Ethnic differences in forensic hospitalisation

It is sobering to note that Coid et al (2000) have once again found that variations in compulsory hospitalisation cannot be entirely attributed to racial bias, as some would lead us to believe. This was a large multi-centre study that did not limit itself to inner-city areas. The authors must be congratulated on their courage in challenging a popular and attractive myth and at the same time suggesting that services should be culture-sensitive.

Regarding their question of whether (predominantly White) forensic psychiatrists actively select White people with personality disorders as more suitable for treatments such as psychotherapy in secure setting, the answer may lie in the fact that maybe White people do have a greater chance of having a personality disorder (and thus meriting treatment) than the Black or Asian population. There is a study currently taking place at the Institute of Psychiatry and Broadmoor Hospital which is looking at Black patients with personality disorders, and the results should be most interesting. The Asian people in this study show a less than expected degree of morbidity, personality disorder, substance use and previous conviction, in spite of sharing the same socio-economic disadvantage, which is consistent with current knowledge. To paraphrase Freud, maybe a cigar is just a cigar.