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A booklet entitled "Aspects of Mental Health in a Multi-Cultural Society" was published by the former Community Relations Commision in 1976. The forward by David (Lord) Pitt states:

" The aim of this booklet is to provide guidance for professionals, particularly doctors and social workers, to help them meet the needs of members of minority ethnic groups who have mental health problems. Two points are emphasised in the booklet. One is the importance of cultural background in the presentation of illness. The other is the stress to which ethnic minorities are exposed in the process of migration and particularly in their adjustment to life in this country.

Much of a psychiatrist's work, and certainly that of a social worker, is not concerned with formal mental illness, but with effects of socially determined conditions such as poor housing, unemployment and relative poverty. Any newcomer is exposed to social disadvantage, aggravated in the case of black immigrants by racial prejudice and discrimination.

Racial prejudice and discrimination are undoubtedly the most urgent and serious problems facing minority ethnic groups in this country. all the people we interviewed in the course of preparing this booklet stressed this. The effect of discrimination on mental health is uncertain, but the fact that its affects general well-being and happiness can hardly be doubted. This must be recognised by doctors and social workers, a task the National Health Service should find raltively easy because of the large numbers of members of minority ethnic groups working as prfessionals in the service."

Three decades on where have we been reached? Reports churned out annually repeat a problem with mental health higher than average among black groups, now not newly arrived and not a minority in an increasing number of cities in the UK. The statement emphasised in the first paragraph "the importance of cultural background in the presentation of illness" seems as little understood now as it was then. The consequences are alarming.

In addition a medical model of illness persists in medical circles, but particularly it seems in mental health, whereas the probable causes are likely to be socially determined. The idea that because many people from minority ethnic groups work as professionals in the health service is going to help has proved a great fallacy. While there is probably now a much greater number of those groups in the service their numbers in positions as consultants remains proportionally small, particularly so for the african and Caribbean communities. Fanon's work has a particular resonance in our present society.