The central point of Professor Singh's piece (pp. , this issue) is that neither institutional nor individual-level racism accounts for the high rates of serious mental illness among African–Caribbean and African people living in England. Patel & Heginbotham (pp. , this issue) claim that ‘all the evidence suggests that Black people and many people from other minority ethnic groups are being admitted to and detained in psychiatric hospitals either unnecessarily or at disproportionate rates’. There is absolutely no evidence for the former and scant evidence for the latter. Rather, as with alcoholism in Scottish and Irish, and coronary artery disease in Asian people living in England, the raised admission rates among Black people in England are a proportionate response to high rates of illness onset. Research shows that it is the circumstances in which Black people live in England that account for the vast bulk of the excess of illness. Attributing the high rates to racism (institutional or otherwise) in the psychiatric services does a disservice to ill Black people and their families who are in immediate need of skilled help. It also prevents a focus on the real culprits, which are discrimination and isolation in society, unemployment, insufficient support for poor families and single mothers, and being brought up in inner cities where crime and drug misuse are rife. Until exposure to these risk factors is diminished, people of African–Caribbean, and to a lesser extent African origin will continue to become ill at rates considerably above those of both the native White population and other minority groups living in England. As Professor McKenzie wrote in the Guardian recently (2 April 2007) when discussing the high rates of serious mental illness in Black British people: ‘If we knew that one group in society were 10 times more likely to develop lung cancer, we would focus on them – perhaps with a targeted anti-smoking strategy. We would not just make lung cancer treatment services more equitable.’