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Why are we being labelled?

INJUSTICE: There is an ethnic bias in diagnosis of patients

THE MEDIA coverage that has been given to a recent study asserting that black people are at greater risk of developing psychotic disorders than their white counterparts comes at a time when data shows that the use of the Mental Health Act against people from the UK’s African Caribbean communities is at an all-time high.

One would be excused for seeing the widespread dissemination of this research as a bid to justify the way that the Mental Health Act has been used against more than three generations of black Britons.


The coverage that this study has gained is in stark contrast to the absence of exposure given to the experiences faced by black people who are locked up in secure psychiatric facilities up and down the country.

A recent United Nations tweet acknowledged that the way the Mental Health Act is used against black people of African descent living in the UK is as serious a human rights concern as the mass incarceration of African Americans, who are warehoused in the prison industrial complex in the United States.

This UN tweet follows the Council of Europe’s race committee’s report, published in 2016, on their country review of the UK’s human rights record on race relations. Recommendations from this international human rights body expressly called on the British Government to address the institutional racism within mental health services faced by black people of African descent who are detained in this system.

Matilda MacAttram

The UN’s concerns over the treatment of black Britons who are forced to use mental health services is not just over the coercive and punitive ‘care’ that they are disproportionately subject to, but also the way in which the Mental Health Act has been used as a tool of oppression against this group.

Among these concerns are: the disproportionate use of long-term seclusion, for weeks, months and in many cases even longer; as well as the routine attendance of police on locked psychiatric wards, often in riot gear, to ‘assist’ clinical staff in restraining patients, so that they can be forcibly medicated.

Central to this injustice is diagnosis that black people are labelled with once they are detained under the Mental Health Act. It is the labelling of black people by psychiatrists as suffering from a psychotic condition at a 4.6 times higher rate than their white counterparts, which forms the basis of assertion made by psychiatrist James Kirkbride from University College London and his colleagues from the University of Cambridge: “There are higher risks of psychotic disorders among ethnic minorities.”

This dangerous assumption made in the study, entitled Social Epidemiology of Psychoses in East Anglia, that the higher labelling of black people of African descent with a diagnosis of psychosis is an indicator of higher morbidity rates, is fundamentally flawed.

The high rates of labelling black people of African descent with a diagnosis of psychosis is no real finding, but rather an indication of bias in diagnostic practice – this is what urgently demands scrutiny and reform.


It has been acknowledged for decades now that in psychiatry, there is an ethnic bias in both diagnosis and attribution of risk. If there is to be any real improvement in the way the Mental Health Act has been used against black Britain and in the experience and outcomes of those already detained in this system, then scrutiny must be on addressing the failures within the statutory mental health serves and uprooting the institutional racism within this system. Central to this needs to be prioritising the wholesale reform of a current diagnostic model that pathologies cultural norms and medicalises the social issues of black Britons of African descent.

Matilda MacAttram is director at Black Mental Health UK and a Fellow of the United Nations Working Group of Experts on People of African Descent.

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