What do people think about this? i am an AMHP and so have a role in admitting patients to hospital if they are unwell. We had many lectures on the amhp training about this subject, which has made me more aware of the issue. I work in london and do find very high numbers of people from ethnic minority groups on our caseload, but i find it hard to believe that our team discriminates and would seek to admit someone to hospital, because they are not white, even on an unconscious level. However the stats say we do, so why is this?
Does immigration cause mental ill health?
Do we misinterpret cultural differences as mental health symptoms?
Are we inherently racist and see certain mental health clients as more risky, perhaps because they are not white?
Are there real differences between ethnic backgrounds in terms of their vulnerability to mental illness, like there is for certain physical illnesses?
Does the life style of of some people from EM backgrounds cause mental illness?
My suspicion is that the interpretation of cultural differences is relevant. Has there been any serious research on this issue?
juli05:Does immigration cause mental ill health?
this is definately an issue when they are first generation imigrants and there is research to back it up however i am sure that not all the people from BME groups you are talking about are immigrants.
i find it a fascinating subject too. have you read rogers and pilgrims book a sociology of mental illnes as that has some interesting stuff on ethnicity in there
I am replying a off the top of my head here but can probably find references tomorrow..
Firstly, I think while immigration is an issue in relation to mental health, it most certainly affects second generation immigrants - arguably more so - because there are more issues of vying with different cultures and falling between two - so living in a society with different values to those of your parents.
I also remember learning that it was more likely that some people from minority ethnic backgrounds might be less likely to access primary health care as early as those from the majority ethnic backgrounds such as white british - therefore when the difficulties or illnesses were picked up they were more serious.This could be due to discrimination or the different attitudes towards discussing mental illness and the stigma that exists (although I think that's an issue across the board).
I have no doubt there is some institutional racism and the effects of discriminatory attitudes can be a factor to increase vulnerability to mental illness. Also there is a relationship between poverty and poor mental health.
There are lots of risk factors and there has been lots of research on these matters.
surfer: My suspicion is that the interpretation of cultural differences is relevant. Has there been any serious research on this issue?
Yes surfer there has. There was a lot of research done on cultural misunderstandings in the 1990s. That's when the term 'breadfruit psychosis' was coined meaning that people from Afro-carribean backgrounds were more likely to appear psychotic because white Western shrinks didn't always appreciate their cultural norms.
There's also the institutional racism that was rife back then. The report 'Big, black and dangerous' from 1991 (I think) spoke of the perceptual/cultural problems that led to a black man being restrained 'to death' in circumstances that would probably not have involved restraint had he not matched the prevailing stereotype at the time - hence the report's title.
Sorry I'm doing this off the top of my head so can't be any more precise than that.
Cheers,
Stuart
Visit my blog at http://stuartsorensen.wordpress.com/
Stuart Sorensen: surfer: My suspicion is that the interpretation of cultural differences is relevant. Has there been any serious research on this issue? Yes surfer there has. There was a lot of research done on cultural misunderstandings in the 1990s. That's when the term 'breadfruit psychosis' was coined meaning that people from Afro-carribean backgrounds were more likely to appear psychotic because white Western shrinks didn't always appreciate their cultural norms. There's also the institutional racism that was rife back then. The report 'Big, black and dangerous' from 1991 (I think) spoke of the perceptual/cultural problems that led to a black man being restrained 'to death' in circumstances that would probably not have involved restraint had he not matched the prevailing stereotype at the time - hence the report's title. Sorry I'm doing this off the top of my head so can't be any more precise than that. Cheers, Stuart
hmmmmmmmmm, institutional racism. was this present in psychiatry? the NHS? i wonder because if it is are suggestingting that MHO's were racist? the psychiatrists? the s/w's? the nurses? the psychologists?
anyway, i know in glasgow there is a great influx of immigrants into psychiatric service's services when an illeagal immigrant is refused assylum and told they are to be leaving the country. better known as 'assylum declined psychosis'. an absolute abuse of of taxpayers monay.
titchmagoo: hmmmmmmmmm, institutional racism. was this present in psychiatry? the NHS? i wonder because if it is are suggestingting that MHO's were racist? the psychiatrists? the s/w's? the nurses? the psychologists? anyway, i know in glasgow there is a great influx of immigrants into psychiatric service's services when an illeagal immigrant is refused assylum and told they are to be leaving the country. better known as 'assylum declined psychosis'. an absolute abuse of of taxpayers monay.
