Working for change

Professor James Nazroo explains the scientific approach being taken by the Synergi Collaborative Centre, influenced by the "exceptionally high rates of diagnosis of severe mental illness", particularly among ethnic minority people.

Synergi Collaborative Centre Stroke

Working for change

The issues that the Synergi Collaborative Centre is setting out to tackle are profoundly troubling, longstanding and extremely difficult to address.

Our central concern is the exceptionally high rates of diagnosis of severe mental illness (such as schizophrenia) among some groups of ethnic minority people, a pattern that has been repeatedly documented since the early research on this was carried out in the 1970s.

And these are exceptionally high rates: a risk of close to six times higher for Black Caribbean people compared with White people. There are almost no other conditions for which the risk is so high in one group compared with another.

In partnership with a full range of stakeholders, we are pursuing three core topics in relation to this:

  • Why are ethnic minority people at greater risk of symptoms relating to severe mental illness?
  •  

  • Why are ethnic minority people so much more likely to receive a diagnosis of severe mental illness and have adverse pathways into care, like being detained in hospitals and being compulsorily treated?
  •  

  • How might approaches to prevention and treatment be systematically reformed to reduce these inequalities?

The large difference between the observed rates of symptoms of psychotic illness in community studies and the observed rates of diagnosis of a psychotic illness in a clinical setting needs careful examination.

The former is still very high, between one and a half to two times higher for Black Caribbean people compared with White people, but nowhere near the almost six times higher rates of diagnosis mentioned earlier.

It is vitally important to investigate pathways into and processes of care to inform reforms in care systems and society, more generally.

Three principles underlie our ways of working to address these issues. The first is to acknowledge and investigate the importance of multiple disadvantages in explaining adverse outcomes for ethnic minority people.

To understand this we need to acknowledge the ways in which racism shapes people’s life chances; how the common experience of low level ‘micro-aggressions’, alongside more occasional direct and violent acts, inflict trauma on individuals and communities; how the organisation and practice of institutions reflect and amplify ethnic disadvantage; and how broader social structures (housing, employment, and education, among others) reinforce, rather than mitigate, ethnic disadvantage. The impacts of racism are profound.

The second is to take on and implement the principles of co-design of our approach, co-production of evidence and co-creation of solutions. Here we are mindful of a wide range of stakeholders in this endeavour, from the dominant powerful voices of commissioners and providers of services and relevant professional bodies, to campaigning NGOs, who are advocating and implementing alternative approaches, to clinicians who are working on the ‘frontline’ to deliver inpatient and community services. And then – most importantly – the more hidden and often silenced voices of patients and their families and carers.

Also, having the word collaborative in our title was deliberate. We believe that taking such a thoroughly inclusive approach is necessary to get a full understanding of the situation, and to identify possible solutions. Which is why we need you to become involved in this important work.

The third principle behind our approach is to work within a high quality scientific framework, a new form of science that places stakeholders’ accounts at the heart of our actions, with a focus on multiple disadvantages and racism, and a commitment to collaborative working.

Recognising the intractable fundamental causes, together with the collection and consideration of the full range of evidence in a robust way, is crucial to scientific and societal progress. The evidence and the solutions we jointly produce must be based on the highest quality approach.

Reflecting these challenges, the ambition of the Synergi Collaborative Centre is great. We have an opportunity to make a difference. And we need you for that to happen.

Photo credit: A ward at Surrey County Asylum, Cane Hill Hospital. Photo credit: Mark Davies/Guzilian