Understanding Mixed Racism and Mental Health in Acute Settings

2. Mixed Race, Mixed Racism and Mental HealthMixed race people in the acute mental health system Dr David Ndegwa Clinical Director : Lambeth Forensic Services & SLAM MSU Services / Consultant Forensic Psychiatrist

3. Problems with Literature Very few studies report numbers of mixed ethnicity people Where they are reported when describing characteristics of population they are then combined with black subjects in analysis No separate analysis in terms of outcomes for either black or mixed ethnicity subjects in treatment/intervention studies No clarity about the various meanings of self ascribed racial groups (e.g. are they explained by political stance or appearance?) Studies of clinical populations are not similar to studies of general populations samples Similar problems to those reported for ethnic differences studies of incidence and prevalence of psychiatric disorders : - numerator and denominator selection - validity of assessment tools when used across cultures - alleged epidemics (elevated risks) could be true schizophrenia undetected/misdiagnosed affective psychosis or probably other atypical psychosis, e.g. drug induced psychosis

4. Environmental Factors (Racism) Very little research on its description, measurement biological or social and psychological effects Needs to explore connection between racism and behaviour or psychopathology Theoretical models or understandings of how racism operates needed Need for epidemiological investigators to explore the relationship between perceived racism and health outcomes Need to explore psychological and physiological concomitants of perceived racism in laboratory and ambulatory monitoring studies Need to explore/understand the effects of context on modifying psychological and physiological effects

5. Combined and Sex-specific age-adjusted incidence rate ratios (IRR’s) with corresponding 95% confidence intervals in ethnic minority groups From Fearon P. et al 2006

6. Age specific incidence ratios (IRR’s) with corresponding 95% confidence intervals in ethnic minority groups for all psychosis From Fearon P. et al 2006

7. Criminal Justice Statistics 2007/2008

8. Note: Figures may not add to 100% due to rounding Stops and searches recorded by the police under Section 1 of the Police and Criminal Evidence Act 1984 and other legislation Notifiable offences The data in these rows is based on ethnic appearance, and as such does not include the category Mixed ethnicity (the data in the rest of the table is based on self-identified ethnicity) Information on ethnicity is missing in 19% if cases; therefore, percentages are based on known ethnicity Commencements Sentenced

9. Youth Offending From Fearon P. et al 2006

10. Count me in Census - 2008 31,020 inpatients 10% from black or white/black mixed group 77% white British 23% were minority ethnic groups Rates of admission higher than average fall in admission rate for “black other” (what is this?) but not black, white/black mixed group Lower rates of referrals to GP’s High rates of referred from CJS Higher rates of compulsory admission (detention under the MHA) particularly Section 37/41 High seclusion rates Higher than average rates of restraint among “other white” and white/black Caribbean group Higher proportion experiencing physical assault High proportion experiencing medium lengths of stay More likely than average to be on a MSU or high secure ward