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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 April 14; 334(7597): 761.
PMCID: PMC1852023
Institutional Racism

Editorial is unduly provocative

Cornelius Ani, specialist registrar in child and adolescent psychiatry1 and Obeagaeli Ani, locum consultant child and adolescent psychiatrist2

As black psychiatrists working in the NHS, we find McKenzie and Bhui's editorial unhelpful and unduly provocative.1 For example, although it is possible that racism has a role in increasing detention rates among black patients, the editorial ignores other well established and, in our view, more important factors.

In our combined clinical experience, which includes acute adult, forensic, and child and adolescent psychiatry, and many Mental Health Act assessments, one of the main reasons for increased detention rates for black patients is an inadequate community support network. Supportive intermediaries (such as family members) can increase treatment adherence, detect early relapse signs, and enable early non-coercive intervention.2 In our experience, compared to other ethnic minorities, the relative inadequacies of support networks predispose black patients to adverse care pathways resulting in crisis and police intervention and disproportionate use of the Mental Health Act. This experience is supported by the AESOP study, which found that black patients were more likely to live alone.3

We are neither blaming the victim nor shooting the messenger, but blanket invoking of racism is too simplistic and fails to acknowledge other difficulties in black communities, some of which we can tackle better by reflectively looking inward rather than outward.


Competing interests: None declared.


1. McKenzie K, Bhui K. Institutional racism in mental health care. BMJ 2007;334:649-50. (31 March.) [PMC free article] [PubMed]
2. Singh SP, Burns T. Race and mental health: there is more to race than racism. BMJ 2006;333:648-51. [PMC free article] [PubMed]
3. Morgan C, Mallett R, Hutchinson G, Bagalkote H, Morgan K, Fearon P, et al. Pathways to care and ethnicity. 1: Sample characteristics and compulsory admission. Report from the AESOP study. Br J Psychiatry 2005;186:281-9. [PubMed]

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