Race and mental health: there is more to race than racism

It occurred to me that there was no difference between men, in intelligence or race, so profound as the difference between the sick and the well.

F Scott Fitzgerald. The Great Gatsby. 1925

The “Count me in” census for England and Wales showed higher rates of admission for mental illness and more adverse pathways to care for some black and minority ethnic groups and produced predictable accusations of institutional racism within psychiatry.1 Lee Jasper, chair of African and Caribbean Mental Health, stated: “This 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.”2 In fact, the census clearly states that it “highlights the differences between various black and minority ethnic groups and the need to avoid generalisations about these groups. It does not show a failure in the services” (page 7) and comments that “although many possible explanations have been put forward for these patterns, the evidence is inconclusive” (page 27). Not surprisingly it was the accusation of institutional racism, described as a “festering abscess within the NHS,”2 that made the headlines. Mr Jaspers is not alone in expressing such concerns. Several reports and inquiries have also alleged that psychiatry is institutionally racist.^3–6 What then, is the evidence that the census findings can be attributed to racism within psychiatry?