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PAPERS:
STEFAN PRIEBE, JAY WATTS, MIKE CHASE, and ALEKSANDRA MATANOV
Processes of disengagement and engagement in assertive outreach patients: qualitative study
The British Journal of Psychiatry 2005; 187: 438-443 [Abstract] [Full text] [PDF]
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[Read eLetter] Not the full story with African-Caribbean patients
olufemi oluwatayo   (30 November 2005)

Not the full story with African-Caribbean patients 30 November 2005
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olufemi oluwatayo,
consultant psychiatrist
none

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Re: Not the full story with African-Caribbean patients

olufemi{at}doctors.org.uk olufemi oluwatayo

Dear Editor, I read with interest this paper by Priebe et al. I commend the authors for their work in trying to throw more light on our understanding of factors influencing patients' engagement with services, especially African- Caribbean patients.

Amongst other studies, our study (Oluwatayo & Gater, 2004) showed that African-Caribbean patients are more likely to disengage from services than their White British counterparts. Not much work has been done in understanding the reason for this. I feel the sort of qualitative approach used in this paper is the way forward.

I however wish to comment on the their conclusion that African- Caribbean patients do not have a qualitatively distinct process of disengagement with services. I feel we need to know more before we can come to such conclusion. I will focus on size of study and one aspect of the views explored.

In my opinion the views of 18 African-Caribbeans patients are not enough to make a definitive conclusions on such an important subject, moreso when the patients are those that have re-engaged with services after a period of disengagement. It will be more informative to interview more of them in terms of absolute numbers and those in different situations for example those who have not re-engaged in the community, in secure units, in prison etc.

With regard to the content of the views explored, of the three main themes that emerged from their study, the "desire to be independent and able person" touch on the area of insight that interests me. This theme includes the patients' acceptance of being mentally ill. I will be interested in knowing how many of the 26 patients who expressed difficulty in this theme are of African-Carribean origin, my feeling is that there will be disproportionately more African-Caribbeans.

My clinical experience with African-Caribbean patients indicates that the idea of being mentally ill is a very difficult one to accept and this impacts on every other aspects of their care including disengagement from services. Of equal importance is what it actually means to be mentally ill and what the psychotic symptoms means to them, say for example in terms of coping with a society that they perceive as completely hostile to them.

I implor the authors and other researchers in the field to consider these points in future studies.

Thank you

References: Oluwatayo, O.G & Gater R (2004) The role of engagement with services in compulsory admission of African-Caribbean patients. Social Psychiatry and Psychiatry Epidemiology, 39 (9), 739-743.