Ethnic inequalities in compulsory psychiatric hospital detentions during UK COVID-19 lockdowns: regression discontinuity design in time study

Background Ethnic inequalities in compulsory psychiatric hospital detentions are well-documented in the UK and internationally. It is unknown how UK coronavirus disease 2019 (COVID-19) lockdown measures, which led to restrictions in public movement, gatherings, in-person health service delivery and changes to police powers, further impacted inequalities. Aims In this study, we assessed whether national lockdown measures impacted ethnic inequalities in voluntary and compulsory psychiatric hospital admissions during the COVID-19 pandemic. Method Daily counts of admissions and detentions to psychiatric hospitals were extracted from a large population-level sample of secondary mental health service users in South East London. Changes during two COVID-19 lockdown periods, over 2020–2021, were compared with pre-pandemic periods (2016–2019) with the use of a regression discontinuity in time design to assess ethnic inequalities in voluntary and compulsory mental health admissions. Results Compared to the pre-pandemic reference (2016–2019), after adjusting for seasonal and weekly trends, overall admissions to mental health units dropped during the first COVID-19 lockdown (incidence rate ratio (IRR) 0.87 (95% CI: 0.75–1.00)), but compulsory detentions rose (IRR 1.25 (1.05–1.54)). This was mostly due to higher compulsory detentions in the Black Caribbean group (IRR 1.54 (1.08–2.19)). During the second COVID-19 lockdown, whereas total daily admissions remained similar to the pre-pandemic reference (IRR 1.03 (0.92–1.15)), total new daily detentions was elevated (IRR 1.28 (1.11–1.49)), specifically in Black Caribbean (IRR 1.53 (1.14–2.06)) and Black African (IRR 1.57 (1.06–2.34)) groups. Conclusions COVID-19 lockdown measures exacerbated pre-existing ethnic inequalities in compulsory psychiatric detention, particularly for those from Black Caribbean and Black African backgrounds. There is a need to address ethnic inequalities in compulsory psychiatric detentions and attend to exacerbations of pre-existing inequalities during health emergencies like the COVID-19 pandemic. This cannot be achieved without addressing systemic racism within criminal justice and healthcare systems and tackling inequalities in wider social and economic determinants of mental health.