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Pathways to Care for Patients with a First Episode of Psychosis

A Comparison of Ethnic Groups

Published online by Cambridge University Press:  02 January 2018

Eleanor Cole ,
Gerard Leavey ,
Michael King ,
Eric Johnson-Sabine  and
Amanda Hoar
Eleanor Cole*
Affiliation:
University Department of Psychiatry, Royal Free Hospital School of Medicine, Rowland Hill Street, London NW3
Gerard Leavey
Affiliation:
University Department of Psychiatry, Royal Free Hospital School of Medicine, Rowland Hill Street, London NW3
Michael King
Affiliation:
University Department of Psychiatry, Royal Free Hospital School of Medicine, Rowland Hill Street, London NW3
Eric Johnson-Sabine
Affiliation:
University Department of Psychiatry, Royal Free Hospital School of Medicine, Rowland Hill Street, London NW3
Amanda Hoar
Affiliation:
Department of Psychiatry, St Ann's Hospital, St Ann's Road, London N15
*
Dr Cole, St Ann's Hospital, St Ann's Road, London N15 3TH
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Abstract

Background

It 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.

Method

As 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.

Results

While 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.

Conclusions

The 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.

Type
Papers
Information
The British Journal of Psychiatry , Volume 167 , Issue 6 , December 1995 , pp. 770 - 776
Copyright
Copyright © 1995 The Royal College of Psychiatrists 

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References

Awiah, J. (1992) Refugee Groups in Haringey. Haringey Health Authority, London.Google Scholar
Birchwood, M., Cochrane, R., MacMillan, F., et al (1992) The influence of ethnicity and family structure on relapse in first-episode schizophrenia. A comparison of Asian, Afro-Caribbean, and White patients. British Journal of Psychiatry, 161, 783–790.CrossRefGoogle ScholarPubMed
Browne, D. (1990) Black People, Mental Health and the Courts. National Association for the Care and Rehabilitation of Offenders.Google Scholar
Haringey Council (1993) Haringey in Figures. Strategic planning, development and equalities unit.Google Scholar
Harrison, G., Holton, A., Nielson, D., et al (1989) Severe mental disorder in Afro-Caribbean patients: some social, demographic and service factors. Psychological Medicine, 19, 683–696.CrossRefGoogle ScholarPubMed
King, M., Coker, E., Leavey, G., et al (1994) Incidence of psychotic illness in London: a comparison of ethnic groups. British Medical Journal, 309, 1115–1119.CrossRefGoogle Scholar
Moodley, P. & Perkins, R. E. (1991) Routes to psychiatric inpatient care in an Inner London Borough. Social Psychiatry and Psychiatric Epidemiology, 26, 47–51.CrossRefGoogle Scholar
Owens, D., Harrison, G. & Boot, D. (1991) Ethnic factors in voluntary and compulsory admissions. Psychological Medicine, 21, 185–196.CrossRefGoogle ScholarPubMed
Perkins, R. E. & Moodley, P. (1993) Perception of problems in psychiatric patients: denial, race and service usage. Social Psychiatry and Psychiatric Epidemiology, 28, 189–193.CrossRefGoogle ScholarPubMed
Pipe, R., Bhat, A., Matthews, B., et al (1991) Section 136 and African/Afro-Caribbean minorities. The International Journal of Social Psychiatry, 37, 14–23.CrossRefGoogle ScholarPubMed
Ritchie, J., Dick, D. & Lingham, R. (1994) The Report of the Enquiry into the Care and Treatment of Christopher Clunis. London: HMSO.Google Scholar
Rwegellera, G. G. C. (1980) Differential use of psychiatric services by West Indians, West Africans and English in London. British Journal of Psychiatry, 137, 428–432.CrossRefGoogle Scholar
Sartorius, N., Jablensky, A., Korten, A., et al (1986) Early manifestations and first contact incidence of schizophrenia in different cultures. Psychological Medicine, 16, 909–928.CrossRefGoogle ScholarPubMed
Szmukler, G. I. (1981) Compulsory admissions in a London borough: II. Circumstances surrounding admission: service implications. Psychological Medicine, 11, 825–838.CrossRefGoogle Scholar
Weller, M. R., Weller, B., Baumann, E., et al (1988) The local use of Section 136. Bulletin of the Royal College of Psychiatrists, 12, 235–6.CrossRefGoogle Scholar
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