Bhui Kamaldeep, Dein Simon, Pope Catherine
Department of Psychiatry and Nuffield Department of Primary Care Health Sciences, University of Oxford, UK; East London NHS Foundation Trust, UK; and World Psychiatric Association Collaborating Centre, UK.
Queen Mary University of London, UK.
BJPsych Open. 2021 Apr 12;7(3):e78. doi: 10.1192/bjo.2021.38.
Ethnic inequalities in the experiences and outcomes of severe mental illness are well established. These include a higher incidence of severe mental illnesses (psychoses), adverse pathways into and through care, including crisis care, police and criminal justice systems involvement, and care under the powers of the Mental Health Act. The situation persists despite awareness and is driven by a mixture of the social determinants of poor health, societal disadvantage and structural racism, as well as conflictual interactions with care systems, which themselves are configured in ways that sustain or deepen these inequalities. Although training and education are often proposed, this is not shown to have sustained effects. Clinical processes (interviewing/assessment/formulation/intervention) need to address systemic influences and improve the cultural precision with which care is delivered, organised and commissioned. We discuss clinical ethnography and present evidence of its value in addressing systemic as well as individual care needs for diverse communities.
严重精神疾病的经历和结果方面的种族不平等现象已得到充分证实。这些不平等包括严重精神疾病（精神病）的发病率较高、进入和接受护理（包括危机护理）的不良途径、警方和刑事司法系统的介入以及依据《精神健康法》的权力进行的护理。尽管人们已经有所认识，但这种情况依然存在，其原因是健康状况不佳的社会决定因素、社会劣势和结构性种族主义的综合作用，以及与护理系统的冲突性互动，而护理系统本身的构成方式又维持或加深了这些不平等。尽管人们经常提议开展培训和教育，但这并未显示出有持续的效果。临床过程（访谈/评估/制定/干预）需要应对系统性影响，并提高提供、组织和委托护理时的文化精准度。我们讨论了临床人种志，并展示了其在满足不同社区的系统性以及个体护理需求方面的价值证据。
