Thanks Neil and others,
I agree this sort of research (Singh et al) was produced in the past too. One serious error made by Singh et al. (which I suspect they know about) is well known in transcultural psychiatry and called 'category fallacy' (Kleinman, 1977)- taking a category constructed in one particular social-cultural context and using it in a very different context. Such research should really not get past peer reviews but they do (as many dubious psychiatric papers do when they fit into popular ideas). Category fallacy is often a mistake made by people taking a narrow medical approach to what mental health and mental illness mean. 'Schizophrenia' as an objective 'illness' category - an objective 'thing' - has NO scientific validity as 'illness' altho' as a judgment made by us about someone's problems of living it may or may not be useful (Kendell and Jablesnky, 2003) . I do not think this particular diagnosis is any longer useful (except to justify oppression and control) especially in a multi-ethnic society where racism - both institutional and personal - exists. Again too papers like this one misunderstand (or are blind to) what institutional racism means. Institutional racism is implemented through institutional processes such as diagnoses and other judgements we make often unwittingly especially when we follow mechanical ways of coming to judgements about people. It works I think through the power of stereotypes, and assumptions (e.g. about cultures, behaviour etc.) and so on. I have not read the paper fully - just glanced at it - but I would think the results could have led to very different conclusions if wider context of diagnosis, lived experience of the subjects studied etc. were taken into consideration. The tragedy is that if that had been done it may not have been accepted for publication in the particular journal!
Bad research is a big problem because governments use 'results' for political purposes, such as justifying racism in psychiatric services or as Appleby did a few years ago (Neil Sanyal points out) that the answer to high rates of schizophrenia being diagnosed / sectioning of African- Caribbean people was 'social engineering' of their families. See http://www.guardian.co.uk/society/2010/feb/03/mental-health-bme-schizophrenia-letter
Ref:
Kleinman, A. (1977) ‘Depression, somatization and the “new cross cultural psychiatry”’, Social Science and Medicine, 11, 3-10.
Kendell, R. E. and Jablensky, A. (2003) ‘Distinguishing Between the Validity and Utility of Psychiatric Diagnoses’, American Journal of Psychiatry, 160(1), 4-12.
Hope this helps,
Suman
Suman Fernando
WEBSITE: http://www.sumanfernando.com
Honorary Professor, Faculty of Social Sciences & Humanities
London Metropolitan University
Formerly
Senior Lecturer in Mental Health, European Centre for Migration & Social Care (MASC)
University of Kent
Consultant Psychiatrist, Chase Farm Hospital, Enfield, Middlesex
-----Original Message-----
From: Health of minority ethnic communities in the UK [mailto:[log in to unmask]] On Behalf Of Neil Sanyal
Sent: 17 July 2013 16:10
To: [log in to unmask]
Subject: Ethnicity as a predictor of being detained under MHA 1983
I would be interested in what people on this forum think about the issues illustrated in the email trail below (please start at the bottom). This is regarding some recently published research that claims to purport that Ethnicity is not a factor in being detained under the MHA 1983. My response to this is included below and one other AMHP who works in London has kindly added some research that backs me up. I would be particularly interested in Dr Suman Fernando's views on this as I know he is a member of this forum. I apologise if some of the links in the email trail below cannot be accessed.
Neil Sanyal
Senior Social Work Practitioner
Romsey Community Mental Health Team
Hampshire
From: [log in to unmask] [[log in to unmask]] on behalf of Dave Sheppard [[log in to unmask]]
Sent: 16 July 2013 15:11
To: [log in to unmask]
Subject: RE: [MHAandMCA] Ethnicity as a predictor of detention under the Mental Health Act
“In most minority groups, people who went to hospital were shown to be significantly more likely to be treated under the mental health act.”
