Abstract
On Jan 9, 2017, Theresa May, the British Prime Minister, gave a speech about “the burning injustice of mental illness”, mentioning “injustices in the way black people with mental ill health in particular are treated”, and promising that politicians would “take action to put things right.” In response to three decades of UK research on ethnic differences in mental health, such emotionally charged rhetoric has been commonplace, but has rarely produced meaningful change. Mental health care in ethnic minorities is complex, and needs dispassionate and objective scrutiny of evidence and its limitations, with careful disentanglement of the interactions between ethnicity, culture, community histories, legacies of racism, and the labyrinthine service structures that people with mental illness and their families must navigate to get appropriate help. In The Lancet Psychiatry, Phoebe Barnett and colleagues present findings from a systematic review and meta-analysis of ethnicity and legal detention of people with mental illness, an impressive attempt at providing just such scrutiny. Although the findings are not strikingly different from what is known, this comprehensive paper is a timely reminder of how far we are from fully understanding the problem—let alone solving it—and why the stated political intention to put things right might be easy to promise but hard to deliver.
Highlights
Almost half of the papers included in this review offered no explanations for ethnic variations, or offered explanations that lacked evidential support.[2]
In the ENRICH programme,[6] we found that for similar experiences of inadequate mental health care, white patients and families attributed poor care to bad service, whereas black patients and their carers considered services racist
How should we solve the complex problem of ethnic differences in mental health care? We should certainly aim to provide easier access to better services, which offer choice, promote shared decision making, pay attention to cultural differences, and focus on therapeutic engagement
Summary
Mental health care in ethnic minorities is complex, and needs dispassionate and objective scrutiny of evidence and its limitations, with careful disentanglement of the interactions between ethnicity, culture, community histories, legacies of racism, and the labyrinthine service structures that people with mental illness and their families must navigate to get appropriate help. In The Lancet Psychiatry, Phoebe Barnett and colleagues[2] present findings from a systematic review and metaanalysis of ethnicity and legal detention of people with mental illness, an impressive attempt at providing just such scrutiny. Barnett and colleagues[2] have updated previous similar reviews,[3,4] and expanded their data beyond the UK, including both ethnic minority and migrant populations.
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