There is ample evidence in the psychiatric literature to show that black people are over-represented as patients in psychiatric hospitals. Over the past two decades there has been a steady increase in the reported levels of admissions of black people to psychiatric hospitals (Cochrane, 1971; Bebbington et al., 1981; Harrison et al, 1988). Epidemiological studies show that most of these hospital admissions are accompanied by a diagnosis of a major psychotic illness, particularly schizophrenia. Earlier researchers suggested that nativity was the pre-eminent factor in determining risk of hospital admission partly because of hypotheses that mental illness was a consequence of migration (Bagley, 1976). More recent studies, however, claim that ethnicity (regardless of place of birth) is the crucial variable (Burke, 1984).
Some of the more recent findings have aroused considerable debate in both academic and professional circles and in the black community. There has been little agreement or consistency amongst academics as to a singular or multiple cause for the over-representation, and speculation has ranged from genetic susceptibility, adverse reactions to racism and cultural differences between psychiatrist and patient. However, the professional consensus is that there is an ethnic ‘vulnerability’ to mental illness somewhat separate from the quality of professional practice (diagnosis and treatment) or institutional processes (compulsory admission) (Littlewood, 1981; Littlewood & Lipsedge, 1981). The challenge, then, is to arrive at an explanation that would interrogate these speculations. It is most notable that the idea that hospital admissions may not be a true reflection of levels of mental illness in the black community (or that referral of black people to psychiatric hospitals is subject to different criteria) has not been given rigorous scrutiny.
We will try to show in this paper that black people are more likely than their white counterparts to come to the attention of psychiatrists, regardless of their presenting symptoms. In addition, we also argue that the disproportionate number of black people in psychiatric facilities is also dependent upon different clinical criteria, e.g. dangerousness, severity of illness, and prognosis. Finally, we also suggest that the experience prior to the clinical encounter may be central in determining whether a black person sees a psychiatrist at all. Therefore, contacts with social services, physicians, health care and law enforcement agencies may be important in averting or precipitating psychological crises.