Henry Clifford is Head of Communications for Bright Blue
Discussions on the failures of integration have traditionally revolved around numbers, values, language, economics and, as the Grooming Gangs Scandal showed, crime. However, for all the discussions around the compatibility between migrants and the host country, there is a missing link, one neither detached from culture nor a straightforward consequence of it: mental health.
In the UK and the West more generally, the scientific process has, over a few hundred years, categorised mental disorders into different buckets and has constructed interventions which, in principle, can treat individuals who are suffering. We have psychoanalysis, talk therapy, behavioural therapies, and drugs, all of which can be administered by professionals steeped in our psychological culture.
The scientific literature around mental disorders mirrors the cultural infrastructure within which its subjects exist. Everyone is familiar with Freud’s early models of the Oedipus complex; psychoanalytic practice has moved on from there, but it still revolves around the relationships found within the early family — the cornerstone of Western culture. The relationship to be self-forged within our culture is heavily mediated through the family, as our cultural norms shape expectations and neurosis.
This is not the same across all cultures, and experiences of mental disorders can vary massively depending on the underlying narratives that shape the relationship to self.
For example, in 2015, the British Journal of Psychiatry published a paper entitled: “Differences in voice-hearing experiences of people with psychosis in the USA, India and Ghana”. What it found was significant: in the USA, voices were more likely to take the form of violent commands, including suicidal ones and assaults on their self-worth. By contrast, in Ghana, people were more likely to experience the “voice of God”, a generally well-meaning and positive set of religiously informed maxims, while in India, the most common experience was the voice of family members instructing them to undertake household chores.
It’s hard to see how, given such different internal experiences of the same disorder, the same treatment plan or screening criteria would be appropriate in each case. It seems likely we need to treat mental illness differently across different cultures.
RD Laing, the Scottish psychiatrist, argued that mental disorders are in fact a function of a “divided self”, a fracturing of the adjustment between ego and self — often caused by trauma, confusion, repression, or misalignment.
Whether Laing’s model is entirely correct or not (and it is a divisive one within the psychological community), the results of clinical practice are clear — an individual struggling with mental health troubles needs to be able to embed and ground themselves within something to unify their psyche.
For many, this is participation in culture. The shape of that culture and how it mentalises the symptoms of mental illness has a huge effect on how the individual will heal and reintegrate, as demonstrated by the different cultural experiences of schizophrenics.
Religion, community, social, or familial bonds can all fill that need and act as a solid base on which the mentally ill can rebuild themselves. We’ve watched at population scale how detachment plays out both in the rise of mental illness in the age of social media, and since the isolation of the COVID pandemic. These are clear examples of how mental health deteriorates when social connections break down. It is a mirror for the same issues faced by those attempting to align within a culture they are not part of.
This is borne out in data on mental illness: migrants and their children are more likely to suffer from psychosis. In fact, second-generation immigrants are more likely than their parents to become psychotic; a 2005 study in the American Journal of Psychiatry found that migrants were nearly three times more likely than the baseline population to become psychotic. Among second-generation migrants, that number rose to four-and-a-half times.
To be clear, this isn’t uniform across all groups, but it is persistent across countries. Studies in the UK, Scandinavia, and the USA have all found increased risk of psychosis in migrant populations. In the UK, the highest rates are found among Afro-Caribbean migrants (more than six-and-a-half times that of the wider population), and the lowest rates among Asian migrants (one-and-a-half times that of the wider population).
First-generation migrants are grounded within one culture as children, and then move to another as adults. This causes challenges, which may account for higher rates of mental illness. Second-generation migrants face an even harder task — while growing up between two cultures, they become fully embedded within neither. Unfortunately, the policy of multiculturalism has failed to address the need for individuals to be grounded psychologically within a culture, intensifying this internal split rather than ameliorating it.
The left blames this disparity on discrimination and racism, which likely contributes. But psychologically grounded individuals are better able to cope with adversity. While the left may be correct that discrimination plays a role, I would argue that it is at most a proximate rather than ultimate cause of psychological breakdown.
With this in mind, a clear picture begins to emerge around the issue of integration. It isn’t just a matter of numbers, language, and “British Values” but something deeper and, as yet, not a part of the political debate.
It is worth noting that the vast majority of mentally ill people are not dangerous; they simply need support to get back on their feet. Mentally ill people are more likely to be victims than perpetrators of violent crime, so proper mental health discussion around migration should revolve mostly around supporting healthy and productive participation in society.
However, in extreme circumstances, a lack of engagement with the underlying causes for the over-representation of ethnic minorities in mental health can have deadly consequences. In 2020, during a psychotic episode, a man named Valdo Calocane kicked at a woman’s door; she was so frightened she jumped from a first-floor window and seriously injured her spine. Not long after, he was diagnosed with paranoid schizophrenia and treated “in the community”. Over the next three years, he was flagged multiple times to authorities for evading the conditions of his care plan, repeatedly sectioned and then released despite his repeated non-compliance. In 2023, he went on a stabbing spree, killing three people.
The public inquiry into the case has heard testimony that the decision not to detain him was due to concerns over the historic over-representation of black men in psychiatric detention.
We shouldn’t expect parity in numbers within our mental health system, nor should we expect that the same treatment plans will work for individuals from different backgrounds. To do so is to ignore the realities of mental health and its intersection with culture. This is a point that conservatives know well, that equality of outcome is not the result of fairness, but its inverse.
Integration is an increasingly important part of our politics. To address the issues caused by mass immigration properly we need to broaden our analysis to include all elements of the process, only then can we formulate policies which address the underlying issues.
