Intended for healthcare professionals

Analysis And Comment Controversy

Race and mental health: there is more to race than racism

BMJ 2006; 333 doi: (Published 21 September 2006) Cite this as: BMJ 2006;333:648
  1. Swaran P Singh (, professor of social and community psychiatry1,
  2. Tom Burns, professor of social psychiatry2
  1. 1 Health Sciences Research Institute, Warwick Medical School, University of Warwick, Coventry CV4 7AL,
  2. 2University of Oxford, Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX
  1. Correspondence to: S P Singh
  • Accepted 5 July 2006

Some minority ethnic groups in England and Wales have higher rates of admission for mental illness and more adverse pathways to care. Are the resulting accusations of institutional racism within psychiatry justified?

It occurred to me that there was no difference between men, in intelligence or race, so profound as the difference between the sick and the well.

F Scott Fitzgerald. The Great Gatsby. 1925

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 produced predictable accusations of institutional racism within psychiatry.1 Lee Jasper, chair of African and Caribbean Mental Health, stated: “This census confirms once and for all that mental health services are institutionally racist and overwhelmingly discriminatory. They are more about criminalising our community than caring for it.”2 In fact, the census clearly states that it “highlights the differences between various black and minority ethnic groups and the need to avoid generalisations about these groups. It does not show a failure in the services” (page 7) and comments that “although many possible explanations have been put forward for these patterns, the evidence is inconclusive” (page 27). Not surprisingly it was the accusation of institutional racism, described as a “festering abscess within the NHS,”2 that made the headlines. Mr Jaspers is not alone in expressing such concerns. Several reports and inquiries have also alleged that psychiatry is institutionally racist.36 What then, is the evidence that the census findings can be attributed to racism within psychiatry?

Rates of mental illness in minority groups

High rates of mental illness in migrant groups have been recognised and speculated on throughout the past century. A scientific approach to understanding the issue originated with Odegaard's observation of raised rates in Norwegian immigrants in …

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