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LETTERS: Trevor Turner and Sue Collinson What about stigma, evidence base, and consistency? BMJ 2007; 334: 814-b [Full text]

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Moving forward from the Present Position

Mark Agius, Seema Yasmin Medical Student University of Cambridge   (24 April 2007)

Moving forward from the Present Position 24 April 2007
Mark Agius, Associate Specialist Bedford Hospital, Seema Yasmin Medical Student University of Cambridge Send response to journal: Re: Moving forward from the Present Position	Turner et al raise some very important issues. [1] They are right in stating that admission rates and length of stay reflect the severity and social disruption generated by illness, rather than simply the prevalence of mental illness. They are right in pointing out that, once patients are unwell, treating them appropriately cannot be seen as evidence of racism. Ani and Ani [2] are also right in pointing out that inadequate community support, including lack of adequate care co-ordination , supporting treatment adherence and identification of early signs of relapse will lead to increased detention rates. It is known that a prolonged duration of untreated psychosis can lead to a more severe mental illness and hence to a higher likelihood of hospitalisation and also use of the mental health act.[3] It is acknowledged that AESOP has demonstrated that there is a different prevalence of psychotic illness in different ethnic groups.[4] We certainly need further study in order to understand how all these factors work together to produce the unfortunate results which Makenzie and Bhui present. [5] However, in the meantime , if we are to achieve improvement in our treatment of patients of all ethnicities, we need to be more effective in implementing our mental health policies, and especially focus our attempts on engaging with young persons in all communities in order to appropriately detect and treat psychosis early. Mark Agius [1] Turner T, Collinson S. What about stigma, evidence base, and consistency ? BMJ 2007 334;814. [2] Ani C, Ani O. Editorial is unduely provocative. BMJ 2007 334 ;761. [3] Marshall M , Lewis S, Lockwood A, Drake R, Jones P, Croudace T Association Between Duration of Untreated Psychosis and Outcome in Cohorts of First-Episode Patients’ Archives of General Psychiatry 2005 62; 975- 983. [4] Kirkbride JB, Fearon P, Morgan C, Dazzan P, MorganJ, Tarrant T, LloydJ, HollowayJ, Hutchinson G, Leff JP, Mallett RM, Harrison GL, Murray RM, PB Jones. 2006 Heterogenicity in Incidence Rates of Schizophrenia and Other Psychotic Syndromes: Findings from the 3-centre Aesop Study. Archives of General Psychiatry 63;250-258. [5] McKenzie K, Bhui K. Institutional Racism in Mental Health Care. 2007 BMJ 334; 649-650. Competing interests: None declared