The Aesop ( Aetiology and Ethnicity in Schizophrenia and other Psychoses) study is controversial. Reported last year, the conclusion of this large study completed by the Institute of Psychiatry read that social rather than genetic causes for severe mental illnesses could be related to circumstances that may be more prevalent in the lifes of (particularly) African Caribbean community for example issues of family breakdowns, unemployment and I’d suggest poverty, all of which are more prevalent in minority ethnic communities.
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This study creates all sorts of problems. Even in my own office, I’ve seen the ‘I told you so’ attitude expressed by one practitioner who maintains the differences. I personally, while unable to debunk research carried out without exploring the methodology, have an understanding that poverty has a significant effect on rates of serious mental illness and our ability to cope – regardless of ethnicity.
The Guardian, back on 9 December 2009, quoted Louis Appleby as saying that ‘New Horizons’ took into account this research study and has been written with this in mind, focussing less of different services and streams for people from minority ethnic groups but rather looking at personalising services to individuals across the board and – with the rest of New Horizons – shifting more attention to preventative matters.
“There are genuinely very high rates [of schizophrenia], and the causes are social causes affecting people before they come into contact with mental health services. That’s quite a step, and you won’t find previous documents that have been so clear about these controversial issues. Instead of trying to build separate services for individual groups, it is about a service that is more personal to individuals.”
So where does that leave us?
Today, the Guardian prints an open letter from a number of mental health campaigners and academics challenging the Aesop study, its conclusions and the way it has been reported.
Quite rightly, the letter states that this conclusions tell us nothing new. We have known for a long time that there are higher rates of incidence of schizophrenia among minor ethnic populations however, there are reasons for this that might be related to the way and the stages at which diagnosis is made.
The letter states that
The way in which this ‘finding’ about diagnostic patterns has been reported stigmatises and pathologises African Caribbean communities as being inherently flawed in some way that generates ‘mental illness’ – a throwback to the discredited Moynihan report in the US, which stated in 1965 that the African American family was a ‘tangle of pathology’. There is plenty of evidence on the nature and extent of institutional discrimination and racism in the British mental health system. Failing to recognise this and, even more seriously, singling out groups and blaming their lifestyle or culture is the thin end of a socially divisive wedge. If ‘social engineering’ is being called for, it may be more effective to apply it to mental health services and service providers, not to communities.
Which (unsurprisingly if you look at the signatories!) makes the point far better than I could.
I feel the loss of community and culturally based resources wouldn’t necessarily help Mental Health services in the long run and if we try to ignore the impact that racism on a personal level as well as on an institutional level has had on creating these societal constructs in the first place – we can absolve ourselves of responsibilities for the cause and blame minority cultures themselves for the situations that oppressions have set them within.
Unsurprisingly the BNP (British National Party) – jumped on the Aesop Study – providing the ‘evidence’ for their beliefs of racial and ethnic superiority. That isn’t to say the research itself is necessarily flawed but research studies can be made to report just about anything we want them to. There is a research study around that can point to just about any issue and provide evidence for it or against it.
The problem with producing evidence such as this is that it can shift responsibility. The responsibility though of creating environments in which the difference thrives, lies with the majority ethnic group as well.
Difference is crucial to accommodate within services and if it is done in a way which acknowledges the significance of decades, nay, centuries of oppressive practices and institutional racism within the ‘system’, it will be far more effective – rather than trying to separate an individual from their cultural heritage or cut services that might be more tailored to different cultural and ethnic groups.
It is most definitely a challenge for the New Horizons ‘era’ that we are moving into but hopefully one that practitioners on the ground, at least, will be able to address to some extent.