Intended for healthcare professionals


Institutional racism in mental health care

BMJ 2007; 334 doi: (Published 29 March 2007) Cite this as: BMJ 2007;334:649
  1. Kwame McKenzie, honorary consultant (,
  2. Kamaldeep Bhui, professor of cultural psychiatry and epidemiology2
  1. 1Barnet Enfield and Haringey Mental Health Trust, St Anne's Hospital, London N15 3TH
  2. 2Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London, Queen Mary's School of Medicine and Dentistry, London EC1M 6BQ

    Services have some way to go before they meet the challenges of a multicultural society

    Last week, the Healthcare Commission reported the findings of the “Count me in” one day census of National Health Service hospitals, private mental health hospitals, and learning disability units.1 It makes grim reading for people of African and Caribbean origin living in England and Wales.

    The survey of 32 023 inpatients on mental health wards in 238 NHS and private healthcare hospitals reported that 21% of patients were from black and minority ethnic groups, although they represent only 7% of the population. Rates of admission were lower than average in the white British, Indian, and Chinese groups, but three or more times higher than average in black African, black Caribbean, and white and black Caribbean mixed groups. Not only were people in these three groups more likely to be admitted to hospital, but those in hospital were 19-39% more likely to be admitted involuntarily. Once in hospital, people who defined themselves as black Caribbean had the longest stay.1

    Though high incidence rates of severe mental illness have been reported in people of African and Caribbean origin, admission rates reflect the prevalence of an illness. National community based prevalence studies have not found high rates of psychosis or other serious mental illnesses that could account for these findings.2 Moreover, increased incidence and prevalence of mental illness has been reported in some groups of South …

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