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Mental Health News
Article Date: 25 Sep 2006 - 22:00pm (PDT)
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Psychiatry services in England and Wales have been
accused of being institutionally racist, but are these
accusations justified?
In 2005, the "Count me in" census for England and Wales
showed higher rates of admission for mental illness and
more adverse pathways to care for some black and
minority ethnic groups and led to accusations of
institutional racism within psychiatry. Several reports
and inquiries have also alleged that psychiatry is
institutionally racist.
But Professors Swaran Singh and Tom Burns argue in this
week's BMJ that these accusations are erroneous,
misleading, and ultimately counterproductive
Higher rates of mental illness in migrant groups have
been proposed as evidence of racism within psychiatry,
they write. Yet rates of psychiatric disorder are high
for all migrants, irrespective of ethnicity. This
suggests an explanation that is not ethnic specific and
is environmental rather than genetic.
High rates of detention and adverse pathways to care for
ethnic minority patients have also been attributed to
racism. Yet a recent UK study suggested that the greater
stigma of mental illness in the African-Caribbean
community might act as a barrier to early help seeking
until a crisis develops.
It also suggested that, over time, the relationship
between ethnic minority patients and mental health
services deteriorates, thereby creating a spiral of
downwards engagement.
Hence, a legitimate question is whether some groups of
patients are more likely to refuse help from psychiatric
services. And if so, why?
These findings highlight that there are perfectly
reasonable alternative explanations for why the rates
and manner of admission vary between different ethnic
groups, say the authors. Construing racism as the main
explanation for the excess of detentions among ethnic
minorities adds little to the debate and prevents the
search for the real causes of these differences.
In psychiatry, accusations of racism simply feed into
ethnic minority communities' alienation and mistrust of
services. They create a self fulfilling prophecy whereby
ethnic minority patients are primed to expect services
to be poor and racist, decline all offers of voluntary
admission, are detained, and disengage with services
over time.
There is a serious risk to potential patient care if
charges of institutional racism deter staff from taking
clinically appropriate decisions and actions, they warn.
Hence, any potential solutions must go beyond the health
sector and involve statutory as well as voluntary and
community agencies. The problem does not reside
exclusively in psychiatry and hence the solutions cannot
emerge from psychiatric services alone.
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Contact: Emma Dickinson
BMJ-British
Medical Journal
