| Summary: | Introduction: It has been consistently found that Black-Caribbean patients experience disproportionate rates of compulsory hospital admission during First Episode Psychosis (FEP). Existing research can only partially explain this phenomenon, which suggests that other more comprehensive explanations must exist. This thesis aims to address this limitation and develop both an empirical and theoretical understanding that explains ethnic variation in detention rates specific to FEP. Thesis Aim: To identify new variables that account for excessive rates of detention amongst Black-Caribbean patients during FEP, which can help develop a theoretical explanatory model. Method: A mixed method pathways to care study was conducted consisting of two parts. In the quantitative part, a multi-ethnic cohort of FEP patients was recruited at the point of entry into an Early Intervention Service (EIS) where socio-demographic, clinical, help seeking behaviours and symptom attributions during the pathway to care were collected. In a separate qualitative design, carers’ narrative accounts of the processes leading to detention were also explored, comparing and contrasting ethnic difference between Black-Caribbean and other groups. Results: From the quantitative arm, 122 FEP patients were recruited of which 46 were White-British (37.7%), 44 Black-Caribbean (36.06%) and 32 Asian-Pakistani (26.22%). Through the logistic regression analysis conducted, eight variables were found to attenuate the association between the Black-Caribbean sample and elevated rates of compulsory detention. In the qualitative work, 17 interviews were conducted and revealed many unique features in the process of detention for Black-Caribbean patients, such as; a lack of awareness of the early signs of psychosis, the influence of patients fragment living status and the importance of a psychotic episode manifesting itself through a crisis event. Discussion: Through an iterative process, a theory is developed that married well key explanatory finding from both arms of the study, in accounting for ethnic differences in detention rates. This theory is named the ‘crisis hypothesis’, and is discussed in detail within.
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