Emergency psychiatry, compulsory admissions and clinical presentation among immigrants to the Netherlands

TLDR

In the UK, Black people use psychiatric emergency services more than White people, but it is unclear whether this pattern holds elsewhere in Europe. The study compares emergency service contact and compulsory admission risks between Dutch natives and immigrant groups in the Netherlands, assessing ethnicity’s independent effect on compulsory admission. The authors analyzed data from 720 individuals referred to emergency psychiatric services in Greater Rotterdam, The Netherlands. Immigrant groups in the Netherlands showed significantly higher relative risks for emergency psychiatric contacts, psychotic disorders, and compulsory admissions, with Moroccans, Surinamese, and Dutch Antilleans at greatest risk, but after adjusting for clinical factors non‑Western origin was no longer associated with compulsory admission, suggesting overrepresentation may stem from differing clinical presentations.

Abstract

Background Black individuals in the UK have higher rates of contact with psychiatric emergency services than their White counterparts. It is unknown whether this is also the case in other European countries. Aims To compare the risk of contact with psychiatric emergency services and of compulsory admission between immigrant groups to The Netherlands and Dutch natives, and to determine the unique contribution of ethnicity to compulsory admission. Method Study of 720 people referred to emergency psychiatric services in Greater Rotterdam, The Netherlands. Results The relative risks (RRs) for contacts with psychiatric emergency services, for having a psychotic disorder and for compulsory admission were significantly higher in most immigrant groups. Moroccans, Surinamese and Dutch Antilleans had the highest risks of compulsory admission. After controlling for symptom severity, danger, motivation for treatment and level of social functioning, non-Western origin was no longer associated with compulsory admission. Conclusions Non-Western immigrant groups were overrepresented in psychiatric emergency care and were admitted compulsorily more frequently, possibly owing to a different clinical presentation.