Factors associated with higher risks of emergency compulsory admission for immigrants: a report from the ASAP study

Specific ethnic groups appear to be disproportionally represented in emergency compulsory admissions. This may be due to a parallel higher risk of psychopathology, but different pathways to care in patients from ethnic minorities may also be an explanatory factor. In this article we concentrate on the influence of ethnic background, pathways to psychiatric emergency services and the amount of past psychiatric treatment as predictors of emergency compulsory admission.

All the patients coming into contact consecutively with the Psychiatric Emergency Service Amsterdam (PESA) from September 2004 to September 2006 were included in the study. We collected socio-demographic and clinical characteristics, and data about prior use of mental health services and referral to the emergency service.

The risk of compulsory admission for immigrants from Surinam and the Dutch Antilles (OR 2.6), sub-Saharan Africa (OR 3.1), Morocco and other non-Western countries (each OR 1.7) was significantly higher than for native Dutch people. After controlling for socio-demographic characteristics, diagnosis, referral pattern and psychiatric treatment history, this correlation was no longer found.

We found no evidence to substantiate the hypothesis that ethnic background plays an independent role in emergency compulsory admission. Police referral rather than referral by a GP, and being diagnosed with a psychosis, seemed to be explanatory factors for the high risk of compulsory admission for non-Western immigrants. Infrequent contact with secondary mental healthcare during the previous five years was not found to be consistently associated with a higher risk.