Reply to Ian Bronks' letter for the Bulletin: Mike Shooter

First things first, I did indeed talk about the possibility of institutional racism in both the practice of psychiatry and the structures of our psychiatric profession (the two may not be unconnected). I did so as part of a speech to the inaugural meeting of the British Association of Pakistani Psychiatrists in Birmingham about the challenges facing the College in the next few years.

Institutional racism was defined in the MacPherson Report as ‘The collective failure of an organization to provide an appropriate and professional service to people because of their colour, culture or ethnic origin. It can be seen or detected in processes, attitudes and behaviours which amount to discrimination, through unwitting prejudice, ignorance, thoughtlessness and racist stereotyping which disadvantages minority ethnic people’.

The key words here, I think, are ‘collective’, ‘service’ and ‘unthinking’. By this definition, I believe that the implementation of any legislation that results in young black males who live in inner city areas being six times more likely to be caught by it, must contain an element of institutional racism — and one can see why.

Young black males tell us that they are wary of psychiatric services that do not seem sympathetic to them; they feel, with some justification, that they are more likely to be perceived as dangerous than their white counterparts. They are loath, therefore, to come forward early when treatment might be most effective and the consequences complete the vicious circle. I think that is a collective failure that we all need to address, including a government whose current proposals for Mental Health Act reform would compound the problem with their emphasis on dangerousness and their loose criteria for compulsion.

I make no apology for this view, or for the fact that the College has commissioned a three-year external audit of all its processes and structures for evidence of institutional racism. I am not sure that we can expect to eradicate it from practice if it is there in the College to which we belong — unwitting though that may be.