In SCOTLAND
Ethnic 'inequalities' in Scottish mental health care, BBC News, 16th July 2013
http://www.bbc.co.uk/news/uk-scotland-23318736
From: [log in to unmask] [mailto:[log in to unmask]] On Behalf Of Sanyal, Neil
Sent: 12 July 2013 17:45
To: [log in to unmask]
Subject: RE: [MHAandMCA] Ethnicity as a predictor of detention under the Mental Health Act
Swaran Singh’s research was used back in 2008 by the previous government to let itself off the hook for not having achieved much from the Delivering Race Equality Strategy over the previous four years. The message was that psychiatrists did not misdiagnose BME patients with schizophrenia and that ethnicity was not an important factor in the way psychiatrists dealt with them. Anyone who reads Suman Fernanado’s (and others’) books like “Race Culture and Mental Health” will be able to work out that Swaran Singh is extremely wide of the mark. But it suited the government to draw a veil over everything. In that same year Louis Appleby was trying to convince us all that African Caribbean people’s problems with schizophrenia and other mental illness has been caused mainly by having absent fathers. So RD Laing was right after all then eh? And now this week we have this wonderful piece of research, yet again from Swaran Singh and others, claiming to show that ethnicity still has nothing to do with being sectioned. If I had the time to conduct a critical analysis of this piece of research I think I might find some flaws. Please tell that to the many thousands of people from BME backgrounds who are still being disproportionately detained under the MHA 1983 and whose numbers continue to be high. This problem is so endemic it is a scandal and speaking as someone who worked very hard to make elements of the DRE strategy work in my region it is more than disappointing that not much has changed!!
Neil
Neil Sanyal
Senior Practitioner/AMHP
Romsey Community Treatment Team
5 Horsefair Mews
Romsey
Hampshire
SO51 8JG
Tel: 01794 830323
Fax: 01794 830321
From: [log in to unmask] [mailto:[log in to unmask]] On Behalf Of Dave Sheppard
Sent: 02 July 2013 23:43
To: [log in to unmask]
Subject: RE: [MHAandMCA] Ethnicity as a predictor of detention under the Mental Health Act
http://www.communitycare.co.uk/articles/02/07/2013/119299/ethnicity-has-no-impact-on-odds-of-being-detained-under-mental-health-act-study.htm
“The research only focused on information collected at Mental Health Act assessments so could not rule out "any ethnic bias” that existed in decisions over who is assessed, or in the care a person received following detention.”
From: [log in to unmask]<mailto:[log in to unmask]> [mailto:[log in to unmask]] On Behalf Of Steve Chamberlain
Sent: 02 July 2013 23:37
To: [log in to unmask]<mailto:[log in to unmask]>
Subject: Re: [MHAandMCA] Ethnicity as a predictor of detention under the Mental Health Act
"There is no evidence for that amongst those assessed under the MHA, ethnicity has an independent effect on the odds of being detained."
But does that take into account the number and proportion of people from certain ethnic groups being assessed?
If you have a disproportionate number of people from a particular ethnic group being assessed under the Act, even if the same proportion are detained as those in the other groups, then questions need to be asked about why so many are being assessed?
Steve
[log in to unmask]<mailto:[log in to unmask]>
On 2 Jul 2013, at 21:45, Dave Sheppard <[log in to unmask]<mailto:[log in to unmask]>> wrote:
Ethnicity as a predictor of detention under the Mental Health Act, S. P. Singh, T. Burns, P. Tyrer, Z. Islam, H. Parsons and M. J. Crawford, Psychological Medicine / FirstView Articles Copyright © Cambridge University Press 2013 Published online: 24 June 2013
Abstract
Background. There has been major concern about the ‘over-representation’ of Black and ethnic minority groups amongst people detained under the Mental Health Act (MHA). We explored the effect of patient ethnicity on detention following an MHA assessment, once confounding variables were controlled for.
Method. Prospective data were collected for all MHA assessments over 4-month periods in the years 2008, 2009, 2010 and 2011 each in three regions in England: Birmingham, West London and Oxfordshire. Logistic regression modelling was conducted to predict the outcome of MHA assessments – either resulting in ‘detention’ or ‘no detention’.
Results. Of the 4423 MHA assessments, 2841 (66%) resulted in a detention. A diagnosis of psychosis, the presence of risk, female gender, level of social support and London as the site of assessment predicted detention under the MHA. Ethnicity was not an independent predictor of detention.
Conclusions. There is no evidence for that amongst those assessed under the MHA, ethnicity has an independent effect on the odds of being detained.
http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=8943662&fulltextType=RA&fileId=S003329171300086X
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