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Several decades of mental health research in the UK repeatedly report that people of African-Caribbean origin are more likely than other ethnic minorities, including the White majority, to be diagnosed with schizophrenia and related psychoses. Race-based inequalities in mental healthcare persist despite numerous initiatives such as the UK’s ‘Delivering Race Equality’ policy, which sought to reduce the fear of mainstream services and promote more timely access to care. Community-level engagement with members of African-Caribbean communities highlighted the need to develop culturally relevant psychosocial treatments. Family Intervention (FI) is a ‘talking treatment’ with a strong evidence-base for clinical-effectiveness in the management of psychoses. Benefits of FI include improved self-care, problem-solving and coping for both service users and carers, reducing the risk of relapse and re-hospitalisation. Working collaboratively with African-Caribbeans as ‘experts-by-experience’ enabled co-production, implementation and evaluation of Culturally adapted Family Intervention (CaFI). Our findings suggests that a community frequently labelled ‘hard-to-reach’ can be highly motivated to engage in solutions-focussed research to improve engagement, experiences and outcomes in mental health. This underscores the UK’s Mental Health Task Force’s message that ‘new ways of working’ are required to reduce the inequalities faced by African-Caribbeans and other marginalised groups in accessing mental healthcare. Although conducted in the UK (a high-income multi-cultural country), co-production of more culturally appropriate psychosocial interventions may have wider implications in the global health context. Interventions like CaFI could, for example, contribute to reducing the 75% ‘mental health gap’ between High and Low-and-Middle-Income counties reported by the World Health Organization.

This chapter briefly summaries research over the past four decades (and prior) associated with black men and mental health in the UK. The chapter also examines some responses to the research. This is because we unfortunately remain in a situation where black men in Britain are 17 times more likely than white counterparts to be diagnosed with a psychotic illness. Research into the mental health needs of black men has been conducted repeatedly in the UK, with each new generation hopeful for change. By briefly exploring some policies that have emerged to address this inequality, this chapter highlights the barriers to change.

The practice of transracial adoption often triggers strong emotions, effecting views on its ethical validity, both from individuals who are pro transracial adoption and those who strongly resist transracial adoption. This chapter will consider transracial adoption of children of African-Caribbean origin and its psychological impact along a continuum of psychological wellbeing, psychological adjustment and aspects of mental health. The chapter will draw on literature from the USA and, where available, from the UK.

One of the earliest publications on transracial adoption by Grow and Shapiro (1974) explored the psychological adjustment of African-American children placed within white American families. This study along with later studies (Silverman & Feigelman, 1981) concluded that the children were adjusting well in placement. Further early research appeared to suggest that transracial placements have little negative impact on issues of self-esteem, racial or self-identity or intellectual development (Curtis, 1996; Hayes, 1993; Hollingsworth, 1997, 1998; McRoy, 1994; Simon, Altstein & Melli, 1994; Vrogeh, 1997).

The undermining impact on mental health for transracial adoptees appears to be an argument related to the disconnect between the child’s developing racial identity and lack of preparation for racism and the cultural and ethnic group social devaluation likely to be experienced in a white racist society. The impact of loss of ethnic identity is said to be a key issue in the research on transracial adoption. Ethnic identity is the connection or recognition that one is a member of a specific ethnic or racial group and coming to adopt those associated characteristics into the group associated cultural and historical connections into oneself identity (Rotheram & Phinney, 1987). The establishment of a secure and accurate racial identity is said to be a protective factor in psychological adjustment. This chapter will explore issues and narratives related to this argument.

Research suggests that African-Caribbeans are less likely than their white British counterparts to ask for mental health support (Cooper et al., 2013). This is despite research identifying that minority groups as a whole, when compared to the white majority, report higher levels of psychological distress and a marked lack of social support (Erens, Primatesta, & Prior, 2001). Those who do request support are less likely to receive antidepressants (British Fourth National Survey of Ethnic Minorities, 1994; Cooper et al., 2010) even when controlling for mental health symptom severity, with African-Caribbeans less likely to make use of medication for depression even when prescribed (Bhui, Christie, & Bhugra, 1995; Cooper et al., 2013). Studies reporting on reasons for black people being less likely to attend for mental health consultation with their GP suggest a variety of explanations why this may be, focussing both on the suspicion of what services may offer (Karlsen, Mazroo, McKenzie, Bhui, & Weich, 2005) and the concern of black clients that they may experience a racialised service with stigma (Marwaha & Livingstone, 2002). Different understandings and models of mental illness may also exist (Marwaha & Livingstone, 2002). Different perspectives and models of mental health may deter black people from making use of antidepressants even when prescribed. Despite a random control trial showing that African-Caribbean people significantly benefit from targeted therapy services (Afuwape et al., 2010), the government, despite a report by the Department of Health in 2003 admitting there was no national strategy or policy specifically targeting mental health of black people or their care and treatment has not yet built on evidence-based success. One important aspect recognised by the Department of Health (2003), was that of the need to develop a mental health workforce capable of providing efficacious mental health services to a multicultural population. Although there were good strategic objectives little appeared to exist in how to meet this important objective, particularly in the context of research showing that such service provision could show real benefit. The Department of Health Guidelines (2003) focussed on the need to change what it termed as ‘conventional practice’, but was not specific in what this might be, or even how this could improve services to ethnic minorities. There was discussion of cultural competencies without defining what these were or referencing publications where these would be identified. There was a rather vague suggestion that recent work had begun to occur, but no indication that this had been evaluated and shown to have value (Royal College of Psychiatrists, 2001). Neither British Association for Counselling and Psychotherapy nor British Psychological Society makes mention of the need for cultural competencies in organisational service delivery to ethnic minority clients. This chapter will describe, explore and debate the need for individual and organisational cultural competencies in delivering counselling and psychotherapy services to African-Caribbean people to improve service delivery and efficacious outcomes.

