Angela Greatley on racism and the NHS

A few weeks before the Macpherson report was published, David "Rocky" Bennett died at the Norvic Clinic after being restrained by nursing staff there. The subsequent report into his death, published some five years later in 2004, directed similar accusations at the NHS.

Ten years after Macpherson, and five years after the Bennett inquiry, the concept of institutional racism remains highly contested and emotionally charged. What cannot be disputed, however, is that many black and minority ethnic communities' experiences of health services and the criminal justice system are quite different to those of the white British population.

BME mental healthcare

These problems are particularly severe for mental healthcare. Late last year, the fourth annual Count Me In census was published by the Healthcare Commission. It showed that people from several black and minority ethnic communities continue to be admitted to psychiatric hospital at a higher rate than average in England and Wales.

There remain dramatic differences between ethnic groups in their likelihood of being in medium or high-secure hospital, in their chances of being referred to mental health services by the police or the courts rather than by their GP, and in their risk of being secluded in acute wards.

Four years ago, the government launched Delivering Race Equality, its strategy to tackle these variations. The strategy set out to redress differences in the treatment of black and minority ethnic people in mental health services, through measures such as the introduction of 500 community development workers to bridge the gap between services and communities. Some of those posts are yet to be filled, a year beyond the (extended) deadline of December 2007.

Pushing for change

Inevitably, it will take some time before the impact of a strategy that depends so much on changing culture and everyday practice is felt by individuals and communities on a large scale. But that should not stop any of us from seeking speedier improvements at every level.

It is all too easy to accept the differences described each year by Count Me In, or to dispute what proportion of the difference is actually due to discriminatory treatment.

The reality remains that many black and minority ethnic communities experience all kinds of public services more negatively than white British people, and it is in the interactions between those services that some of the worst instances of poor treatment and discrimination occur, albeit unwittingly on the whole.

We need also to be aware that, while much remains unchanged, new factors emerge as society shifts. This year's Count Me In report noted an increasing proportion of "other white" people in psychiatric wards, which it ascribed to migration within Europe. Achieving greater race equality means being alert to these changes as well as pursuing the more longstanding issues that affect some black people in particular.