Hi Titchmagoo,
I'm going off the top of my head I'm afraid. I remember the breadfruit psychosis term from my student days when it was a very familiar term - at least in the hospital where I trained.
I'm afraid I don't know what the situation was/is in Scotland in relation to institutional racism within the NHS mental health services but there was much concern in England in the early 1990s about just that.
Oh and to answer your question:
Institutional racism does not need people to be racist to exist. It is when the rules and systems that are in place (perhaps designed from a particular cultural perspective) discriminate against others even though that was never the intention.
So no - I'm not accusing anyone of racism - but I am saying that I remember much concern about institutional (and I suspect unintended) racism at that time. I will suggest that people were and still are fallible and that is all it takes for a culture of unintended institutional racism to develop.
Stuart Sorensen: titchmagoo: hmmmmmmmmm, institutional racism. was this present in psychiatry? the NHS? i wonder because if it is are suggestingting that MHO's were racist? the psychiatrists? the s/w's? the nurses? the psychologists? anyway, i know in glasgow there is a great influx of immigrants into psychiatric service's services when an illeagal immigrant is refused assylum and told they are to be leaving the country. better known as 'assylum declined psychosis'. an absolute abuse of of taxpayers monay. Hi Titchmagoo, I'm going off the top of my head I'm afraid. I remember the breadfruit psychosis term from my student days when it was a very familiar term - at least in the hospital where I trained. I'm afraid I don't know what the situation was/is in Scotland in relation to institutional racism within the NHS mental health services but there was much concern in England in the early 1990s about just that. Oh and to answer your question: Institutional racism does not need people to be racist to exist. It is when the rules and systems that are in place (perhaps designed from a particular cultural perspective) discriminate against others even though that was never the intention. So no - I'm not accusing anyone of racism - but I am saying that I remember much concern about institutional (and I suspect unintended) racism at that time. I will suggest that people were and still are fallible and that is all it takes for a culture of unintended institutional racism to develop. Cheers, Stuart
ah, right, the worst kind of racist s/w's, dr's and nurses, racists that don't know they racists working in a racist system. but thats okay cos they don't mean it really.
titch - I think you may be deliberately misrepresenting "institutional racism".
If you are genuinely interested to find out more there is a considerable body of argument/evidence about it surrounding the Stephen Lawrence case. Nothing to do with mental health, but the "institutional racism" issues are well-aired.
The Aesop study (Aetiology and Ethnicity in Schizophrenia and other Psychoses) that suggested that the incidence of schizophrenia in African Caribbeans was 9 times greater than the white population.
http://www.iop.kcl.ac.uk/departments/?locator=398&context=997
A recent "Dimensions and Diversity" report form NHS Scotland has concluded that people who experience prejudice in any form are more likely to develop mental health problems than people who do not.
The report identified a "deep-rooted vein of prejudice" in Scotland that was "stoked by a fear of diversity". The recently published Survey of British Social Attitudes seemed to indicate a growth of liberalism and tolerance towards people previously regarded as "different". Is Scotland different to the rest of Britain, or have these studies come up with seemingly contrary results?
From my point of view i agree that there is misintrepreting culture difference. For example, what a minority ethnic does might annoy white or some body else while it is just way of life for the minority group. So what am trying to say is when we do with Ethnic minority is bettet to be open minded and think widely_ by saying what does mean by culture and his culture or if you dont understand ask.
MAna
The last mental health act commision biannual report has real data from real service users on this so read that rather than get bogged down with teh point scoring here
I posted the link to the AESOP study, but found the headline findings hard to believe. It appears I am not the only one and there are serious concerns about it's methodology:
http://www.guardian.co.uk/society/2010/feb/03/mental-health-bme-schizophrenia-letter
Immigration is up there with all the other key stressors - divorce/separation from a spouse, move of home, death of a close relative - in fact someone leaving their country is very likely to have experienced all of these, so there has to be a heightened risk of mental distress. We don't need research, it's common sense.
But going back to the original piece in Community Care, the problem is when Count Me In figures are referred to nationally. In terms of identifying good practice, they are meaningless when the overall figures are quoted from. What we need to know are the mental health services where there is evidence of reduced admission, and then further analysis as to why. We sought to address this within our DRE focused implementation site project and our evaluation report can be found at: http://www.cnwl.nhs.uk/equality_diversity_news.html The whole point of the Focused Implementation Sites was to establish test beds for good practice and to report on them.