如果再看看其人的自述又会得出什么结论呢？
Being black in Britain is bad foryour mental healthThere is anepidemic of psychotic illness in those of African and Caribbean origin, so whyare we doing nothing to stop it?Kwame McKenziehttp://www.guardian.co.uk/commentisfree/2007/apr/02/comment.healthhttp://www.guardian.co.uk/commentisfree/2007/apr/02/comment.health
I have hadproblems being a psychiatrist since the first day I worked in the Maudsleyhospital. The Maudsley is in south London, and every day I saw more and moreyoung people of African and Caribbean origin developing serious mentalillnesses. As a young black man I identified with them, found it disturbing,and vowed to do something about it: so I started research in the area.Unfortunately, that made things worse rather than better; partly because thestatistics are so chilling, and partly because of the response to them.
Over the last 30 years there havebeen 20 studies showing that people of Caribbean and African origin have anincreased risk of being treated for serious mental illnesses such asschizophrenia and mania. The increased rate is of epidemic proportions -between five and 12 times greater than for white people. And if anything, it isgetting worse.
On March 31 each year, a one-daycensus is carried out for all Britain's psychiatric inpatients, and the resultsof last year's census have just been published. Of the 32,000 people inhospital, those who defined themselves as black Caribbean and black Africanwere over-represented by three- or fourfold. But one other group stood out -those who defined themselves as "black other". The vast majority ofthis group are young, British-born black people, and they were 18 times morelikely to be in hospital than the British average.
It is always prudent to treatstatistics with caution. Hospital admission reflects not only the amount ofillness in a community but also the ability of the community to cope with thatillness. For instance, in highly supportive, tight-knit communities, morepeople are treated at home. But it is hard to believe that this increased rateis not at least in part due to a true increase in the amount of illness. Thisis backed up by years of research and a recent international review, whichconcluded that migrants are more likely to develop mental illness. But the riskis doubled in black migrants to white countries, and the risk is increasedagain in their children. It seems that it is not about migration alone or beingblack - it is about being black in a white country. The rate of serious mentalillness in the Caribbean and in Africa is not high, but the rate of mentalillness in Britons of Caribbean and African origin is.
You can recover from a psychoticillness, but many people have long-term problems. The cost to the individualwith a psychotic illness, to their family and carers and wider society, isimmense. Most sufferers are unemployed and on benefit; there is an increasedrisk of suicide; life expectancy is lower; and their children are more likelyto develop a mental illness and be taken into care. In one study, 50% of carerswere clinically depressed. This undermines their ability to support others.
Psychotic illnesses start youngand persist. Taking the cost of benefits and loss of tax revenue into account,mental illness is the single most expensive part of the health budget. Those ofAfrican and Caribbean origin are already disproportionately living in povertyand struggling to offer a social system that supports and develops the young.How does a community stop itself from disintegrating under such a burden?
We have some of the best mentalhealth services in the world but we are nowhere near a cure for psychosis.Where there is no cure, prevention is important, and where there is anincreased rate of illness in a group they should be the target for prevention.But we have no prevention strategy.
We have an excellent plan forimproving mental health services for black and minority ethnic groups, but weneed to go further. If we knew that one group in society were 10 times morelikely to develop lung cancer, we would focus on them - perhaps with a targetedanti-smoking strategy. We would not just make lung cancer treatment servicesmore equitable.
Though we will not be able toprevent all psychosis, we should be able to prevent some of it. We know thatpsychotic illnesses are associated with poverty, poor education, racism, livingin a city, poor obstetric care, head injuries or brain infection when you areyoung, childhood trauma, family break-up, and cannabis use. We know thattargeting childhood and adolescence is important.
Prevention of mental illness inblack communities is the sort of complex problem that should attract ahigh-level government inquiry that leads to action. I am used to hearingpoliticians say that doing nothing is not an option. This is an area where thephrase has real meaning. The high rates of mental illness in people ofCaribbean and African origin are not going to go away. If anything, theirlegacy will blight a generation and the impact will be felt by us all.
Mental health services have beenaccused of institutional racism over their treatment of black patients. Thegovernment has asserted that this is not a useful term. But the lack of acoherent prevention strategy is an institutional problem that needsinstitutions, not individuals, to act.
I have moved from south London tonorth London but, 17 years on, I am still watching young people of Caribbeanand African origin coming through the door with serious mental illnesses whichtear their families apart. We are still doing nothing to stop it.
· Kwame McKenzie is professor of mental health andsociety at the University of Central Lancashire and a senior lecturer intranscultural psychiatry at University College London
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把专业人士变无业游民：谁最适合移民？