This is an opinion article. The views expressed belong to the author.
October was both Black History Month, held by the NGO One People since 2024, and the week of mental health awareness established by the Luxembourg League for Mental Hygiene (Ligue Luxembourgeoise d’Hygiène Mentale).
Yet racial inequities in psychiatry in Luxembourg – along with their devastating consequences for racial minorities, particularly Black people – are rarely acknowledged. As a Black bipolar woman who has been using psychiatric services for over eight years, I have faced racial discrimination at every level of my journey.
These experiences include, for instance, learning in peer support groups that I was eligible for services but that none of the professionals I met ever provided them – while white participants had benefited from them – and having to wait 30 minutes at a pharmacy counter because the clerk wanted to confirm the legitimacy of my prescription.
Research carried out in North America and the UK, where ethnic data collecting is allowed, has provided ample evidence of these disparities: Black adults have greater prevalence of mental health issues yet benefit from the lowest rates of care across all ethnic groups.
It is also more likely that Black people obtain psychiatric services through the criminal justice system rather than through a regular practitioner. Moreover, they are more commonly subjected to involuntary commitment than Whites, and coercive measures in psychiatry – such as restraint or seclusion – are administered to Black patients at rates sometimes more than four times greater than those of their white counterparts.
This scenario can be explained in part by the continuation of a “colorblind” racial ideology in the health sector, which tends to downplay racism as a structural issue inherent in institutions and instead portrays it as an individual expression of personal bias.
This ideology is further reinforced by a dominant rhetoric claiming that healthcare is evidence-based and free of bias. Such statements neglect the influence of institutional racism on the lived experiences of service consumers and staff from minority backgrounds, as well as on diagnostic and treatment decisions.
Research undertaken in the United States suggests that medical workers typically try to downplay racism in healthcare delivery, employing wording that absolves institutions of accountability.
Comparable patterns are evident in the United Kingdom, where psychiatry has been demonstrated to rely on biomedical theories entrenched in colonial knowledge systems, consequently disregarding the lived experiences of racial minorities.
As a result, when differences in access to psychiatric care are detected, they are more typically attributed to patients’ personal attributes or cultural views than to institutional racism. This leads to the disregard of the racist experiences faced by racialised service consumers and staff, as well as to the neglect of any program trying to eradicate racism within healthcare.
This moralising concept of racism typically causes anti-racist campaigns in psychiatric services to focus on unconscious bias training and staff awareness. While such attempts may increase understanding and empathy, they seldom achieve meaningful or tangible change.
Actions must go beyond individual behaviour and attack the basic system of racism. This includes changing legislation, reconsidering care pathways, and ensuring that the voices of minorities are placed at the core of solution-building. Racial inequities and the failure of psychiatric services to serve Black and Afro-descendant populations would continue in the absence of such reforms.
Racism in psychiatry must first be acknowledged as a structural reality rather than an individual problem in order to be effectively addressed. Research, policy, and practice must understand racism as an ideology and a major structuring component within healthcare, affecting who receives care, how care is delivered, and with what effects.
Bansal N, Karlsen S, Sashidharan SP, Cohen R, Chew-Graham CA, Malpass A. Understanding ethnic inequalities in mental healthcare in the UK: A meta-ethnography. PLoS Med (2022).
Halvorsrud, K., Nazroo, J., Otis, M. et al. Ethnic inequalities and pathways to care in psychosis in England: a systematic review and meta-analysis. BMC Med 16, 223 (2018).
Pedersen, M.L., Gildberg, F., Baker, J. et al. Ethnic disparities in the use of restrictive practices in adult mental health inpatient settings: a scoping review. Soc Psychiatry Psychiatr Epidemiol, 505–522 (2023).
Okah, E., Thomas, J., Westby, A. et al. Colorblind Racial Ideology and Physician Use of Race in Medical Decision-Making. J. Racial and Ethnic Health Disparities, 2019–2026 (2022).
Hamed, S., Bradby, H., Ahlberg, B.M. et al. Racism in healthcare: a scoping review. BMC Public Health, 988 (2022)-
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