Institutional racism in mental health care

McKenzie, Kwame; Bhui, Kamaldeep

doi:10.1136/bmj.39163.395972.80

Cited by 111 publications

(77 citation statements)

References 4 publications

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“…3,[90][91][92] However, this view has been challenged as providing simplistic explanations for complex processes. 7 Ethnic differences are evident even at first presentation of psychosis; therefore, contributory factors must operate before presentation to psychiatric services and these need to be understood in a wider social context.…”

Section: Chapter 7 Discussionmentioning

confidence: 99%

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Ethnicity, detention and early intervention: reducing inequalities and improving outcomes for black and minority ethnic patients: the ENRICH programme, a mixed-methods study

Singh

Islam

Brown

et al. 2013

Programme Grants for Applied Research

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BackgroundBlack and minority ethnic (BME) service users experience adverse pathways into care. Ethnic differences are evident even at first-episode psychosis (FEP); therefore, contributory factors must operate before first presentation to psychiatric services. The ENRICH programme comprised three interlinked studies that aimed to understand ethnic and cultural determinants of help-seeking and pathways to care.Aims and objectivesStudy 1: to understand ethnic differences in pathways to care in FEP by exploring cultural determinants of illness recognition, attribution and help-seeking among different ethnic groups. Study 2: to evaluate the process of detention under the Mental Health Act (MHA) and determine predictors of detention. Study 3: to determine the appropriateness, accessibility and acceptability of generic early intervention services for different ethnic groups.MethodsStudy 1: We recruited a prospective cohort of FEP patients and their carers over a 2-year period and assessed the chronology of symptom emergence, attribution and help-seeking using semistructured tools: the Nottingham Onset Schedule (NOS), the Emerging Psychosis Attribution Schedule and the ENRICH Amended Encounter Form. A stratified subsample of user–carer NOS interviews was subjected to qualitative analyses. Study 2: Clinical and sociodemographic data including reasons for detention were collected for all MHA assessments conducted over 1 year (April 2009–March 2010). Five cases from each major ethnic group were randomly selected for a qualitative exploration of carer perceptions of the MHA assessment process, its outcomes and alternatives to detention. Study 3: Focus groups were conducted with service users, carers, health professionals, key stakeholders from voluntary sector and community groups, commissioners and representatives of spiritual care with regard to the question: ‘How appropriate and accessible are generic early intervention services for the specific ethnic and cultural needs of BME communities in Birmingham?’ResultsThere were no ethnic differences in duration of untreated psychosis (DUP) and duration of untreated illness in FEP. DUP was not related to illness attribution; long DUP was associated with patients being young (< 18 years) and living alone. Black patients had a greater risk of MHA detention, more criminal justice involvement and more crisis presentations than white and Asian groups. Asian carers and users were most likely to attribute symptoms to faith-based or supernatural explanations and to seek help from faith organisations. Faith-based help-seeking, although offering comfort and meaning, also risked delaying access to medical care and in some cases also resulted in financial exploitation of this vulnerable group. The BME excess in MHA detentions was not because of ethnicity per se; the main predictors of detention were a diagnosis of mental illness, presence of risk and low level of social support. Early intervention services were perceived to be accessible, supportive, acceptable and culturally appropriate. There was no demand or perceived need for separate services for BME groups or for ethnic matching between users and clinicians.ConclusionsStatutory health-care organisations need to work closely with community groups to improve pathways to care for BME service users. Rather than universal public education campaigns, researchers need to develop and evaluate public awareness programmes that are specifically focused on BME groups.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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Section: Chapter 7 Discussionmentioning

confidence: 99%

“…3,91 Senior figures such as the previous mental health 'tsar' 103 and successive presidents of the Royal College of Psychiatrists 104,105 have accepted institutional racism as the cause of ethnic differences in the UK. One report (p. 6) 106 has emphasised that:…”

Section: Are Black and Minority Ethnic Patients Disproportionately Dementioning

confidence: 99%

Ethnicity, detention and early intervention: reducing inequalities and improving outcomes for black and minority ethnic patients: the ENRICH programme, a mixed-methods study

