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

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Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.

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Authors and Affiliations

  1. Institute of Psychiatry, Kings College London, London, UK

    Martin Webber MSc & Peter Huxley PhD

  2. Social Work & Social Care Section, PO 32, Health Services Research Dept., Institute of Psychiatry, de Crespigny Park, London, SE5 8AF, UK

    Martin Webber MSc

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  1. Martin Webber MSc
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  2. Peter Huxley PhD
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Correspondence to Martin Webber MSc.

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Webber, M., Huxley, P. Social exclusion and risk of emergency compulsory admission. A case-control study. Soc Psychiatry Psychiatr Epidemiol 39, 1000–1009 (2004). https://doi.org/10.1007/s00127-004-0836-3

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