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Ethnicity and outcome of appeal after detention under the Mental Health Act 1983

  • Ramin Nilforooshan (a1), Rizkar Amin (a2) and James Warner (a3)
Abstract
Aims and Method

There is insufficient research into the relationship between ethnicity and appeals against detention under mental health legislation. We sought to identify rates and success of appeals in different ethnic groups through a retrospective analysis of all detentions under the Mental Health Act 1983 over 1 year.

Results

We found high rates of appeals overall, with substantial differences between ethnic groups (36 (39%) White British compared with 71 (63%) Black Caribbean (P = 0.0001) and 21 (68%) White Irish (P = 0.01) individuals (Yates corrected chi-squared)). Success rates on appeal were very low in all groups.

Clinical Implications

There are significant ethnic differences in appeals against detention under the Mental Health Act.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
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BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
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Ethnicity and outcome of appeal after detention under the Mental Health Act 1983

  • Ramin Nilforooshan (a1), Rizkar Amin (a2) and James Warner (a3)
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eLetters

Doctors ethnicity also matters

Chiara A Solari, Specialty Trainee 1 in Psychiatry
09 December 2009

Nilforooshan et al.(1) recently examined the rates and outcome of appeal against detention under the Mental Health Act 1983 for different ethnic groups. They found that Black Caribbean and White Irish groups, whilst lodging significantly more appeals compared to other ethnic groups (at 63% and 68% respectively compared to 39% White British), were underrepresented in the group of patients who successfully had their sections discharged . While these findings are revealing, they would have been more useful if the ethnicity of the tribunal members overseeing the appeal was also taken into account.

The 2005 Census by the Royal College of Psychiatry (2) reveals the ethnic breakdown of British psychiatrists by grade and highlights the increasing ethnic diversity of psychiatrists in Britain today . Moreover, Morgan and Beerstecher (3) recently studied GP practices and found that ethnic minority patients tend to be cared for by ethnic minority doctors . Hence any analysis of the impact of ethnicity on the individual treatment of a patient and of the system of care as a whole would be incomplete and potentially flawed without the inclusion of the ethnicity of the professionals involved. In the decades old debate on the institutional racism of mental health services, the trend so far has been to assume by default that psychiatrists are ethnically or culturally White British. It is important that future studies take into consideration the evolution of the workforce in terms of ethnicity, but also gender and social class.

Dr Chiara Solari ST1 in Psychiatry, Oxfordshire and Buckinghamshire Mental Health NHS Foundation Trust, Early Intervention in Psychosis Service, Littlemore Centre for Mental Health, Sandford Road, Littlemore, Oxford. OX4 4XNEmail: chiara.solari@obmh.nhs.uk

Dr Joseph El-Khoury ST6 in Adult Psychiatry, Oxfordshire and Buckinghamshire Mental Health NHS Foundation Trust

References:

Nilforooshan R., Amin R., and Warner J. Ethnicity and outcome of appeal after detention under the Mental Health Act 1983 Psychiatric Bulletin 2009; 33: 288-290

Royal College of Psychiatrists, London UK (2005) Annual Census of Psychiatric Staffing (http://www.rcpsych.ac.uk/pdf/Census%20results%20-%202005.pdf)

Morgan C., Beerstecher H.J., Ethnic Group and Medical Care: What about doctor factors? BMJ 2009;339: b4060
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Conflict of interest: None Declared

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Unintended consequences

Aileen A O'Brien, Senior Lecturer and Honorary Consultant Psychiatrist
17 August 2009

An explanation not suggested by the authors for the low successs rateof appeals is the requirement, for section 2 cases, that the tribunal occurs within a week of appealing. My experience is that Section 2 is increasingly being used, even for patients well known to services. Two doctors and an AMP regard a patient detainable; the patient is admitted; then the request for a report comes through within a time scale where it is difficult to do more than a cursory assessment. This is in the context of functional teams where the inpatient doctors preparing the report will often have had no prior knowledge of the patient. It defies logic to suggest that within a week a full assessment including report will have been completed and as the assessment is incomplete it is difficult for anytribunal to release a patient. What was undoubtedly introduced with the laudable aim of reducing innapropriate detention I believe had had the opposite effect. ... More

Conflict of interest: None Declared

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