With the migrant crisis enveloping large parts of the world with millions of people moving around, it is critical that both the new countries and their policy makers as well as NGOs understand mental health needs of migrants. Over the past half a century studies from Britain have shown that some minority ethnic groups are more prone to developing psychiatric disorders. These studies followed the pioneering work of a Norwegian psychiatrist Odegaard who demonstrated that rates of schizophrenia were higher among the Norwegians who had migrated to the USA in comparison with those who had stayed in Norway.
Interestingly the increase occurred only 10-12 years after migration suggesting that rather than the actual stress of migration it were the subsequent social and economic factors. Among these the most researched groups are south Asians and African-Caribbeans. African-Caribbeans have been shown to have 7-14 times the rates of their British counterparts just like Turkish migrants to Germany and Guyanese migrants to the Netherlands. South Asians show little difference in rates of schizophrenia but south Asian women especially those aged between 18-24 are nearly 3 times more likely to attempt self-harm when compared with their age matched British peers. So what is it that causes such massive differences?
Looking at possible causes we have to start with genetic causes. There seems to be limited data but it is clear that the rates of schizophrenia in the Caribbean countries are the same as that seen among white British. It had been argued that some individuals who are prone to develop psychiatric disorders are more likely to migrate but that has not been confirmed.
Cultures influence development, presentation and help-seeking. So are the cultures to blame? The answer as ever is both yes and no. we carry our cultures with us wherever we go. It has been demonstrated that migrants may experience culture shock on arrival as well as cultural bereavement at what they have left behind. Settling down in the new country may cause culture conflict with the majority culture but also within their own culture. Cultures have been broadly classified as ego-centric and socio-centric as well as masculine and feminine. The tension between these dimensions can lead to what can be described as cultural contraction (of one's own cultural values) and cultural expansion (feeling confident enough to accept and absorb ideas, attitudes and behaviours from the majority cultures).
Although there have been some suggestions that early use of cannabis in vulnerable individuals may cause psychosis, the evidence for black and ethnic minority groups is not as robust. Another potential explanation that deserves better and deeper understanding is the role social inequalities and social determinants play especially in black and minority ethnic groups. In a study few years ago we found that discrepancy between aspiration and achievement was significant in some domains in BME groups. These discrepancies may affect the individual's self-esteem. Similarly parenting styles and separation from fathers was associated but we cannot be sure that it was causative. Thus early screening for mental illness and support is a must if a massive increase in mental illness in the future in these vulnerable individuals is to be avoided.
There will be a panel discussion on Race and the Politics of Mental Illness as part of Changing Minds, a new festival exploring mental health and the arts at Southbank Centre, 6-7 February that The Huffington Post UK is partnering with.