Abstract
BackgroundMuch research attention has been given to the high rates of psychosis diagnosed in the Black community. However, little has been heard about possible reasons for this from Black African and Caribbean mental health service users themselves.AimsTo determine how Black African and Caribbean service users perceive and explain these apparent differences.MethodsWe conducted four focus groups between 2014 and 2015 with 35 participants from the Black African and Black Caribbean community in Lambeth and Southwark, South East London, diagnosed with a psychotic illness. Recruitment was through a local voluntary sector organization and other community contacts.ResultsEach group described an elevated risk of psychosis in their community and explanations followed the following themes, with increased rates due to: (a) an accumulation of stressors due to disadvantaged ethnic minority status, (b) further disadvantage due to inequitable experiences of mental health services, (c) an absence of community support and (d) a double stigma: as a result of external discrimination, due to ethnicity, and internal stigma about mental illness from within the Black community itself.ConclusionsBlack mental health service users attributed an elevated risk of psychosis in their community to an accumulation of stressors directly related to ethnic minority status.
Highlights
The relationship between ethnicity and psychosis has been a continuing theme in psychiatric epidemiology, for over 80 years since Ødegaard first reported elevated rates of schizophrenia among Norwegian migrants to the US.[1]
There is a large body of research evidence showing that members of some migrant and ethnic minority groups, and those from Black African and Black Caribbean communities, are more likely to be diagnosed with a psychotic illness; with at least double the risk according to two recent comprehensive reviews.[2,3]
While supporting evidence has been given for each, studies often lack a clear overall theoretical framework to explain why migrant and ethnic minority groups are at an increased risk.[4,5,6,7]
Summary
The relationship between ethnicity and psychosis has been a continuing theme in psychiatric epidemiology, for over 80 years since Ødegaard first reported elevated rates of schizophrenia among Norwegian migrants to the US.[1]. In recent years the number of studies on this theme has increased exponentially, partly as a result of the increasing availability of large datasets of psychiatric records in which ethnicity has been recorded Research in this area is at a critical point where a number of theories have been proposed, along with some supporting evidence, but a convincing explanation has yet to be established. We propose that one useful starting point would be the accounts of ethnic minority service users themselves, investigating those explanatory factors they think are most relevant This would have important secondary benefits; this is a politically sensitive topic and the way findings have been disseminated has in the past met with a hostile reception, in part, because authors may have failed to recognise how their work might be interpreted by the Black community.[11,12]. Little has been heard about possible reasons for this from Black African and Caribbean mental health service users themselves
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