Swaran Singh: the social environment of immigrants explains their high rates of psychosis

Race is everywhere in British psychiatry. Responding to charges of institutional racism, politicians promise to make services more culturally sensitive. Black mental health groups argue for ethnically matched clinicians and special services for minorities. Yet, despite millions spent on equality initiatives, the number of black patients on psychiatric wards remains stubbornly high. Afro-Caribbeans are 44 per cent more likely than whites to be sectioned, 29 per cent more likely to be forcibly restrained, 50 per cent more likely to be placed in seclusion, and make up 30 per cent of inpatients on medium secure psychiatric wards.

To anti-racists this is a vivid illustration of the extent and entrenchment of institutional racism. In 2004, John Blofeld, a former high court judge, led an investigation into the death of black schizophrenic patient David Bennett at the Norvic clinic in 1998. Blofeld’s inquiry concluded that at the time, the mental health services were “a festering abscess” of institutional racism. Lee Jasper, ex-mayoral adviser to Ken Livingstone and former chair of the African Caribbean Mental Health Commission, said the inquiry proved the mental health service was like one in “an institutionally racist state.” He said: “Would you send your mother, if she were black, to a mental health institution? Not on these figures.”

Yet in clinical practice psychiatrists bend over backwards to be sensitive to the cultural needs of their patients—sometimes to the detriment of those patients. As a psychiatrist who has worked in the NHS for nearly 20 years, I have come across several cases where clinicians have subordinated their judgement to concerns about culture and race. I remember a severely unwell Nigerian woman whose delusions and hallucinations about witchcraft were accepted by her doctors as a cultural norm. I treated a Sikh woman who had become sexually and financially reckless in the early stages of manic depression. Her husband’s attempts to get help were dismissed as the cultural response of an Asian male unable to deal with female independence. Only after she was detained under the Mental Health Act did she get the proper help. But by the time she had recovered her marriage was over, her children were in care and her business was ruined.

Using data from a survey of community mental health teams, the King’s Fund reported in 2007 that black and white patients’ experiences of…

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