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BMJ. 2007 December 15; 335(7632): 1233.
PMCID: PMC2137069

Minority groups still show high rates of admission to mental health services in England and Wales

People from black and minority groups are continuing to show high rates of admission to mental health and learning disability services, according to a census of the ethnic group of inpatients in England and Wales published last week.

The Count Me In Census 2007 showed that some black and minority ethnic groups were at least three times more likely than average to be admitted to mental health and learning disability services. The pattern was similar to that seen in two previous surveys, in 2006 and 2005.

The census collected information about 31 187 inpatients in mental health wards at 257 NHS and independent healthcare organisations in England and Wales and 4153 in patients in 120 organisations that provide services for people with learning disabilities on one day, 30 March 2007.

Results showed that rates of admission to mental health services were particularly high for men from black groups (ethnic categories reported by patients as black Caribbean, black African, and other black, which is likely to be mainly second generation West Indian and Caribbean) and mixed white and black groups (with one parent or recent forebear from a white group and one from a black group), with rates three or more times higher than average in England and Wales.

The standardised admission ratio was 330 for men of black African origin and 535 for men of black Caribbean origin, compared with an average of 100. The rate was highest in men from the other black group, at 19 times higher than average, with a standardised admission ratio (summary estimate of admission rate relative to the average rate, which is taken as 100) of 1927.

In contrast, men from white British, Indian, and Chinese ethnic groups had standardised admission rates that were lower than average by 16%, 24%, and 38%. Rates of admission for women showed a broadly similar pattern.

Rates of referral from GPs and community mental health teams for inpatients in mental health services for black Caribbean, black African and other black groups were lower than average. Conversely, rates of referral from the criminal justice system were higher than average in the black Caribbean and other black groups.

Nearly half (43%) of inpatients were detained under the Mental Health Act on admission, which was a slight increase compared with 2006 (40%) and 2005 (39%). Overall rates of detention were 19-38% greater than average among people from the black Caribbean, black African, other black and white-black Caribbean mixed groups.

The census also showed that 68% of mental health inpatients were treated in mixed sex wards. The report considered that this posed problems of privacy, dignity, and safety for people with mental illness.

Results for inpatients with learning difficulties showed that rates of admission were two to three times higher than average in the white-black Caribbean mixed, white-black African mixed, black Caribbean, and other black groups. These results were similar to those reported in 2006, and for the rates for inpatients in mental health establishments. The report showed that is was likely that some of the patients from the black groups were mental health patients.

Veena Raleigh, fellow in information policy with the Healthcare Commission and one of the report’s authors, said that the findings reflected previous research that indicates that higher rates of admission to mental health services are because of greater prevalence of mental illness in some ethnic groups.

“The results need to be interpreted in the light of research findings which show that rates of mental illness and care pathways differ between ethnic groups. We believe that strategies for reducing the ethnic differences observed in secondary mental healthcare must start with a multiagency approach based on primary, secondary, and tertiary prevention, thereby reducing the risk of acquiring mental illness and securing early and effective engagement with community and inpatient mental health services when needed,” she told the BMJ.

The census is one of the three key building blocks of the government’s five-year action plan, Delivering Race Equality in Mental Health Care. The report recommends that agencies must work together to prevent and better manage mental illness in black and minority ethnic groups. This will require a multiagency response not just from service providers, but also from other agencies, such as GPs, local authorities, and the criminal justice system, it said.

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