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Statistics 3: Race, culture and mental health

This factsheet is targeted at mental health professionals, journalists and students. However, it is also our aim to present mental health statistics in a way which makes the subject accessible to all those who are interested in mental health.

This factsheet was written by Inger Hatloy. Updated February 2010.

 Copyright note for Mind factsheets: You are welcome to print and photocopy this page of Mind's website. Organisations are free to distribute copies to service users and colleagues, but must ensure they always use the latest version, as available on the website, at the time of distributionHow to define ethnicity
Ethnicity, rate of mental illness and admission to psychiatric hospitals
The reliability of statistics on ethnicity and mental health
Ethnic origin and psychosis
Ethnic origin and common mental disorders
Depressive episodes
Anxiety disorders
Mixed anxiety and depressive disorders
Self harm
Endnotes         

Note on terminology: where terms such as 'Black' and 'White' have been capitalised in this publication, it has been done so to express the categorisation of ethnicity as described in the cited research.

How to define ethnicity

Ethnic monitoring only became mandatory in publicly funded mental health services in 1995. [1] Therefore, little reliable data has been available on how minority ethic groups are treated by mental health services in England and Wales. The Healthcare Commission concludes in its 2005 Count me in report [2] that poor ethnic monitoring ‘shows both lack of understanding of the value of having such data for planning services, and removes from services information that is needed to ensure that individual patients receive culturally sensitive and relevant care.’

However, people who do record and monitor ethnicity frequently find it a complex task. One reason for this is that individuals’ and groups’ perceptions of what group they belong to will vary according to views and perceptions held by the individual and by society. [3] For example, some people of African origin who are born in the UK might perceive themselves as Black African; others might prefer to classify themselves as Black British. People from the Indian subcontinent might want to define themselves as, for example, Gujaratis or Punjabis; but in the 2001 Census they were offered the options of ‘Indian’, ‘Pakistani’, ‘Bangladeshi’ or ‘other Asian’.

How ethnicity is defined will change over time because of social and political attitudes; for example, in 1976, Office of Population Censuses and Surveys referred to the minority ethnic population as ‘the population of New Commonwealth and Pakistan ethnic origin.’ [4]

As perceptions and attitudes change it is important to note that an ethnic group classification can only be valid and meaningful for the time and context in which it is used. [5]

An individual’s perception of what ethnic group he or she belongs to may be different to the perception of what group that person is seen as belonging to by the person who is recording and monitoring ethnicity. In A practical guide to ethnic monitoring in the NHS and social care the Department of Health suggest that a person should assign their own ethnic group. People should not be assigned their ethnicity by staff. [6]

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Ethnicity, rates of mental illness and admission to psychiatric hospitals

Both past and recent research suggests that some groups – notably Black Caribbean, Black African and other Black groups – are over-represented in psychiatric hospitals. [7]

The high number of African Caribbean people being diagnosed with schizophrenia is well documented, with some studies reporting between two to eight times higher rates of diagnosis compared to the White population. [8]

The ‘Count me in’ census was introduced in England in 2005 and designed to support the Department of Health’s five year action plan ‘Delivering Race Equality in Mental Health Care’. The census also aimed to support the Welsh Assembly Government’s ‘Raising the Standard: Race Equality Action Plan for Adult Mental Health Services in Wales’. Key goals were to reduce rates of admission, detention and seclusion among black and minority ethnic groups. Unfortunately the figures show that these goals have not been achieved. [9]

Data from the 2005 ‘Count me in’ census showed that men from Black and White/Black mixed groups had the highest rates of admission to psychiatric hospitals. They were three or more times likely than the general population to be admitted. Women from the Black and mixed White/Black groups were two or more times likely than the general population to be admitted to psychiatric hospitals. Unfortunately, figures from the later surveys, including the 2009 ‘Count me in’ census, suggest the situation is still the same. [10]

White British, Chinese and Indian men were less likely than the average population to be admitted according to figures from all the five Count me in census reports. [11]

Men from Black Caribbean, Black African, and other Black groups were more likely than other groups to have been detained under the Mental Health Act 1983. The figures follow the same pattern in all the ‘Count me in’ reports from 2005 to 2009. [12]

Studies have shown that Irish people have higher rates of mental illness than the general population. [13] The Irish are often overlooked because they are White. Yet studies have found that Irish-born people living in the UK have a higher rate of suicide than any other minority ethnic group living in the country. [14]

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The reliability of statistics on ethnicity and mental health

Statistics can appear very convincing, simply because most people interpret numbers as facts. However, the story behind the numbers may be more obscure than the figures indicate.