Singh

Islam

Brown

et al. 2013

Programme Grants for Applied Research

View full text Add to dashboard Cite

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“…Although a similar proportion of patients were classified as suffering from schizophrenia, at an individual level, agreement about the diagnosis of schizophrenia in black patients was only reached in 55% of cases. 'Race thinking' (resorting to cultural stereotypes), 23 and examples of institutional racism within the mental health service 24 (discriminatory practices within an organisation) may also result in a degree of clinician bias in everyday practice.…”

Section: How This Fits Inmentioning

confidence: 99%

Schizophrenia in black Caribbeans living in the UK: an exploration of underlying causes of the high incidence rate

2008

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“…8 In order for medical education to meet the goal of improving healthcare for the whole population, training needs to incorporate the principle of individualising care, including recognising the specific health needs, values and communication issues of ethnic minorities. [9][10][11][12][13] Although UK healthcare professional training bodies in medicine, nursing, physiotherapy, occupational therapy, speech and language therapy and pharmacy have all issued general guidelines that encourage equality and diversity appreciation in educational curricula, 14 there are currently no requirements for teaching centres to provide formal cultural diversity training.…”

Section: Introductionmentioning

confidence: 99%

Cultural diversity training for UK healthcare professionals: a comprehensive nationwide cross-sectional survey

Bentley¹,

Stevanovic²,

Sharma³

2008

Clinical Medicine

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-Healthcare inequalities within the UK based on patients' ethnicity have been found over the last five years in a large number of medical specialties. One possible explanation for this lies in ignorance of ethnic minority healthcare needs among professionals. Cultural diversity programmes have been shown to improve patient outcomes including compliance, yet these are not as yet requirements for any UK healthcare professionals with the exception of psychiatrists. This paper documents the frequency, regional variation, characteristics and motivations for cultural diversity training through a questionnaire survey of the educational leads of every UK medical school, postgraduate deanery and schools of nursing, physiotherapy, occupational therapy, speech and language therapy, and pharmacy. The results showed a wide variation in teaching practices between healthcare professions and geographical regions. This study provides evidence for the need for national guidelines to incorporate cultural competency training by all UK healthcare professional training bodies. IntroductionEthnic minorities account for approximately 8% of the total population of the UK, equivalent to 4.6 million people, 1 yet their quality of healthcare has been found to be inferior compared to white Caucasians in diseases including heart disease, 2 stroke, 3 cancer, 4,5 HIV, 6 prenatal care, 7 and mental health. 8 In order for medical education to meet the goal of improving healthcare for the whole population, training needs to incorporate the principle of individualising care, including recognising the specific health needs, values and communication issues of ethnic minorities. 9-13 Although UK healthcare professional training bodies in medicine, nursing, physiotherapy, occupational therapy, speech and language therapy and pharmacy have all issued general guidelines that encourage equality and diversity appreciation in educational curricula, 14 there are currently no requirements for teaching centres to provide formal cultural diversity training. In this study the nationwide frequency, characteristics and motivations for formal cultural diversity teaching for the main types of UK healthcare professionals are documented. It was hypothesised that regions of the UK that have relatively small proportions of ethnic minorities would be less likely to feature cultural diversity training within their healthcare programmes. Methods Search strategyHealth professional courses for the 2006/7 year were identified through the Universities and Colleges Admission Service (UCAS) -the sole UK central organisation through which applications are processed for entry to full-time undergraduate courses, higher national diploma and university diploma -in the following subjects: medicine, physiotherapy, nursing, occupational therapy, speech and language therapy, and pharmacy. The names and contact addresses of the dean or director of medical education (or equivalent) for each training programme were subsequently identified. The list was complemented with informatio...

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Institutional racism in mental health care

Cited by 111 publications

References 4 publications

Ethnicity, detention and early intervention: reducing inequalities and improving outcomes for black and minority ethnic patients: the ENRICH programme, a mixed-methods study

Ethnicity, detention and early intervention: reducing inequalities and improving outcomes for black and minority ethnic patients: the ENRICH programme, a mixed-methods study

Schizophrenia in black Caribbeans living in the UK: an exploration of underlying causes of the high incidence rate

Cultural diversity training for UK healthcare professionals: a comprehensive nationwide cross-sectional survey

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