The demography of nurses and patients on acute psychiatric wards in England

Aims and objectives. To describe the ethnic and demographic composition of staff and patients on acute psychiatric wards in England. Background. A significant proportion of the UK population (7·6%) belong to an ethnic minority and there are concerns that ethnic minority patients are not well served by psychiatry, in particular that they are subject to excessive force and coercion. Design. Survey of a random sample of psychiatric wards in three regions. Methods. A survey was conducted of staff (n = 1536) and patients (n = 11 128) on 136 acute admission psychiatric wards. Results. Ethnic minority patients were more likely to be admitted with a diagnosis of schizophrenia, younger, more likely to be admitted for a risk of harm to others and more likely to be legally detained. The association between ethnic minority status and detention remains, even when risk, age, gender and diagnosis are taken into account. Ethnic minority patients come from areas of greater social deprivation and fragmentation. Ethnic concordance between staff and patients varies, but the greatest difference is found in London where the proportion of minority staff is greater than the proportion of minority patients. Conclusions. There continues to be evidence that ethnic minority patients are subject to an excessive amount of legal coercion in English mental health services. However, the proportion of staff belonging to an ethnic minority is greater than the proportion of patients. Relevance to clinical practice. Solutions to the problem of excessive use of legal coercion with ethnic minority patients need to be found. Changes of recruitment strategies are required if concordance is to be achieved.