Misunderstood, misdiagnosed

The media coverage given to Frank Bruno’s admission to a
psychiatric hospital was extraordinary. Yet in many ways Bruno is
no different to other individuals who have been treated under the
Mental Health Act 1983. Every day around five people an hour are
sectioned in the UK, and people who have gone through the process
say time and again how traumatic it can be.

But, once again, two familiar issues have been raised. The first is
that people from ethnic minorities continue to be over-represented
in mental health services. The second is that services are still
failing to reach people early enough, resulting in help often only
becoming available when an individual is in a crisis. On average,
people suffering from psychosis have to wait an average of 18
months before they get help.

Half of black people and a third of Asian people who took part in a
survey said that they felt their cultural needs were not taken into
consideration in the care they received, compared with just 17 per
cent of white people. Psychiatrists’ failure to understand
patients’ racial and cultural differences might result in
inaccurate diagnosis.

Although data is limited, rates of mental illness in countries such
as Jamaica and parts of West Africa do not indicate a
predisposition for mental illness among black people. So maybe it
is the case that some professionals – be they doctors, nurses,
social workers, policemen or psychiatrists – find it difficult to
respond to the diverse needs of today’s society?

Actions that come across as delusional may not be when viewed in
the appropriate cultural context. Take the case of a Balinese man
who had a serious motorcycle accident. He felt compelled to create
small rice figures and place them at dangerous places such as road
intersections, and at the homes of people who had recently died, in
order to appease local spirits.

To a Western psychologist such behaviour may seem delusional, but
from a Balinese point of view it makes sense; millions of Balinese
make religious offerings every day. But misunderstanding this kind
of behaviour could lead to misdiagnosis.

The modernisation programme in mental health appears to have had no
positive impact on the experience of ethnic minorities. Unless
specific and co-ordinated action is taken, ethnic minorities will
continue to experience inadequate and inappropriate care within
mental health services.

Claire Felix is a service development manager for mental
health charity Rethink.