Fear, black people and mental illness: a vicious circle?

Health Soc Care Community. 2004 Sep;12(5):439-47. doi: 10.1111/j.1365-2524.2004.00506.x.


The relationships between black communities and the mental health (MH) services are fraught. Paradoxically, black communities receive the MH services they don't want, but not the ones they do or might want. Black people mistrust and often fear services, and staff are often wary of the black community, fearing criticism, and not knowing how to respond, are fearful of black people, in particular, young black men. The situation is fueled by prejudice, misunderstanding, misconceptions and sometimes racism. The present paper describes the findings of a study to explore the issues in greater depth. The study was premised on a belief that there are 'circles of fear' which lead to poorer treatment of black communities. A purposive sampling approach was used to seek out groups and individuals in whom the 'circles of fear' were likely to be evident. The findings suggest that there are fears which impact negatively on the interaction between black communities and MH services. Two major themes emerged in this study, i.e. the sources of fear and the consequences of fear. Sources of fear included perceptions of MH services, attitudes to mental illness and diagnosis, and experiences of hospital care. The impact of fear included limited trust, limited engagement and delayed help-seeking behaviour. The study concludes that these fears mar the interactions between these communities and MH services, affect help-seeking behaviour adversely, and lead to restrictive and punitive interventions. Progress will only be made in breaking the 'circles of fear' if there is a systematic change in the experience of black services users at each point in the care pathway.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • African Continental Ancestry Group / psychology*
  • Attitude to Health / ethnology
  • Community Mental Health Services / statistics & numerical data*
  • England
  • Fear / psychology*
  • Female
  • Health Services Accessibility
  • Humans
  • Male
  • Mental Disorders / ethnology*
  • Mental Disorders / psychology
  • Middle Aged