A race for the truth

This is an academic book which dispassionately covers familiar territory - that of unpacking the race and mental health agenda. The editors have assembled a Who's Who of practitioners and thinkers in the field to focus, yet again, on the shortcomings of mental health diagnoses, care and treatment.

Bhugra and Bahl's opening essay looks at the vexed issues of ethnicity and the problems inherent in attempting to define it.

They begin by acknowledging that while 'one would like to develop and maintain watertight definitions for ethnicity, neat boundaries and operational criteria are not always possible'.

They conclude, not surprisingly, that 'any definition of ethnicity remains a difficult area'. Well, yes.

But where does that take us?

The premise of the book is that the discussions are meant to draw out the nuances of ethnicity in relation to epidemiological factors, pathways to care and social considerations, among others.

Leff 's discussion of the limitations of Western instruments in interpreting cross-cultural manifestations of mental ill-health is welcome, not least because it explores the incidence of depression, as well as schizophrenia.

McKenzie and Murray's challenge to their own findings of diagnoses of psychosis, and in particular schizophrenia, among their minority ethnic patients was noteworthy.

This involved an invitation to the noted Jamaican psychiatrist Fred Hickling to, in effect, second-guess their diagnosis. Interestingly, in this case, no significant differences were found in the two sets of diagnoses in relation to African Caribbean patients.

Vyas' focus on child psychiatry and the discussion on the under representation of Asian children in psychiatric services is useful and informative.

Likewise the chapters on alcohol related problems, cross-cultural approaches to dementia, and the role of GPs in the diagnosis and treatment of African-Caribbean patients will find their places in the wealth of research on ethnicity and mental health.

In short, there is very little which is objectionable, unless it is that the emphasis on adherence to scientific research as the evidence base for understanding social and environmental factors can tend to get in the way of stating what can seem like the obvious to many black and minority ethnic users of mental health services. This approach also lends weight to the perception, in academic circles, that the personal testimony of users and carers is somehow second best.

The authors re-state old chestnuts. The litany of misdiagnosis, poor access, overrepresentation in secure services etc is well known, well reported and well researched. The important difference worth noting in this context relates to the publisher.

Gaskell is an imprint of the Royal College of Psychiatrists. The publication of this text is a signal that the RCP has begun seriously to take on board issues of ethnicity and mental health. We can only hope that the people for whom it is intended - those involved in practice 'at the coalface' of care and treatment - are listening.

Melba Wilson Non-executive director, South West London and St George's Mental Health trust