Over-representation of Black people in secure psychiatric facilities

K. Bhui

Department of Psychiatry, St Bartholomew's and The Royal London School of Medicine and Dentistry, Queen Mary & Westfield College, University of London, Mile End Road, London EI 4NS

EDITED BY MATTHEW HOTOPF

I read with great interest Lelliot et al's (2001) survey of patients from an inner-London health authority in medium secure psychiatric care. In particular, the authors set out to compare Black and White patients and found statistical differences which they dismiss. The scores on the Health of the Nation Outcome Scales and compound variables of clinical behaviour and social function differed between Black and White patients, but Lelliot et al comment that these may not be clinically significant.

If statistically significant findings on scales used in the study need not be explained, then the instruments cannot be considered valid to address the third aim of the study, to compare Black and White patients. Black patients were significantly less morbid on a number of clinical, social and behavioural variables, including affective symptoms, activities of daily living, problems with living skills, relationship problems and other mental or behavioural problems of self-harm and overactive and aggressive behaviour. Why should Black patients with less severe psychopathology or aggressive behaviour continue to find themselves in medium secure units?

There are two possible explanations. One is non-engagement with treatment options in less secure environments. It is known that Black patients are more likely to abscond from in-patient units (Falkowski et al, 1990) and that they are increasingly dissatisfied with each consecutive in-patient admission (Parkman et al, 1997).

An alternative explanation is that Black patients are perceived to be more dangerous despite lower ratings of psychopathology (Cope, 1990; Lewis et al, 1990). Lelliot et al unfortunately dismiss important findings as clinically insignificant. These very findings warrant further research and exploration and such work may well deliver a better understanding of why Black people are over-represented in secure psychiatric facilities.

REFERENCES

Cope, R. (1990) Psychiatry, ethnicity & crime. In Forensic Psychiatry (eds R. Bluglass & P. Bowden). London: Churchill Livingstone.

Falkowski, J., Watts, V., Falkowski, W., et al (1990) Patients leaving hospital without the knowledge or permission of staff — absconding. British Journal of Psychiatry, 156, 488-490.[Abstract]

Lelliott, P., Audini, B. & Duffett, R. (2001) Survey of patients from an inner-London health authority in medium secure psychiatric care. British Journal of Psychiatry, 178, 62-66.[Abstract/Free Full Text]

Lewis, G., Croft-Jeffreys, C. & David, A. (1990) Are British psychiatrists racist? British Journal of Psychiatry, 157, 410-415.[Abstract]

Parkman, S., Davies, S., Leese, M., et al (1997) Ethnic differences in satisfaction with mental health services among representative people with psychosis in South London: PRiSM Study 4. British Journal of Psychiatry, 171, 260-264.[Abstract]