Some research suggests that although more Black Caribbean people are treated for psychosis, this may not indicate that they are more likely to have such an illness. Rather, it could be that the way they express their symptoms is interpreted in such a way that they are more likely than others to be prescribed treatment for these symptoms. [15]

Further, research indicates that more African Caribbean and other Black people with psychosis are being admitted to hospital for treatment because of the way they initially got in contact with the mental health services. Evidence suggests that they are more likely to have been in contact with the police or other forensic services prior to admission. They are also more likely to have been referred to treatment by a stranger rather than by a relative or a neighbour. It is important to note that this happens despite the fact that they are less likely than White people to show evidence of self harm and are no more likely to be aggressive to others before admission to a mental health hospital. [16]

Research also suggests that although there is no evidence indicating that African Caribbean people are more likely to be aggressive than their White counterparts, staff in mental health hospitals are more likely to perceive them as potentially dangerous. Evidence also suggests that psychiatrists are more likely to consider this group as potentially dangerous to others. It is therefore possible that African Caribbean people are more likely to be diagnosed with psychosis because of bias among those who treat them. [17] Research in the US shows similar results. [18]

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Ethnic origin and psychosis

 Psychotic illness affects a very small portion of the population – around one person in 200 in the UK. [19] Because of the small numbers, it has been difficult to produce statistics that accurately reflect any differences between ethnic groups. Although the figures below indicate some differences in the prevalence of psychosis, it is important to note that only the difference between Black Caribbean women and White women can be considered as statistically significant. [20] 

Estimated annual prevalence of psychosis by gender [21]

The above figures are from the Fourth National Survey of Ethnic Minorities (FNS). As expected, it shows a higher rate of psychotic illness for Black Caribbean people than for White people, with Black Caribbean people being twice as likely as White people to be diagnosed with psychosis.

However, the difference is much lower than previous studies have indicated. More importantly, previous studies have indicated that the rate of psychosis is particularly high among Black Caribbean men. The FNS study suggests that the difference was largely due to higher rates of psychosis among Black Caribbean women.

The study further showed that those from a poorer background were more likely to suffer from a psychotic illness. This was the case for Black people as well as for White people. It also emerged that those living in inner cities seemed at higher risk. [22] These findings support the theory that mental illness is related to living conditions rather than ethnicity or race.

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Ethnic origin and common mental disorders

Common mental disorders include disorders such as depression and anxiety. Many more people are likely to experience these disorders than psychosis. As the table below indicates, there are some differences between different ethnic groups.

Any common mental disorder in past week for men and women by ethnic group [23]

Common mental disorders such as depression and anxiety are not considered as serious or disabling for the individual as psychotic disorders such as schizophrenia or bipolar disorder. However, as the disorders are far more common, they affect more people, and have a much greater impact on the community. One estimate suggested that they account for one third of days lost from work due to ill health. [24] The Labour Force Survey suggests that common mental disorders such as depression and anxiety plus stress accounts for more than 40 per cent of days lost to ill health. [25]

Although many more people will experience a common mental disorder – more than 15 per cent of the population in the UK may be affected at any time – few studies have attempted to find out how different minority groups have been affected by these disorders. Most research has focused on the rarer psychotic disorders.

Depressive episodes

The above table indicates that, among men, White and Pakistani subjects reported depressive episodes most often (2.4 per cent). However, it is important to note that as the numbers reported are small, the differences between the groups cannot be considered statistically significant.

Irish men reported the highest level of common mental disorders (18.4 percent); however, they reported fewer depressive episodes (1.8 percent) than men from all other groups, except Indians.[26]

The highest levels of depressive episodes were reported by Pakistani women (6.3 per cent) and Indian women (5.7 per cent). Both these groups show a much higher rate that their male counterparts. In other ethnic groups there was no significant gender difference. Bangladeshi women showed the lowest rate (1.6 per cent).

Anxiety disorders

The highest rates of anxiety reported were from Irish men (5.9 per cent) and Indian women (7.3 per cent).

Mixed anxiety depressive disorder

The lowest rate of mixed anxiety depressive disorder among men was found in the White (7.4 per cent) and Pakistani (7.1 per cent) groups. However, the differences between the men were not statistically significant.

Pakistani women reported the highest rate (17.0 per cent) and Bangladeshi women reported the lowest rate (9.4 per cent) of mixed anxiety depressive disorder. The differences between women in the other groups were not statistically significant.

