Where next for understanding race/ethnic inequalities in severe mental illness? Structural, interpersonal and institutional racism.

James Y Nazroo,Kamaldeep S Bhui,James Rhodes

doi:10.1111/1467-9566.13001

James Y Nazroo, Kamaldeep S Bhui + Show 1 more

Open Access

https://doi.org/10.1111/1467-9566.13001

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Abstract

In this article we use the example of race/ethnic inequalities in severe mental illness to demonstrate the utility of a novel integrative approach to theorising the role of racism in generating inequality. Ethnic minority people in the UK are at much greater risk than White British people of being diagnosed with a severe – psychosis related – mental illness, and this is particularly the case for those with Black Caribbean or Black African origins. There is entrenched dispute about how we might understand the drivers of this inequality. To address this dispute we build on, and to a certain extent refine, established approaches to theorising structural and institutional racism, and integrate this within a theoretical framework that also incorporates racist/discriminatory interactions (interpersonal racism). We argue that this provides a conceptually robust and thorough analysis of the role of inter‐related dimensions of racism in shaping risks of severe mental illness, access to care, and policy and practice responses. This analysis carries implications for a broader, but integrated, understanding of the fundamental drives of race/ethnic inequalities in health and for an anti‐racism public health agenda.

Highlights

Ethnic minority people are more likely to be diagnosed as having a severe – psychosis related – mental illness than the white majority in the UK and this is the case for those with Black Caribbean or Black African origins
Singh and Burns (2006) go somewhat further, claiming that: ‘Construing racism as the main explanation for the excess of detentions among ethnic minorities adds little to the debate and prevents the search for the real causes of these difference’
They argue that coercive treatment should not be seen as punitive, rather ‘The Mental Health Act is an enabling act: it allows services to ensure that treatment is available for those most in need of it’ (Singh and Burns 2006)

Summary

Introduction

Ethnic minority people are more likely to be diagnosed as having a severe – psychosis related – mental illness than the white majority in the UK and this is the case for those with Black Caribbean or Black African origins. We examine the evidence for the relationship between interpersonal and structural racism and race/ethnic inequalities in the risk of severe mental illness.

Results

Conclusion