Skip to main content Accessibility help

Pathways to Care for Patients with a First Episode of Psychosis: A Comparison of Ethnic Groups

  • Eleanor Cole (a1), Gerard Leavey (a1), Michael King (a1), Eric Johnson-Sabine (a1) and Amanda Hoar (a2)...



It is reported that patients from ethnic minority groups, in particular Afro-Caribbeans, are more likely to enter less desirable pathways to psychiatric care. We aimed to determine whether ethnicity significantly affected time to presentation, type of first contact, rates of compulsory admission and police and primary care involvement, in patients with their first episode of psychosis.


As part of a prospective epidemiological study, patients and their carers were interviewed using a semi-structured questionnaire to trace the various persons and agencies seen en route to their first contact with psychiatric services.


While compulsory admission was more likely for Black patients, the excess was less striking than in previous studies. Black patients were no more likely than other patients to have police involvement. The most important factors in avoiding an adverse pathway were having a supportive family member or friend and the presence of a general practitioner to assist in gaining access to psychiatric services.


The routes to psychiatric services for first onset patients are different to those for chronic patients. Variables associated with social support were more important than ethnicity in determining pathways to care. Police involvement and compulsory admissions were strongly associated with the absence of GP involvement and the absence of help-seeking by a friend or relative. It may be that ethnicity becomes an important variable after the patient has come into contact with psychiatric services.


Corresponding author

Dr Cole, St Ann's Hospital, St Ann's Road, London N15 3TH


Hide All
Awiah, J. (1992) Refugee Groups in Haringey. Haringey Health Authority, London.
Birchwood, M., Cochrane, R., MacMillan, F., et al (1992) The influence of ethnicity and family structure on relapse in first-episode schizophrenia. A comparison of Asian, Afro-Caribbean, and White patients. British Journal of Psychiatry, 161, 783790.
Browne, D. (1990) Black People, Mental Health and the Courts. National Association for the Care and Rehabilitation of Offenders.
Haringey Council (1993) Haringey in Figures. Strategic planning, development and equalities unit.
Harrison, G., Holton, A., Nielson, D., et al (1989) Severe mental disorder in Afro-Caribbean patients: some social, demographic and service factors. Psychological Medicine, 19, 683696.
King, M., Coker, E., Leavey, G., et al (1994) Incidence of psychotic illness in London: a comparison of ethnic groups. British Medical Journal, 309, 11151119.
Moodley, P. & Perkins, R. E. (1991) Routes to psychiatric inpatient care in an Inner London Borough. Social Psychiatry and Psychiatric Epidemiology, 26, 4751.
Owens, D., Harrison, G. & Boot, D. (1991) Ethnic factors in voluntary and compulsory admissions. Psychological Medicine, 21, 185196.
Perkins, R. E. & Moodley, P. (1993) Perception of problems in psychiatric patients: denial, race and service usage. Social Psychiatry and Psychiatric Epidemiology, 28, 189193.
Pipe, R., Bhat, A., Matthews, B., et al (1991) Section 136 and African/Afro-Caribbean minorities. The International Journal of Social Psychiatry, 37, 1423.
Ritchie, J., Dick, D. & Lingham, R. (1994) The Report of the Enquiry into the Care and Treatment of Christopher Clunis. London: HMSO.
Rwegellera, G. G. C. (1980) Differential use of psychiatric services by West Indians, West Africans and English in London. British Journal of Psychiatry, 137, 428432.
Sartorius, N., Jablensky, A., Korten, A., et al (1986) Early manifestations and first contact incidence of schizophrenia in different cultures. Psychological Medicine, 16, 909928.
Szmukler, G. I. (1981) Compulsory admissions in a London borough: II. Circumstances surrounding admission: service implications. Psychological Medicine, 11, 825838.
Weller, M. R., Weller, B., Baumann, E., et al (1988) The local use of Section 136. Bulletin of the Royal College of Psychiatrists, 12, 235–6.


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Pathways to Care for Patients with a First Episode of Psychosis: A Comparison of Ethnic Groups

  • Eleanor Cole (a1), Gerard Leavey (a1), Michael King (a1), Eric Johnson-Sabine (a1) and Amanda Hoar (a2)...
Submit a response


No eLetters have been published for this article.


Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *