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Dangers of research based on racist diagnostic assumptions

Friday, 16 June 2017



Importance of not un-critically accepting findings

An opinion piece published in Britain's leading black newspaper, The Voice entitled: 'Why are we being labelled', offers the only black Africancentric critical analysis on a new widely published study's questionable claim, that black people from the UK's African Caribbean communities have higher rates of psychosis than other ethnic groups.

BMH UK are of the view that we cannot underestimate the dangers that lie in the Diaspora being misinformed about one of the most important issues that it is facing to date.

Matilda MacAttram's unedited opinion piece, published here in full, is essential reading for the conscious melanated brothas and sistas from Britain's African Caribbean communities, as well as those who have their best interests at heart, on the importance of not un-critically accepting findings from studies that have serious implications for our communities

Dangers of research based on racist diagnostic assumptions

Stop pathologising black Briton and focus on ending the oppressive use of the Mental Health Act against this community

United_Nations__Tweet__racist_use_of_MH_Act_2017-06-06-17The media coverage that has been given to a 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 disproportionate 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 wide spread dissemination of this research as a bid to justify the racist 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 routine human rights abuses faced by black people who are locked up on secure psychiatric facilities up and down the country.

A recent United Nations tweet acknowledged that the coercive way that 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 African American's, 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.

Mental Health Act used at a tool of state oppression against black Britons of African descent

News-_state_violence_against_black_Britain_-_2The human rights 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 state 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.

The police use of Taser on locked wards and the absence of any statutory requirements for independent and public scrutiny of the use of these firearms against patients, as well as the debilitating high doses of anti-psychotic medication that this group are forced to take based on a the diagnosis that they labelled with are among the injustices that the international human rights community have made it clear need to be addressed.

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 assertions made by psychiatrist James Kirkbride from University College London and his colleagues from the University of Cambridge, 'that there are higher risks of psychotic disorders among ethnic minorities'.

Dangerous assumptions

BMH_UK_The_Voice_comment_16-06-17This dangerous assumption made in the study entitled: 'Social Epidemiology of Psychoses in East Anglia (SEPEA)', 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, particularly in light of the damaging impact that the misdiagnosing of black Britons is having on the UK's African Caribbean communities as a whole.

It has been acknowledged, for decades now, that in psychiatry there is an ethnic bias in both diagnosis and attribution of risk. The body of work by Transcultural psychiatrists has shown that the diagnostic tool used in psychiatry is discriminatory and racist, this is because of the subjective nature of identifying symptoms on which diagnoses are based.

As such the findings of SEPA does not have proper validity as no scrutiny or even reference is made in this study to the fact that the diagnostic tool used in psychiatry is discriminatory, or that the 4.6 higher rate of psychosis among black people cited in this study is of diagnosis not incidence.

There is a pressing need for psychiatry to recognised the limits of the current approaches and acknowledge that diagnoses are not identified objectively; they have no biological markers and are not referenced by any external criteria but rather they are based to a large extent on the perceptions that practitioners have about people.

Indeed wholesale reform of the diagnostic tools used in psychiatry is central to addressing the institutional racism in mental health services and reducing the levels of coercion meted out to black people in these settings, which Theresa May committed to addressing when she announce plans to 'introduce the first new Mental Health Bill for 30 years'.

If there is to be any real improvement in the way the Mental Health Act has been used against black Britain and an 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 skinned melanted people of of African descent living in the UK.

By Matilda MacAttram, director Black Mental Health UK and Fellow, United Nations Working Group of Experts on People of African Descent.

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