Schizophrenia ‘Epidemic’ Among African Caribbeans Spurs Prevention Policy Change

Research shifts government mental health strategy to focus on ethnic minorities and controversial social issues

It is nothing short of an “epidemic”, say the authors of a major study that has found that members of the African Caribbean community are nine times more likely to suffer from schizophrenia than people in the white community.

The study has had a major influence on the thinking behind the Department of Health’s (DH) New Horizons in Mental Health strategy document, unveiled on Monday, which has moved away from the aim of having specialist services for ethnic minorities, and towards dealing with controversial social issues that lie behind the very high rates of psychosis.

The worrying figures emerged from a large study carried out by psychiatrists and epidemiologists at the social psychiatry unit of the Institute of Psychiatry at the Maudsley hospital in south London. Named Aesop (Aetiology and Ethnicity in Schizophrenia and other Psychoses), the study involved 500 patients with mental health problems from various ethnic groups, comparing them with a control group of 350 healthy subjects.

The researchers ruled out genetic issues as the cause, and the previously held suspicions that psychiatrists were more inclined to diagnose schizophrenia when dealing with black males in particular. They concluded instead that the root causes lay in a whole range of social factors that lead to severe social isolation–people living alone, unemployment, and the vexed issue of separation from parents due to family breakdowns in the African Caribbean community amounting to a kind of “sensory deprivation”–all of which have a dramatic effect on people with a tendency towards schizoid personalities.

“When you get figures like this . .&nsbp;. you can only call it an epidemic,” says Julian Leff, emeritus professor at the Institute of Psychiatry. “We need a programme of social engineering, particularly to try to strengthen family structures in the African Caribbean community, with a view to keeping children in stable families. This may sound very difficult, and it would have to be done by African Caribbean community leaders, but it’s feasible.”

Louis Appleby, the government’s mental health tsar, describes the study as “probably the most important ever done in this field.” New Horizons, and a bigger public health and prevention publication to be announced next year, is in line with the findings of the research, says Appleby, adding: “Whereas our previous policy was mainly about reforming community care, this is more about how we can address some of the causes of mental illness, particularly in relation to ethnic minorities.”

The issues are controversial, he admits, touching on sensitive issues such as the number of African Caribbean families with absent fathers. “But it’s very clear,” he says. “There are genuinely very high rates [of schizophrenia], and the causes are social causes affecting people before they come into contact with mental health services. That’s quite a step, and you won’t find previous documents that have been so clear about these controversial issues. Instead of trying to build separate services for individual groups, it is about a service that is more personal to individuals.”

But Paul Corry, director of public affairs for mental health charity Rethink, is less sanguine. He says: “The numbers are so outrageous that you would think there would be really big, properly funded programmes driven through with zeal.”

The DH’s plan for delivering race equality in mental health care in 2005, which proposed the recruitment of 500 community workers to tackle social issues through 80 new community engagement projects, is still short of recruits. While Appleby says the plan has led to individual projects that “seem to have been successful”, what has been more difficult is to evaluate it in a way that shows it has had a single positive outcome, “like better mental health”.

Corry agrees that there “are some good ideas being followed up in a few areas by very good individuals”, but argues that on race equality in mental health services, the government has failed to provide “the joined-up national lead that we are all looking for”.