This chapter discusses the experiences of black men who encounter the phenomena of a mental health diagnosis, detention and death in a forensic setting in England. Although there are black women with mental health issues who have also died in forensic settings, the occurrence is significantly higher for men who become demonised as ‘Big, Black, Bad and dangerous’. The author discusses the historical over representation of mental ill health amongst black people in the general community and the plethora or reasons attributed to this. The author then discusses the various points of entry into the criminal justice system, where black men with mental health issues are over represented. The author explores some inquiries into the deaths of black men in custody and the recommendations that were subsequently made, which successive governments have failed to act upon. The author argues that the term ‘Institutional Racism’ is insufficient to explain this phenomenon; and offers her own theoretical interpretation which is a combination of systemic racism influenced by post-colonial conceptualisation

The aim of this article is an analysis of the links between race and psychotic illness, psychiatric diagnosis and treatment, as well as psychiatric, police and prison violence against people with mental health problems. The analysis focuses on Black men who are more frequently diagnosed with schizophrenia and other psychotic disorders and who face more brutal treatment than other people with such diagnoses. We have adopted a multidisciplinary approach which draws insights from psychiatry, psychology, and sociology and challenges the biologistic interpretation of “mental illness.” We take into account the United States and Britain – two countries with large Black minorities and an established tradition of research on these groups. Among the crucial findings of this study are the facts that racial bias and stereotypes heavily influence the way Black men with a diagnosis of psychotic illness are treated by the psychiatric system, police and prison staff, and that the dominant approach to psychosis masks the connections between racism and mental health.

It has become fashionable in both academic and policy discourse to suggest that the latter provides a way of explaining differential access to education, employment, housing, health and welfare facilities, and so on (Ratcliffe, 1999). External constraining factors, particularly institutional racism and individualised forms of discriminatory behaviour, are said to account for the fact that minorities fail to acquire their full citizenship rights. Sometimes, minorities have been seen as undermining their own interests by a process of self-exclusion.

Meadway School for Girls (not its real name) is a London comprehensive school for girls aged 11–16. I worked there for just under four years as a part-time learning support teacher, with students who had been identified as having ‘special educational needs’. Some of these students also participated in my ethnographic research into the micro/politics of ‘special educational needs’ (Benjamin, 2002). Meadway is, in current terms, a ‘successful school’: relatively high proportions of its students attain examination results at or above normative levels, and it has a low rate of student exclusions. Every year, when the local league tables of schools’ examination results are published, Meadway vies with another local girls’ comprehensive school for top place. This contest for league table precedence is played out on the battleground of percentages of sixteen-year-old leavers achieving at least five passes at grades A^∗ to C in the externally-administered General Certificate of Education (GCSE) examinations. These examinations, traditionally regarded as school leaving examinations, measure individuals’ performance on a scale from A^∗ (the top grade) to G (the lowest grade), though employers, further education institutions and the media commonly recognise only grades from A^∗ to C as passes. Schools’ overall results are collated, and local ‘league tables’ based on the percentages of students scoring five or more A^∗ to C grades are compiled and published. In the academic year ending in 2001, just over sixty percent of Meadway’s leavers attained this ‘benchmark’ of externally-recognised success: the school’s best ever score. Such a figure is above the national average, and is well ahead of the National Learning Target of 50% of sixteen-year-olds achieving such a standard by 2002 (DfEE, 1999). In the statutory documentation of school performance, Meadway itself scores an ‘A’ grade when compared with ‘other similar schools nationally’: that is, comprehensive girls’ schools in which over thirty percent of students are eligible for free school meals.

This chapter analyses the attitude of local government to combating ethnic inequalities in Great Britain and France. With cities often seen as the ‘machines of integration’ and the integration of immigrants happening at the local level, this study looks at the everyday practice in London and Paris.

The response of London to the difficulties of mass migration in the 1950s was initially slow and it took major race riots in the 1970s for significant political change to be made. Boroughs such as Lewisham in South East London responded with policies that reflected their local situation including the formation of the first UK Race Equality Council to give the migrant population a political voice. Although this was a small step, its impact can be seen today with 37% of the council’s workforce coming from a black and minority ethnic (BAME) background.

The attitude of Paris and its Arrondissements shows us another kind of strategy. Its districts follow the multicultural strategy adopted by City hall in 2001, organised around three fields of action: anti-discrimination, citizenship and access to rights and valuing cultures of origin, in the context of extremely strict immigration laws. Examples of positive actions include establishing the advisory body of the city council composed of foreigners, the introduction of courses to learn the French language, special cafes for elderly immigrants, local councillors becoming godparents to illegal immigrants or renovation of the residences of immigrants.

This comparison allows us to see the possible differences in dealing with the same phenomenon, as well as identifying the key factors of its success, which in both cities is predominantly due to the political persuasion of city leaders.