Institutional Racism in Mental Health Services: The consequences of compromised conceptualisation

Abstract

Inequalities in mental health service use and outcome in the British NHS have been attributed to institutional racism. Institutional racism is widely understood in terms of the definition published in the Macpherson report, despite critique of its inability to differentiate the role of individual and institution in discrimination, and weakness in distinguishing racism from other forms of discrimination. The inquiry into David Bennett's death declared the NHS to be institutionally racist, and, although still contested, this has been widely accepted. Poor conceptualisation and the endemic failure to demonstrate how institutional racism leads to iniquitous outcomes can be seen in recommendations to tackle it through individual education. Policy based on a compromised conceptualisation of institutional racism is unlikely to reduce racialised inequalities and, in the face of progress for ethnic minorities else-where, may lead to the conclusion that discrimination is no longer a problem. In the light of recent shifts in what is implied by institutional racism, suggestions for research towards a re-conceptualisation are made.