Inner london collaborative audit of admissions in two health districts. I: Introduction, methods and preliminary findings.

BACKGROUND: There is pressure on acute admission services in inner-city areas. Two deprived London districts with markedly different acute bed ratios but similar sociodemographic backgrounds were compared to test the hypothesis that more facilities mean better service. METHOD: An instrument for auditing the use of short-stay hospital beds was constructed to collect information concerning admissions to, and short-stay patients in, the chosen districts during a three-month period. RESULTS: There was a higher admission rate and substantially greater use of beds per unit population in south Southwark than in Hammersmith & Fulham. Much of the difference was attributable to a higher rate of admission of patients with affective disorders in south Southwark. CONCLUSIONS: The results are not explained by variations in population need, longer in-patient stay, or poorer aftercare leading to early relapse. The question of whether there is over-provision of services compared with real need in south Southwark, or under-provision (particularly for people with affective disorders) in Hammersmith & Fulham, is considered but left open for discussion following a study of ethnic issues and the reasons for admission.

Inner London collaborative audit of admissions in two health districts. II: Ethnicity and the use of the Mental Health Act.

BACKGROUND: Twenty-six per cent of patients in two Inner London districts were admitted to acute wards under the provisions of the Mental Health Act. Compared with those not under compulsion, they were young, male, more likely to be of black Caribbean origin, and to have a diagnosis of schizophrenia of short duration. The hypothesis is tested that ethnicity determines rates of compulsory admission independently of the other factors. METHOD: Sampling and data collection methods were described in the first paper. Statistical analyses included a log-linear analysis of six key variables: compulsory admission, challenging behaviour, diagnosis, ethnicity, age, and sex. RESULTS: There were no substantial differences between districts. Analysis provided two similar statistical models. In both, admission under the Act was strongly associated with challenging behaviour and diagnosis of schizophrenia. In the model of best fit there was no significant interaction term for ethnicity and compulsion. In the second model there was a weak association. CONCLUSIONS: Ethnicity did not appear to be of outstanding importance in decisions to use the Mental Health Act. There was a strong link between ethnicity and diagnosis, independent of compulsion. Differences between the districts made no major contribution to the rates of compulsory admission.

Inner London collaborative audit of admissions in two health districts II: Ethnicity and the use of the Mental Health Act

BACKGROUND: Twenty-six per cent of patients in two inner London districts were admitted to acute wards under the provisions of the Mental Health Act. Compared with those not under compulsion, they were young, male, more likely to be of black Caribbean origin, and to have a diagnosis of schizophrenia of short duration. The hypothesis is tested that ethnicity determines rates of compulsory admission independently of the other factors. METHOD: Sampling and data collection methods were described in the first paper. Statistical analyses included a log-linear analysis of six key variables: compulsory admission, challenging behaviour, diagnosis, ethnicity, age, and sex. RESULTS: There were no substantial differences between districts. Analysis provided two similar statistical models. In both, admission under the Act was strongly associated with challenging behaviour and diagnosis of schizoprenia. In the model of best fit there was no significant interaction term for ethnicity and compulsion. In the second model there was a weak association. CONCLUSIONS: Ethnicity did not appear to be of outstanding importance in decisions to use the Mental Health Act. There was a strong link between ethnicity and diagnosis, independent of compulsion. Differences between the districts made no major contribution to the rates of compulsory admission (AU)

A Portuguese/Brazilian study of Expressed Emotion.

Expressed Emotion is a measure of family interaction, widely used in studies around the world to predict relapse in severe psychiatric disorders. The instrument was originally developed in London. It depends on subtle vocal nuances emerging in the course of the Camberwell Family Interview (CFI). The extent to which these can be picked up in different languages and different cultures is an interesting question. This paper presents the results of a study of EE from Brazil. The two raters achieved good reliability with master tapes in English, and the CFI was then translated into Portuguese. The raters also showed good reliability in Portuguese. This is at least consistent with the idea that similar behaviours can be picked up in different languages and cultures. Twenty nine relatives of 24 patients with schizophrenia were interviewed using the CFI. It was predicted that high Expressed Emotion would be rare in Brazil, a developing country. In fact, 59% of relatives were rated as high EE. Unlike studies from fully industrialized nations this high level of high EE was largely due to over-involvement. Our findings suggest both contextual and cultural influences on the relative salience of the different components of EE, a theme worth pursuing.