For many years, black and some other minority ethnic groups have been badly served by our mental health services. Some of the problems can be attributed to the fact that services have not adapted adequately to the fact that the understanding of what is ‘mental health’ and ‘mental illness’ is culturally determined and ‘one size does not fit all’. However, there has been mounting evidence that institutional racism too plays a major role. Systematic analysis of what is wrong from sociological, historical and political perspectives now shows how deeply embedded racism is in the practices that underpin and inform, the mental health services in the western world, while at the same time showing us ways in which changesfor the better could be brought about.
Mental illness, as ‘illness’ of the ‘mind’,is something very different to most medical illnesses in that their diagnosis is not based on objectively assessed finding but more on judgements made by people working in the ‘psy professions’ influenced strongly by the system of ‘psychiatry’ that developed in a western cultural framework. The lack of biological markers renders most common psychiatric diagnoses scientifically invalid although often deemed reliable (in that professionals trained in a particular way come to similar conclusions) and thereby giving a spurious impression of their usefulness cross-culturally. The lack of scientific objectivity means that in many instances stereotypes and assumptions based on perceptions of cultural and racial ‘types’ result in the practice of psychiatry often being biased, coming over in practice as being institutionally racist and culturally insensitive. In other words, racism is institutionalised in the psychiatric system, being embedded in the judgements made in diagnosis and assessment, especially during risk assessments—the stereotype of ‘big black and dangerous’ playing a powerful role in this in the UK. The result is that when black people are caught up in the psychiatric system or seek treatment for emotional problems, they get a raw deal: Black and Asian people are significantly over–diagnosed with stigmatising ‘conditions’ such as ‘schizophrenia’;are under-referred for talking therapies but instead given large doses of drugs which cause long-term physical problems; and are over-represented among sectioned patients, people served with community treatment orders and those incarcerated in secure hospitals (as ‘dangerous’).
The attempts by our government to bring about race equality in the mental health services in Britain through for instancethe strategy ‘Delivering Race Equality (DRE)’ have not been successful and generally thought to have touched no more that the fringes of the problemsof racism and cultural insensitivity evident in British mental health services for over three decades. One way of counteracting them may be for services to move away from over-dependence on psychiatric diagnoses and risk-assessments; minimizing the use of sectioning, prolonged incarceration, and the use of forced medication; and shifting the focus of care and help for people with mental health problems towards collaborating with service users in aiming at recovery from personal setbacks and social problems that underlie most difficulties of living that present to the health services as ‘mental’ problems and get diagnosed as ‘illness’.
16 November 2014
Suman Fernando
Visiting Professor, Faculty of Social Sciences & Humanities, London Metropolitan University,
Formerly:
Senior Lecturer in Mental Health, European Centre for Migration & Social Care (MASC)
University of Kent; and Consultant Psychiatrist, Chase Farm Hospital, Enfield, Middlesex
Author of:
Mental health Race and CultureThird edition, Macmillan 2010
Cultural Diversity, Mental Health and Psychiatry. The Struggle Against Racism. Routledge 2003
Mental Health Worldwide; Culture, Globalization and Development, Palgrave Macmillan 2014