Background

African Caribbean historical, cultural and social contexts

The term ‘African Caribbean’ refers to people who originate from the Caribbean islands but have an African ancestry. The majority of African Caribbeans in the UK are from the Greater and Lesser Antilles.

Collectively, these islands were formerly called ‘The West Indies’ and include Jamaica, Barbados, Trinidad, St Kitts and others.

The islands differ in their environments, cultures and populations but are linked by common histories of colonialism, slavery and migration.

A brief history

Pre-nineteenth century

The export of tobacco, sugar, cotton, coffee and spices made the Caribbean one of the more profitable parts of the British Empire. However, this required constant new imports of enslaved workforce to maintain its success. During the 1600s and 1700s, over 2 million enslaved Africans were transported to British colonies in the Caribbean as part of what became known as ‘The Triangular Trade’ (click here to see interactive map and learn more). The combination of the diverse cultural origins of African captives coupled with interaction with the peoples who originally inhabited the islands and Europeans resulted in the rich mix of languages, religions, music, cuisines, and material culture still evident in the Caribbean.

1940s-1960s

Although African Caribbean people have been in the UK and Europe for centuries, the arrival of the SS Empire Windrush in Britain in June 1948 carrying nearly 500 Caribbean passengers is often celebrated as the beginning of mass migration from the Caribbean to Britain. During the second half of the 1950s, a quarter of a million Caribbean people (nearly 10% of the population) travelled to the UK and became permanent settlers.

This ‘Windrush Generation’ of the 1950s encountered discrimination in accessing housing (where rental signs declared ‘No Blacks, No Dogs, No Irish’) and employment (regardless of qualifications or training). These first generation Caribbean migrants were subject to adversity, social exclusion and racism whilst being isolated from the support of their extended families in the Caribbean. In response, community activists and church leaders established churches and support organisations. Many, such as The West Indian Sports and Social Club in Manchester, established by the UK’s first Black professor and Nobel Laureate Sir Arthur Lewis , remain at the heart of their communities.

African Caribbean population in the UK

In the mid-1960s, two-thirds of the 400,000 Caribbean population in Britain were immigrants and one-third were their British born children.

By 2011, the UK’s Caribbean population had grown to one million people. Almost three-quarters, who self-identified as ‘Black Caribbean' or Mixed White British and Black Caribbean, were born in Britain. The 2011 Census (Office for National Statistics, 2011) indicates that, of the 2,682,528 residents in Manchester, 107,225 (4.1%) were from ‘Black’ ethnic groups as follows:

  • 44,691 (1.7%) Black African
  • 23,131 (0.9%)  Mixed White/ Black Caribbean
  • 17,767 (0.7%) Black Caribbean
  • 11,639 (0.4%) Black ‘Other’
  • 9,997 (0.4%) Mixed White/ Black African

See: Centre on Dynamics of Ethnicity (CODE) a programme of research concerned with understanding changing ethnic inequalities and identities.

African Caribbean mental health in the UK

Rates of psychosis

One of the most consistent findings from mental health research is that African Caribbean people in the UK are more likely to be diagnosed with schizophrenia than all other ethnic groups. The AESOP (Aetiology and Ethnicity in Schizophrenia and Other Psychoses) study in 3 cities (London, Nottingham, and Bristol) reported schizophrenia rates 9 times higher in African Caribbean people when compared to White British people (Fearon et al., 2006) (PDF 146KB). It is unclear why this should be the case. Theories include:

Misdiagnosis

  • Misinterpretation of presentation/lack of cultural awareness
  • Role of institutional racism
  • ‘Atypical psychosis'

Biological hypotheses

  • Genetic predisposition
  • ‘Migration hypothesis’
  • Perinatal/obstetric factors
  • Childhood risk
  • Cannabis

Psychosocial hypotheses

  • ‘Urbanicity’ and social deprivation (e.g. unemployment, poverty)
  • Parental separation in childhood
  • Impact of racism and ‘micro-aggressions’
  • Social perceptions, stigma, shame
  • Discrimination and social exclusion
  • Externalising attributional style
  • Traumatic life events and difficulties

Intriguingly, rates of schizophrenia in the Caribbean (Jamaica, Barbados and Trinidad) are similar to those of White British people in the UK. Moreover, African Caribbean people are less likely to be diagnosed with other conditions such as depression and anxiety.

Experiences in services

African Caribbean people have more negative experiences of mental health services and worse outcomes than any other ethnic group (The Sainsbury Centre for Mental Health, 2002) (PDF 892KB):

  • Their pathways into care are less likely to involve their General Practitioner (GP) than White British people and more often involve multiple help-seeking attempts
  • They have delayed access to diagnosis and treatment, which means that their symptoms are more severe when they come into contact with mental health services.
  • They are more likely to access services through negative care pathways and be brought into hospital by the police and under the Mental Health Act (2007).
  • Once in contact with services, they experience more coercive care, such as high rates of seclusion and restraint, higher doses of medication and are less likely to be offered psychological therapies, such as family therapy.
  • They experience longer lengths of stay in hospital and, once discharged, higher rates of relapse and readmission back into hospital.
  • They are more likely to be regarded as ‘high risk’ and discharged on costly Community Treatment Orders (CTOs).

Care pathways

Against this background, African Caribbean’s engagement with mental health services is characterised by fear, mistrust and avoidance. This is important because delayed or non-engagement with services results in a vicious circle of negative care pathways, coercive treatment and poorer outcomes. The resultant ‘circle of fear’ reinforces African Caribbean patients and families’ negative attitudes towards and avoidance of mental health services.

The ‘burden of care’ that families experience as a result of long periods of untreated illness can be tremendously stressful, creating hostile home environments and family breakdown. This can cause service users to become socially-isolated, which increases risk of relapse and readmission to hospital. [see key papers]

In response, we are currently working with members of the African Caribbean community (service users, carers, advocates), academics, voluntary sector agencies, NHS and social care professionals to develop a new, culturally-appropriate family therapy (CaFI study).