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Ethnic differences in admissions to secure forensic psychiatry services

Academic Section of Forensic Psychiatry, St Bartholomew's and the Royal London School of Medicine and Dentistry

SIMON GAULT, BA, Programmer and BRIAN JARMAN, FRCP, Emeritus Professor of Primary Health Care

Department of Primary Health Care and General Practice, Imperial College School of Medicine, London

Correspondence: Professor Jeremy W. Coid, Forensic Psychiatry Research Unit, St Bartholomew's Hospital, William Harvey House, West Smithfield, London ECIA 7 BE, UK

Declaration of interest None. Funding was provided by the Department of Health.

Background Persons of African-Caribbean origin are more frequently imprisoned, and increasing evidence suggests they are detained more frequently in psychiatric hospitals, following offending behaviour.

Aims To estimate population-based prevalence rates of treated mental disorder in different ethnic groups compulsorily admitted to secure forensic psychiatry services.

Method A survey was recorded of 3155 first admissions, from 1988 to 1994, from half of England and Wales, with 1991 census data as the denominator adjusted for under-enumeration.

Results Compulsory admissions for Black males were 5.6 (CI 5.1-6.3) times as high as, and for Asian males were half, those for White males; for Black females, 2.9 (CI 2.4-4.6) times as high and for Asian females one-third of those for White females. Admissions of non-Whites rose over the study period. Patterns of offending and diagnoses differed between ethnic groups.

Conclusions Variations in compulsory hospitalisation cannot be entirely attributed to racial bias. Community-based services may be less effective in preventing escalating criminal and dangerous behaviour associated with mental illness in African-Caribbeans.

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