECT) and treatment with ECT during PICU admission (adjusted odds ratio 9.01, 95% CI 2.57–31.59 when adjusted with compulsory admission).<br/> Conclusions: Factors associated with prolonged PICU admission at SCIP were compulsory admission and treatment with ECT during PICU admission. We propose that further study of these two groups should provide clues on how to improve treatment in PICU.