Community treatment orders and associations with readmission rates and duration of psychiatric hospital admission: a controlled electronic case register study

Journal article

Background: Mental health inequities persist between ethnic minority and white majority groups in the UK. However, the pathways through which ethnicity interacts with socioeconomic determinants to shape mental health remain insufficiently understood. This limits the development of targeted policies to promote health equity. Methods: This thesis adopted a mixed methods approach to elucidate ethnic mental health inequities in the UK context. First, a systematic literature review synthesised evidence on associations between ethnicity and mental health from 9 observational studies over the past decade. Next, a quasi-experimental analysis leveraged a regression discontinuity design using the 1972 Raising of the School Leaving Age (ROSLA) policy as an instrument to estimate the causal effect of education on mental health within ethnic minorities. Finally, an intersectional Oaxaca-Blinder decomposition examined the contributions of socioeconomic factors to the mental health gap between women from ethnic minorities and the overall UK population. Results: The systematic review revealed that ethnicity effects are mediated by other determinants like housing and employment, with heterogeneity across ethnic minority groups. The quasi-experimental analysis found no significant effect of increased compulsory schooling on mental health for ethnic minorities. The decomposition showed that socioeconomic differences explain nearly 50% of the mental health gap for minority women, but over 50% remains unexplained, pointing to unobserved systemic biases. Conclusions: The complex interplay between ethnicity, socioeconomics, and systemic factors shapes mental health inequities in the UK. Coordinated efforts addressing social determinants and structural biases are needed alongside further research on causal pathways using intersectional lenses. Tackling ethnic mental health disparities requires a multifaceted approach attentive to this inherent complexity

Authors: Barkhuizen, W; Cullen, AE; Shetty, H; Pritchard, M; Stewart, R

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: BMJ Publishing Group
• Journal: BMJ Open
• Volume: 10
• Issue: 3
• Pages: e035121-e035121
• Publication date: 2020-03-05
• DOI: 10.1136/bmjopen-2019-035121
• EISSN: 2044-6055
• ISSN: 2044-6055
• Language: English
• Keywords: Pediatrics; Community hospital; Register (sociolinguistics); Medicine; Psychiatric hospital; Duration (music); Family medicine; Emergency medicine; Psychiatry