Pathways to care and ethnicity. 2: Source of referral and help-seeking - Report from the AESOP study

University of Cambridge, Cambridge, England, United Kingdom
The British Journal of Psychiatry (Impact Factor: 7.99). 05/2005; 186(4):290-6. DOI: 10.1192/bjp.186.4.290
Source: PubMed


Previous research has found that African-Caribbean and Black African patients are likely to come into contact with mental health services via more negative routes, when compared with White patients. We sought to investigate pathways to mental health care and ethnicity in a sample of patients with a first episode of psychosis drawn from two UK centres.
We included all White British, other White, African-Caribbean and Black African patients with a first episode of psychosis who made contact with psychiatric services over a 2-year period and were living in defined areas. Clinical, socio-demographic and pathways to care data were collected from patients, relatives and case notes.
Compared with White British patients, general practitioner referral was less frequent for both African-Caribbean and Black African patients and referral by a criminal justice agency was more common. With the exception of criminal justice referrals for Black African patients, these findings remained significant after adjusting for potential confounders.
These findings suggest that factors are operating during a first episode of psychosis to increase the risk that the pathway to care for Black patients will involve non-health professionals.

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    • "However, these services draw from a highly selective sample of help-seeking populations and the associated findings of symptom profile and risk for transition is therefore biased (Fusar-Poli et al. 2013). However, there are various consistent factors that are influential in whether and when individuals seek help for mental health (MH) problems (e.g., male gender, McKenzie et al. 2006; younger age, McKenzie et al. 2006; Black ethnicity, Morgan et al. 2005). Prisoners are a population that despite high levels of mental and physical health problems, do not routinely access services of National Health Service (NHS) outside the prison (Harty et al. 2003; Department of Health, 2002). "
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    ABSTRACT: Background. The definition of ultra-high risk (UHR) for psychosis was derived from community-based help-seeking populations. Prisoners have high rates of psychosis and other severe mental health (MH) problems. They also have high rates of risk factors for psychiatric morbidity and yet they are among the populations who are less likely to seek help in the community. Despite a policy of equivalence of care for individuals in prison there are no early intervention services for psychosis in prisons in the UK. This was a study exploring feasibility of introducing such a service into a local London prison. This paper discusses the differences in MH profile of prisoners who met criteria for at-risk mental state compared with those who did not. Method. A two-stage procedure was used. Participants in a local London prison were routinely screened in the first week of arrival in prison with the Prodrome Questionnaire - Brief Version (PQ-B; Loewy et al. 2011). Those that screened positive as well as a small sample of those who screened negative underwent a further semi-structured assessment to see whether they met criteria for UHR state. Data on self-harm and suicide attempt, family psychiatric history, and anxiety and depression was also collected. Results. A total of 891 prisoners were screened, 44% of whom screened positive. A total of 354 underwent second stage assessment, 60 of whom had screened negative. Four groups were identified: those that had no MH problems, a group experiencing First Episode Psychosis, those at UHR of psychosis and a group with other MH problems. The UHR state and Psychotic groups had very similar MH profiles of symptoms and distress. Prisoners with no MH problems were at the other end of the spectrum with few symptoms and little distress. The Other group fell in between this group and the psychotic spectrum group in terms of symptomology and distress. Conclusions. This study is the first to examine risk for psychosis in an adult male prison population. We identified a broad spectrum of MH disorder for which there is little current service provision in prisons. Screening early in the custodial process has the potential to identify unmet MH need and has implications for keeping individuals safe in custody. A long-term strategic approach is required to address MH need in prisons.
    Epidemiology and Psychiatric Sciences 03/2015; -1:1-10. DOI:10.1017/S2045796015000062 · 3.91 Impact Factor
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    • "On the other hand, other studies either found no significant association between duration of untreated psychosis (DUP) and pathways to care [22–24] or found longer treatment delays when service users made physicians or orthodox medical services their first contact in the pathway to care [15, 24]. Similarly, studies that determined the relationship between pathways to care in first episode psychosis and other patient's characteristics such as ethnicity [18, 25–27] gender [20, 25, 26, 28], socio-economic status [20, 25, 26, 29], and symptom profile [30–32] reported conflicting results. "
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    ABSTRACT: There is increasing evidence that delay in the commencement of treatment, following the onset of schizophrenia, may be related to the pathways patients navigate before accessing mental health care. Therefore, insight into the pattern and correlates of pathways to mental care of patients with schizophrenia may inform interventions that could fast track their contact with mental health professionals and reduce the duration of untreated psychosis. This study assessed the pathways to mental health care among patients with schizophrenia (n = 138), at their first contact with mental health services at the Federal Neuro-Psychiatric Hospital Yaba Lagos, Nigeria. Traditional and religious healers were the first contact for the majority (69%) of the patients. Service users who first contacted nonorthodox healers made a greater number of contacts in the course of seeking help, eventuating in a longer duration of untreated psychosis (P < 0.001). However, the delay between the onset of psychosis and contact with the first point of care was shorter in patients who patronized nonorthodox practitioners. The findings suggest that collaboration between orthodox and nonorthodox health services could facilitate the contact of patients with schizophrenia with appropriate treatment, thereby reducing the duration of untreated psychosis. The need for public mental health education is also indicated.
    12/2013; 2013:769161. DOI:10.1155/2013/769161
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    • "The high risks of compulsory admission for these four immigrant groups were probably mainly caused by the fact that these groups were more often characterized by psychotic disorders and police referrals. These findings are in line with those from Rotterdam and the UK (Morgan et al., 2005; Mulder et al., 2006; Oluwatayo and Gater, 2004). The possibility of influence of ethnic bias during the process of referring the patient to the PESA may not be excluded. "
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    ABSTRACT: Specific ethnic groups appear to be disproportionally represented in emergency compulsory admissions. This may be due to a parallel higher risk of psychopathology, but different pathways to care in patients from ethnic minorities may also be an explanatory factor. In this article we concentrate on the influence of ethnic background, pathways to psychiatric emergency services and the amount of past psychiatric treatment as predictors of emergency compulsory admission. All the patients coming into contact consecutively with the Psychiatric Emergency Service Amsterdam (PESA) from September 2004 to September 2006 were included in the study. We collected socio-demographic and clinical characteristics, and data about prior use of mental health services and referral to the emergency service. The risk of compulsory admission for immigrants from Surinam and the Dutch Antilles (OR 2.6), sub-Saharan Africa (OR 3.1), Morocco and other non-Western countries (each OR 1.7) was significantly higher than for native Dutch people. After controlling for socio-demographic characteristics, diagnosis, referral pattern and psychiatric treatment history, this correlation was no longer found. We found no evidence to substantiate the hypothesis that ethnic background plays an independent role in emergency compulsory admission. Police referral rather than referral by a GP, and being diagnosed with a psychosis, seemed to be explanatory factors for the high risk of compulsory admission for non-Western immigrants. Infrequent contact with secondary mental healthcare during the previous five years was not found to be consistently associated with a higher risk.
    International Journal of Social Psychiatry 05/2011; 58(4):374-80. DOI:10.1177/0020764011399970 · 1.15 Impact Factor
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