Walker, Susan Elizabeth;
(2024)
Disparities in detention: An investigation into relationships between sociodemographic status and compulsory psychiatric treatment among children and adolescents.
Doctoral thesis (Ph.D), UCL (University College London).
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Abstract
Disparities in involuntary psychiatric hospitalisation between population subgroups have been identified in adults, but little is known about the factors associated with involuntary hospitalisation in children or adolescents. Improving our understanding of people’s risks of detention from childhood may help to highlight where interventions could be targeted to help reduce life-long healthcare inequalities. I conducted two international systematic reviews, meta-analyses, and narrative syntheses to investigate the clinical and sociodemographic factors associated with involuntary hospitalisation across the lifespan. I then used the Clinical Record Information Search (CRIS) database to identify a large cohort of children and adolescents (n = 1265) who were inpatients in the South London and the Maudsley (SLaM) NHS Foundation Trust over a 13-year period and compared those who were in hospital voluntarily and involuntarily. I found that there are clinical and sociodemographic factors associated with involuntary hospitalisation across all ages, including a diagnosis of psychosis, more severe illness, police involvement in admission and being from a Black rather than White ethnic group. While ethnic and racial disparities in the use of involuntary hospitalisation among adults have been well documented, this has not previously been researched in children and adolescents. Using CRIS, I was able to investigate this further and found that inpatients aged under 18 in SLaM NHS psychiatric hospitals from Black groups were more likely than those from White groups to have an involuntary rather than voluntary hospitalisation, even after adjusting for age, gender, diagnosis, severity of illness, presence of risk, levels of deprivation, previous mental health service use and pathways into care. My findings suggest that racial disparities in the use of involuntary hospitalisation may start in childhood and potentially contribute to a cycle of inequality that continues into adulthood. Understanding the systemic factors underlying these health-care inequalities and the barriers to accessing less coercive psychiatric treatment throughout the lifespan should be a research and policy priority.
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | Ph.D |
| Title: | Disparities in detention: An investigation into relationships between sociodemographic status and compulsory psychiatric treatment among children and adolescents |
| Open access status: | An open access version is available from UCL Discovery |
| Language: | English |
| Additional information: | Copyright © The Author 2024. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request. |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Division of Psychiatry |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10194095 |
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