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J R Soc Med. 2005 February; 98(2): 83.
PMCID: PMC1079395

Racism in the National Health Service: lessons from the past

Dr McNaught is right to point out examples of racism in the NHS (December 2004 JRSM1). But what to do about it? Maybe we can learn some lessons from the past.

Today there is an over-representation of black people in the mental health system but in the 1960s Irish people were over-represented.2 Psychiatrists thought that the prevalence of schizophrenia was high in people from the west of Ireland and invented a new syndrome ‘western seaboard psychosis’.3 Anthropologists descended on the unsuspecting immigrants to ask them if their Catholic faith caused their minds to unbalance and psychiatrists followed to dole out antipsychotics. But then some proper research was done and it showed no excess of schizophrenia in Irish immigrants.4 The methods of case collection in the early studies were poor and cross-cultural comparisons were not properly thought through.3

Today Irish people are no more likely to be diagnosed with schizophrenia than anyone else. How did this happen? I would love to say that it was because of the new research or because of government initiatives. The research helped a bit but the main cures for anti-Irish discrimination were that the new immigrants were richer, better educated, better informed and more questioning. They would not be fobbed off with a misdiagnosis. An increasing understanding and appreciation of Irish culture also helped reduce anti-Irish discrimination generally. The most effective cure of all was time. A cynic would add that, nowadays, people have a new batch of immigrants (such as asylum seekers) to discriminate against.

So we need fewer new policy drives and more changes of heart. These will only come from changes in society. Blaming individuals or even the NHS will not help.

References

1. McNaught A. Health policy and race equality: an illusion of progress? JR Soc Med 2004;97: 579–81 [PMC free article] [PubMed]
2. Dean G, Downing H, Shelley E. First admissions to psychiatric hospitals in south-east England in 1976 among immigrants from Ireland. BMJ (Clin Res) 1981;282: 1831–3 [PMC free article] [PubMed]
3. Cabot MR. The incidence and prevalence of schizophrenia in the Republic of Ireland. Soc Psychiatry Psychiatr Epidemiol 1990;25: 210–15 [PubMed]
4. Commander MJ, Odell S, Sashidharan SP, Surtees PG. Psychiatric morbidity in people born in Ireland. Soc Psychiatry Psychiatr Epidemiol 1999;34: 565–9 [PubMed]

Articles from Journal of the Royal Society of Medicine are provided here courtesy of Royal Society of Medicine Press