Social Psychiatry and Psychiatric Epidemiology

, Volume 39, Issue 12, pp 1000–1009 | Cite as

Social exclusion and risk of emergency compulsory admission. A case-control study




Emergency detentions under section 4 of the Mental Health Act 1983 are more frequent in socially deprived areas of England and Wales. However, it is not clear whether individual socio-economic disadvantage increases likelihood of emergency detention. Therefore, this study tests the hypothesis that a higher proportion of people who are socially excluded will be admitted to hospital under section 4 than those who are not.


A total of 300 mental health act assessments in two London boroughs with different rates of section 4 admissions were studied by retrospective case note review in a case-control design. An index of social exclusion was created and piloted for this study.


The logistic regression analysis discovered four risk factors for section 4 admissions: presenting with a risk to self or others at the mental health act assessment, bi-polar affective disorder, non-White British ethnicity and low social support. There were no significant differences between the two boroughs on these variables. Risk factors for any compulsory admission were: presenting with a risk, psychosis and non-White British ethnicity.


This study found low social support to be the only social exclusion indicator that increases likelihood of admission under section 4. While individual-level variables explain some of the variation in section 4 rates, it is likely that, as indicated by other studies, different configurations of mental health services affect rates to a greater degree.

Key words

social exclusion mental health act emergency detentions approved social workers 


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Copyright information

© Steinkopff Verlag 2004

Authors and Affiliations

  1. 1.Institute of PsychiatryKings College LondonLondonUK
  2. 2.Social Work & Social Care Section, PO 32, Health Services Research Dept., Institute of PsychiatryLondon, SE5 8AFUK

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