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BMJ. 2007 April 21; 334(7598): 814.
PMCID: PMC1853213
Institutional Racism

What about stigma, evidence base, and consistency?

Trevor Turner, consultant psychiatrist1 and Sue Collinson, TB support worker2

If institutional racism is defined as a collective failure that disadvantages people in ethnic minority groups, why is actively treating people for severe illness seen as evidence of such?1 Were this treatment for hypertension, diabetes, or sickle cell anaemia, it would be considered a well targeted intervention.

Admission rates and length of stay in mental health do not reflect illness prevalence but the severity and social disruption generated by that illness. Delays in seeking care (and increased Mental Health Act usage) reflect social isolation (such as the AESOP study) and stigmatised attitudes (such as denial or fear of mental illness).2 And were institutional racism the dominant engine of admission, why is it so differentiated in the races it selects?

Furthermore, did the survey collect ethnicity data on the mental health staff on the wards and in the community teams, where there is a high rate of black and minority ethnic employment? Would that be indicative of institutional racism, or would it be indicative of culturally competent care?

McKenzie and Crowcroft thoughtfully outlined the problem of describing race, ethnicity, and culture in medical research, eschewing politically correct terms.3 However, McKenzie and Bhui now resort to “institutional racism,” “community development workers,”' “race impact assessment,” and “culturally competent care,” as if these were evidence based concepts.1

If there is anything to be understood from this editorial, it is that severe mental illness, requiring hospital care, remains deeply stigmatised; that intervention is presented as coercion; and that those working in mental health, whatever their ethnic background, should argue vociferously for proper funding for wards, community teams, and the promotion of mental health for all.


Competing interests: None declared.


1. McKenzie KJ, Bhui K. Institutional racism in mental health care. BMJ 2007;334:649-50. (31 March.) [PMC free article] [PubMed]
2. 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 Psych 2005;186:281-9.
3. McKenzie KJ, Crowcroft NS. Describing race, ethnicity and culture in medical research. BMJ 1996;312:1054. [PMC free article] [PubMed]

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