Ethnic differences in compulsory admissions for psychiatric disorders in the UK: a systematic review and meta-analysis

Abstract

It is postulated by Mann et al. that some ethnic minorities in the United Kingdom (such as Asian and Black patients) experience more difficulty in being conventionally admitted for psychiatric conditions, and therefore present later with severe symptoms necessitating compulsory admission. (1) This systematic review evaluates whether compulsory admission rates differ between ethnicities in the UK and whether patients are accessing psychiatric healthcare through conventional systems (i.e. referral from primary care).

In our meta-analysis of 10 studies, ethnic minorities were more likely to be compulsorily admitted. Non-White patients were 2.38 times (95% CI: 1.55 – 3.65) more likely to be compulsorily admitted than White patients. Black patients were 2.77 times (95% CI: 1.84 – 4.18) more likely to be compulsorily admitted than White patients. Interestingly, there was no significant difference in compulsory admittance rate between Asian patients and White patients, with Asian patients being 0.96 times (95% CI: 0.78 – 1.17) more likely to be compulsorily admitted than White patients. Although admission rates differed between different races, there was no clear consensus on an increased prevalence of psychiatric disorders amongst minorities based on 32 studies in the United Kingdom. 

The systematic review discusses possible causes for the greater likelihood for compulsory admissions in Black patients compared to White patients, as well as the non-significant result in Asian patients compared to White patients. The possible causes encompass social stigma associated with psychiatric disorders, and cultural and language barriers to conventional psychiatric healthcare in ethnic minorities.