Racism in psychiatry necessitates reappraisal of general procedures and Eurocentric theories

Editor—We agree with the comment in Editor’s Choice (in issue of 6 March) that the effects of the Stephen Lawrence case and the inquiry into it will be far reaching and that no public institution will be exempt. We doubt, though, that the soul searching that has followed the publication of the inquiry report will result in corrective action against institutional racism in the NHS. McKenzie’s editorial is an indication of this¹: although he marshals the evidence to argue that institutional racism is very much part of the structure, procedures, and culture in the NHS, he offers few political and professional strategies to challenge discriminatory practices in the health services.

As McKenzie says, allegations of racial discrimination are not new in the NHS. But he has ignored the most glaring example of racial inequality in service provision in the NHS—that in psychiatry. It is often ignored in debates such as this because any attempt to deal with racism would necessitate a reappraisal of not only the general procedures of psychiatry but also the Eurocentric bias of our theories and a commitment to change the professional culture that is based on pathologising differences.

Psychiatry comes closest to the police among medical specialties in pursuing practices and procedures that explicitly discriminate against minority ethnic groups in the United Kingdom. The disproportionate numbers of black people in psychiatric detention,² the overdiagnosis of schizophrenia in black people, the exclusion of black people from the “softer end” of psychiatric practice because they are deemed psychologically unsuitable,³ the alienation of black patients from mainstream psychiatric services,⁴ the general lack of trust and extreme scepticism about psychiatric practice that is evident in minority communities, and the professional preoccupation with theories of ethnic vulnerability or inferiority, which continue to echo the sentiments of 19th century race science,⁵ all confirm the similarities between policing the black communities and controlling their minds.

Unlike in other branches of medicine, the racial bias in treatment and outcome that is evident in psychiatry cannot be understood fully by an examination of procedures, practice, or policy governing service delivery. The theories and assumptions of psychiatry are problematic when they are applied to people who are socially excluded or culturally marginalised. Black communities in the United Kingdom will continue to bear the brunt of such a professional bias as long as the coordinates of psychiatric practice remain culturally fixed.

Obviously, sufficient challenge to institutional racism must include more than exhortations to examine our practice and change our attitudes. In psychiatry, any attempt to address this issue must incorporate a reappraisal of the purpose and function of professional practices and an alignment of critical professional voices with the larger struggle against racism. The home secretary’s commitment to extend the Race Relations Act to the NHS is welcome; a useful start would be to set up a national inquiry into race and mental health.