Is the mental health system racist?

BBC’s Newsnight programme just had an interesting video report on the renewed debate about whether mental health services are institutionally racist.

While these accusations have been made for some time, what is new is that some black and ethnic minority mental health workers who work in these communities are starting to argue that this label actually makes it more difficult to provide fair treatment to their patients.

The subject was recently tackled in one of regular debates held at the Maudsley Hospital in South East London, which is available online as a podcast.

It is widely known that in the UK, black and ethnic ethnic minority people are much more likely to be diagnosed with a psychotic mental illness, such as schizophrenia, than other members of society.

While this was originally thought to be a sign of racism in itself, studies have suggested that this pattern is true of almost all immigrant communities (e.g. Finnish immigrants to Sweden), rather than simply a black and white issue, and that the rates still hold when psychiatrists are asked to diagnose cases based only on their symptoms with the ethic origin hidden.

The debate has now largely moved on and the focus is now on outcomes and experiences in the mental health system.

For example, regardless of the higher rates of psychosis, it seems that when in contact with mental health services, outcomes for Afro-Carribean people are much worse than white people.

This is where the subtlety in the debate lies. Higher rates of diagnosis in one racial group are not necessarilly a sign of discrimination, but poorer outcomes after treatment has started are more likely to suggest this group is not being fairly treated.

An influential report called ‘Breaking the Circles of Fear’ found that people from ethnic minorties tend to have a more negative experience of the mental health system and fear the consequences of becoming involved with it.

Furthermore, it found that mental health professionals were often afraid of talking about race issues for fear of appearing racist.

Psychiatrists Prof Swaran Singh (pictured) and Dr Shubulade Smith argue in the video report that accusations of racism actually make it more difficult for people from ethnic minority communities to get fair treatment, as it interferes with sensible clinical decision making.

In contrast, campaigners like Lee Jasper and psychiatrist Dr Kwame McKenzie argue that unless we admit that the system is racist, problems won’t be adequately addressed.

One important factor might be that immigrant communities tend to be poor, live in urban environments, have weaker family support and have higher rates of drug and alcohol abuse, all of which have been found to increase rates of schizophrenia.

This makes it difficult to disentangle the effects of mental health treatment, and a society where black and ethnic minority groups are more likely to live stressful and depressed communities.

The fact that ethnic minority psychiatrists are now starting to challenge the idea that the mental health system is racist must be a positive sign, however, as twenty years ago, most would be in agreement that it was not set up to deal with the needs of minority communities.

Link to BBC News on the debate with video report.
Link to podcast of Maudsley Debate ‘The Race Blame Game’.