Singh (2007) and Murray & Fearon (2007) surprisingly and erroneously assume that institutional racism and individual interpersonal racism are the same! They dismiss the contribution of institutional racism to systemic problems in the provision of services and service delivery, and argue that problems in the provision of services and service delivery, and argue that a variety of established aetiological factors are more prevalent in some ethnic groups and that this explains high rates of mental illness. This argument is flawed because the vast majority of studies of aetiological risk factors are cross-sectional where an association is usually assumed. Consider the situation of a patient with misdiagnosis of mental illness, who then is unable to find employment (a risk factor) because of their previous (albeit erroneous) diagnosis.

Institutional racism in clinical practice can manifest by lack of opportunities for staff to receive training in cultural competence, culturally inappropriate psychological treatments, inadequate interpretation services, lack of written materials in the patient's language and a range of other issues. This is at great variance with Singh and Murray & Fearson's interpretation that the institutional racism lobby suggests that clinicians in psychiatry are racist. Institutional racism, along with other factors, may also contribute to lower rates of psychiatric admissions for some ethnic groups; for example, Indian and Chinese had lower rates of admission in the 2006 ‘Count me in’ census. Similarly, elderly patients from a range of minority ethnic groups have poor access to psychogeriatric services. Thus, there is a need to critically examine a range of factors, including institutional racism, in generating an explanatory model for both increased and decreased admission rates, and other variables that differ across ethnic groups.