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Knowing the origins of a concept can help to explain its form. Knowing the history of the struggle to get concepts such as cultural competence acknowledged can help us to understand some of the future difficulties that there may be in more widespread acceptance. This article discusses the development of cultural competence in the US and explains how both the civil rights movement and changes in immigration to the US were key. More recently, secular trends to individual responsibility have changed the lens through which cultural competence is viewed.

Background: the increased incidence of psychosis in African‐Caribbeans in the UK compared to the white British population has been frequently reported. The cause for this is unclear; social factors are said to account for this increase and one factor that is often cited is discrimination.Aims and method: we have looked at two groups of psychotic patients, blacks of Caribbean origin and white British, and present a qualitative comparison of the individual's experience of unfair treatment and its perceived cause.Results: the African‐Caribbean patients did not describe more perceived discrimination than their white counterparts but were more likely to claim that their distress was due to racial discrimination perpetrated by the psychiatric services and society in general. The white patients were more likely to attribute perceived discrimination to their mental illness.Conclusion: this mismatch of explanatory models between black patients and their doctors may account for some inequalities in their treatment, their relative non‐engagement and adverse outcome.Declaration of interest: none.

The purpose of this paper is to calculate the rate of suicide in different religious groups in people of South Asian origin in the UK.

A cross-sectional, secondary analysis of a national data set. A name recognition algorithm was used to identify people of South Asian origin and their religion. Standardized mortality ratios (SMRs) were calculated using this data and data from the national census. Setting: a population study of all those who died by suicide in England and Wales in 2001. Participants: all cases of suicide and undetermined intent identified by the Office for National Statistics for England and Wales.

There were 4,848 suicides in the UK in 2001 of which 125 (2.6 percent) were identified as people of South Asian origin by the algorithm. The suicide rate for all people of South Asian origin was 5.50/100,000 compared to 9.31/100,000 for the population of England and Wales. The age SMR for those whose names were of Hindu, Muslim or Sikh origin were 0.88, 0.47 and 0.85, respectively. Female South Asians have lower rates of suicide, than their South Asian male counterparts.

Religious classification by the computerized program does not guarantee religious affiliation. The data set were confined to one year because religion was not collected prior to the 2001 census.

The rates of suicide for South Asian sub-populations in the UK differ by gender and religion.

On or around the 31 March each year all psychiatric units in the UK undertake the Count Me In census. Now in its fourth year and with 100% of units in England taking part, the Count Me In census offers comprehensive but limited information on all people receiving inpatient psychiatric care. It also offers information on their ethnicity so that comparisons can be made between groups. It is an extraordinary achievement but this achievement has brought with it burdens. Though envisaged as a vehicle for introducing ethnic monitoring, the census is now expected to be a major tool of assessment and an aid to service development. But can this epidemiological survey deliver the information England needs to develop culturally competent services?