Self harm

Figures from all five ‘Count me’ in census shows that the White British group have a higher than average rate of self harm. Black and South Asian groups have a lower than average level of self harm. [27]

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Endnotes

[1] Commission for Healthcare Audit and Inspection, 2005, Count me in, Results of a national census of inpatients in mental health hospitals and facilities in England and Wales, November 05,
[2] Commission for Healthcare Audit and Inspection, 2005, Count me in, Results of a national census of inpatients in mental health hospitals and facilities in England and Wales, November 05,
[3] ONS, 2002, Population projections by ethnic group, a feasibility study.
[4] ONS, 2002, Population projections by ethnic group, a feasibility study.
[5] ONS, 2002, Population projections by ethnic group, a feasibility study.
[6] DH, 2007, A practical guide to ethnic monitoring in the NHS and social care
[7] Commission for Healthcare Audit and Inspection, 2005, Count me in, Results of a national census of inpatients in mental health hospitals and facilities in England and Wales.
[8] Harrison, G., 2002, ‘Ethnic minorities and the Mental Health Act’, The British Journal of Psychiatry (2002) 180: 198-199
[9] Care Quality Commission, 2009, Count me in, Results of the 2009 national census of inpatients on supervised community treatment in mental health and learning disability services in England and Wales
[10] Care Quality Commission, 2009, Count me in, Results of the 2009 national census of inpatients on supervised community treatment in mental health and learning disability services in England and Wales
[11] Care Quality Commission, 2009, Count me in, Results of the 2009 national census of inpatients on supervised community treatment in mental health and learning disability services in England and Wales
[12] Care Quality Commission, 2009, Count me in, Results of the 2009 national census of inpatients on supervised community treatment in mental health and learning disability services in England and Wales
[13] Fitzpatrick, M., 2005, Profiling mental health needs: what about your Irish patients?, British Journal of General Practice, October 2005.
[14] NIMH, 2003, Inside outside, improving mental health services for black and minority ethnic communities in England, DH.
[15] Nazroo, J., King M., 2002, ‘Psychosis – symptoms and estimated rates’, in Sproston, K., Nazroo, J., (ed) Ethnic Minority Psychiatric Illness Rates in the Community (Empiric), National Centre for Social Research, TSO
[16] Nazroo, J.Y, 2001, Ethnicity, Class and Health, Policy Studies Institute
[17] Nazroo, J., King M., 2002, ‘Psychosis – symptoms and estimated rates’, in Sproston, K., Nazroo, J., (ed) Ethnic Minority Psychiatric Illness Rates in the Community (Empiric), National Centre for Social Research, TSO
[18] ‘Mental Health: Culture, Race, and Ethnicity’ (supplement), 2001, Chapter 3: Mental Health Care for African Americans, from Reports of the Surgeon General, National Library of Medicine
[19] Nazroo, J., King M., 2002, ‘Psychosis – symptoms and estimated rates’, in Sproston, K., Nazroo, J., (ed) Ethnic Minority Psychiatric Illness Rates in the Community (Empiric), National Centre for Social Research, TSO
[20] Nazroo, J.Y, 2001, Ethnicity, Class and Health, Policy Studies Institute
[21] Nazroo, J., King M., 2002, ‘Psychosis – symptoms and estimated rates’, in Sproston, K., Nazroo, J., (ed) Ethnic Minority Psychiatric Illness Rates in the Community (Empiric), National Centre for Social Research, TSO
[22] Nazroo, J., King M., 2002, ‘Psychosis – symptoms and estimated rates’, in Sproston, K., Nazroo, J., (ed) Ethnic Minority Psychiatric Illness Rates in the Community (Empiric), National Centre for Social Research, TSO
[23] Weich, S., McManus, S, 2002, ‘Common Mental Disorders’, in Sproston, K., Nazroo, J., (ed) Ethnic Minority Psychiatric Illness Rates in the Community (Empiric), National Centre for Social Research, TSO
[24] Nazroo, J., King M., 2002, ‘Psychosis – symptoms and estimated rates’, in Sproston, K., Nazroo, J., (ed) Ethnic Minority Psychiatric Illness Rates in the Community (Empiric), National Centre for Social Research, TSO
[25] HSE, 2009, Health and Safety Statistics 2008/09, Health and Safety Executive
[26] Nazroo, J., King M., 2002, ‘Psychosis – symptoms and estimated rates’, in Sproston, K., Nazroo, J., (ed) Ethnic Minority Psychiatric Illness Rates in the Community (Empiric), National Centre for Social Research, TSO
[27] Care Quality Commission, 2009, Count me in, Results of the 2009 national census of inpatients on supervised community treatment in mental health and learning disability services in England and Wales

This factsheet was written by Inger Hatloy. Updated February 2010.