Henry Clifford is Head of Communications for Bright Blue
Discussions on the failures of integration have traditionally revolved around numbers, values, language, economics and, as the Grooming Gangs Scandal showed, crime. However, for all the discussions around the compatibility between migrants and the host country, there is a missing link, one neither detached from culture nor a straightforward consequence of it: mental health.
In the UK and the West more generally, the scientific process has, over a few hundred years, categorised mental disorders into different buckets and has constructed interventions which, in principle, can treat individuals who are suffering. We have psychoanalysis, talk therapy, behavioural therapies, and drugs, all of which can be administered by professionals steeped in our psychological culture.
The scientific literature around mental disorders mirrors the cultural infrastructure within which its subjects exist. Everyone is familiar with Freud’s early models of the Oedipus complex; psychoanalytic practice has moved on from there, but it still revolves around the relationships found within the early family — the cornerstone of Western culture. The relationship to be self-forged within our culture is heavily mediated through the family, as our cultural norms shape expectations and neurosis.
This is not the same across all cultures, and experiences of mental disorders can vary massively depending on the underlying narratives that shape the relationship to self.
For example, in 2015, the British Journal of Psychiatry published a paper entitled: “Differences in voice-hearing experiences of people with psychosis in the USA, India and Ghana”. What it found was significant: in the USA, voices were more likely to take the form of violent commands, including suicidal ones and assaults on their self-worth. By contrast, in Ghana, people were more likely to experience the “voice of God”, a generally well-meaning and positive set of religiously informed maxims, while in India, the most common experience was the voice of family members instructing them to undertake household chores.
It’s hard to see how, given such different internal experiences of the same disorder, the same treatment plan or screening criteria would be appropriate in each case. It seems likely we need to treat mental illness differently across different cultures.
RD Laing, the Scottish psychiatrist, argued that mental disorders are in fact a function of a “divided self”, a fracturing of the adjustment between ego and self — often caused by trauma, confusion, repression, or misalignment.
Whether Laing’s model is entirely correct or not (and it is a divisive one within the psychological community), the results of clinical practice are clear — an individual struggling with mental health troubles needs to be able to embed and ground themselves within something to unify their psyche.
For many, this is participation in culture. The shape of that culture and how it mentalises the symptoms of mental illness has a huge effect on how the individual will heal and reintegrate, as demonstrated by the different cultural experiences of schizophrenics.
Religion, community, social, or familial bonds can all fill that need and act as a solid base on which the mentally ill can rebuild themselves. We’ve watched at population scale how detachment plays out both in the rise of mental illness in the age of social media, and since the isolation of the COVID pandemic. These are clear examples of how mental health deteriorates when social connections break down. It is a mirror for the same issues faced by those attempting to align within a culture they are not part of.
This is borne out in data on mental illness: migrants and their children are more likely to suffer from psychosis. In fact, second-generation immigrants are more likely than their parents to become psychotic; a 2005 study in the American Journal of Psychiatry found that migrants were nearly three times more likely than the baseline population to become psychotic. Among second-generation migrants, that number rose to four-and-a-half times.
To be clear, this isn’t uniform across all groups, but it is persistent across countries. Studies in the UK, Scandinavia, and the USA have all found increased risk of psychosis in migrant populations. In the UK, the highest rates are found among Afro-Caribbean migrants (more than six-and-a-half times that of the wider population), and the lowest rates among Asian migrants (one-and-a-half times that of the wider population).
First-generation migrants are grounded within one culture as children, and then move to another as adults. This causes challenges, which may account for higher rates of mental illness. Second-generation migrants face an even harder task — while growing up between two cultures, they become fully embedded within neither. Unfortunately, the policy of multiculturalism has failed to address the need for individuals to be grounded psychologically within a culture, intensifying this internal split rather than ameliorating it.
The left blames this disparity on discrimination and racism, which likely contributes. But psychologically grounded individuals are better able to cope with adversity. While the left may be correct that discrimination plays a role, I would argue that it is at most a proximate rather than ultimate cause of psychological breakdown.
With this in mind, a clear picture begins to emerge around the issue of integration. It isn’t just a matter of numbers, language, and “British Values” but something deeper and, as yet, not a part of the political debate.
It is worth noting that the vast majority of mentally ill people are not dangerous; they simply need support to get back on their feet. Mentally ill people are more likely to be victims than perpetrators of violent crime, so proper mental health discussion around migration should revolve mostly around supporting healthy and productive participation in society.
However, in extreme circumstances, a lack of engagement with the underlying causes for the over-representation of ethnic minorities in mental health can have deadly consequences. In 2020, during a psychotic episode, a man named Valdo Calocane kicked at a woman’s door; she was so frightened she jumped from a first-floor window and seriously injured her spine. Not long after, he was diagnosed with paranoid schizophrenia and treated “in the community”. Over the next three years, he was flagged multiple times to authorities for evading the conditions of his care plan, repeatedly sectioned and then released despite his repeated non-compliance. In 2023, he went on a stabbing spree, killing three people.
The public inquiry into the case has heard testimony that the decision not to detain him was due to concerns over the historic over-representation of black men in psychiatric detention.
We shouldn’t expect parity in numbers within our mental health system, nor should we expect that the same treatment plans will work for individuals from different backgrounds. To do so is to ignore the realities of mental health and its intersection with culture. This is a point that conservatives know well, that equality of outcome is not the result of fairness, but its inverse.
Integration is an increasingly important part of our politics. To address the issues caused by mass immigration properly we need to broaden our analysis to include all elements of the process, only then can we formulate policies which address the underlying issues.