Since the Macpherson report first popularised the term ‘institutional racism’ in 1999, it has been applied to a range of organisations in Britain. But after the initial media and public outrage, how has the widespread application of the phrase affected life inside those institutions?

"the mental health sector has for many years faced accusations of racist treatment"
A disturbing example is that of the mental health sector, which has for many years faced accusations of racist treatment, particularly towards the African-Caribbean population. Anti-racism campaigners point to the Count Me In census 2005, which showed that African-Caribbeans in England and Wales have higher rates of admission for mental illness and when admitted, they are more likely to be detained under the Mental Health Act.. Lee Jasper, race adviser to the Greater London Authority and chair of African and Caribbean Mental Health claimed that the 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’.

In 2004, an official inquiry into the death of David ‘Rocky’ Bennett, a Jamaican-born patient with schizophrenia who died after being physically restrained at a secure unit in Norwich in 1998, concluded that institutional racism was a ‘festering abscess’ in the sector.
But now, mental health professionals are coming forward – some of them ethnic minorities – to argue that the label of institutional racism may be inaccurate and is doing more damage than good.

In September 2006, Swaran Singh and Tom Burns (professors at the Universities of Warwick and Oxford respectively) published an article in the British Medical Journal (BMJ) entitled ‘Race and Mental Health: There is More to Race than Racism’, arguing that the mental health profession was not institutionally racist, and that ethnic differences in rates of illnesses and in the way patients were treated were due to a mix of complex factors. While they did not deny the existence of racism, they insisted its influence in the mental health profession – which includes significant numbers of ethnic minority employees – had been exaggerated, and had obstructed the case for more sophisticated research.

black people of Caribbean origin were nine times more likely than white patients to be diagnosed with psychosis
The statistics regarding ethnic groups in mental health certainly are worrying at first glance. Black people are eight to ten times more likely to be diagnosed with a serious mental health problem than white people. However, Singh and Burns argue that this is not due to racist doctors. International academic research shows that migrant minority groups in almost any country suffer far higher rates of mental illness than the host population. Such groups are also more likely to experience multiple social problems including unemployment, marginalisation, family breakdown, alcoholism or drug abuse, racism, and poor housing and educational opportunities. These adverse experiences increase the risk of mental illness. Therefore the increase in the rate of mental illness diagnosis in minority groups, though caused by social factors, should not be attributed to ‘racist diagnostic practices’.

Furthermore, the largest ever study of psychosis at the Institute of Psychiatry in London suggests that doctors’ diagnoses are not biased by racial prejudice. Doctors were asked to make judgments about patients based on case notes, but data about their ethnicity was removed. The study found that black people of Caribbean origin were nine times more likely than white patients to be diagnosed with psychosis – almost exactly the same rate as their presence in the mental health service. It is not ‘Eurocentric’ psychiatry that is the cause of these worrying statistics, but factors in society at large.

The stigma attached to mental illness – particularly for certain ethnic groups – also means that individuals and families can be reluctant to come forward for help until prompted by a definite incident. A far higher proportion of African-Caribbean patients are admitted to clinics on referral by the criminal justice system. They are almost four times more likely than white patients to be admitted under the Mental Health Act.

Singh and Burns argue that campaigns to raise awareness about racism actually exacerbate this problem: ‘They create a self-fulfilling prophecy whereby ethnic minority patients are primed to expect services to be poor and racist, decline all offers of voluntary admission, are detained, and disengage with services over time’.

Thanks to medical advances and regular contact with experts, many people with serious mental illness can live a normal life. The tragedy is that the political agenda is now seriously distorting the ability of services to help ethnic minority patients.

The accusation of racism has severely crippled doctors’ confidence in dealing with people from ethnic minority groups
The accusation of racism has also severely crippled doctors’ confidence in dealing with people from ethnic minority groups. Dr Shubulade Smith at the Maudsley hospital in London – herself a black woman – told the BBC in an interview in May that she had sat on an assessment panel which had refused to diagnose a black patient at serious risk, both to themselves and the wider public. She said, ‘I don't know what was going on in their minds other than they were too scared of thinking that they might be being racist towards him’.

Unfortunately, instead of welcoming debate on these crucial issues, certain key individuals and institutions have publicly condemned such discussion as dangerous and misguided. Professor Sheila Hollins, president of the Royal College of Psychiatrists, argued that Singh and Burns’ paper ‘risks setting psychiatry back twenty years’. Dr Kwame McKenzie at the University of Central Lancashire said: ‘Swaran Singh has unfortunately no credibility in the voluntary sector or in the communities. Communities don’t like him, they don’t trust him and they don’t think he speaks their language.’ With no evidence to the contrary, such statements appear to be efforts to shoot the messenger rather than deal with the message.
In fact, Singh trained as a psychiatrist in India and has worked in community-based services for over ten years in inner city, multi-ethnic London and Birmingham. Undoubtedly many of his critics are angered that he has spoken out about what many doctors have, up till now, only felt they can discuss in private. But the debate does seem to be opening up now, and it is clear that some are taking his arguments seriously. The National Institute of Health Research recently awarded Singh over £500,000 to investigate ways of reducing inequalities in access to care and outcomes between ethnic groups.

Perhaps decisions like these will break down the wall of silence in the mental health sector and encourage others to speak more honestly about the complexity of the challenges they face.