Journal Article

Ethnic inequalities and pathways to care in psychosis in England: a systematic review and meta-analysis

Halvorsrud, Kristoffer, Bhui, Kamaldeep, Otis, Michaela, Nazroo, James, Brown Hajdukova, Eva

2018

Overview

Background As part of a national programme to tackle ethnic inequalities, we conducted a systematic review and meta-analysis of research on ethnic inequalities in pathways to care for adults with psychosis living in England and/or Wales. Methods Nine databases were searched from inception to 03.07.17 for previous systematic reviews, including forward and backward citation tracking and a PROSPERO search to identify ongoing reviews. We then carried forward relevant primary studies from included reviews (with the latest meta-analyses reporting on research up to 2012), supplemented by a search on 18.10.17 in MEDLINE, Embase, PsycINFO and CINAHL for primary studies between 2012 and 2017 that had not been covered by previous meta-analyses. Results Forty studies, all conducted in England, were included for our updated meta-analyses on pathways to care. Relative to the White reference group, elevated rates of civil detentions were found for Black Caribbean (OR = 3.43, 95% CI = 2.68 to 4.40, n  = 18), Black African (OR = 3.11, 95% CI = 2.40 to 4.02, n  = 6), and South Asian patients (OR = 1.50, 95% CI 1.07 to 2.12, n  = 10). Analyses of each Mental Health Act section revealed significantly higher rates for Black people under (civil) Section 2 (OR = 1.53, 95% CI = 1.11 to 2.11, n  = 3). Rates in repeat admissions were significantly higher than in first admission for South Asian patients (between-group difference p  < 0.01). Some ethnic groups had more police contact (Black African OR = 3.60, 95% CI = 2.15 to 6.05, n  = 2; Black Caribbean OR = 2.64, 95% CI = 1.88 to 3.72, n  = 8) and criminal justice system involvement (Black Caribbean OR = 2.76, 95% CI = 2.02 to 3.78, n  = 5; Black African OR = 1.92, 95% CI = 1.32 to 2.78, n  = 3). The White Other patients also showed greater police and criminal justice system involvement than White British patients (OR = 1.49, 95% CI = 1.03 to 2.15, n  = 4). General practitioner involvement was less likely for Black than the White reference group. No significant variations over time were found across all the main outcomes. Conclusions Our updated meta-analyses reveal persisting but not significantly worsening patterns of ethnic inequalities in pathways to psychiatric care, particularly affecting Black groups. This provides a comprehensive evidence base from which to inform policy and practice amidst a prospective Mental Health Act reform. Trial registration CRD42017071663

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adult / Adults / Asian People / Biomedicine / Black People / Care and treatment / Collaboration / Crime / England / Ethical aspects / Ethnicity / Evidence-based medicine / Female / Global health / Health aspects / Health care industry / Health services / Healthcare Disparities - ethnology / Humans / Inequalities / Judicial system / Literature reviews / Medicine / Medicine & Public Health / Mental disorders / Mental health / Mental health care / Meta-analysis / Minority & ethnic groups / Pathways to care / Patients / Police / Prime ministers / Prospective Studies / Prospero protein / Psychiatry / Psychosis / Psychotic disorders / Psychotic Disorders - ethnology / Psychotic Disorders - therapy / Race / Racial discrimination / Racism / Research Article / Severe mental illness / Social aspects / Socioeconomic Factors / Systematic review / Wales / White People