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Background: the increased incidence of psychosis in African‐Caribbeans in the UK compared to the white British population has been frequently reported. The cause for this is unclear; social factors are said to account for this increase and one factor that is often cited is discrimination.Aims and method: we have looked at two groups of psychotic patients, blacks of Caribbean origin and white British, and present a qualitative comparison of the individual's experience of unfair treatment and its perceived cause.Results: the African‐Caribbean patients did not describe more perceived discrimination than their white counterparts but were more likely to claim that their distress was due to racial discrimination perpetrated by the psychiatric services and society in general. The white patients were more likely to attribute perceived discrimination to their mental illness.Conclusion: this mismatch of explanatory models between black patients and their doctors may account for some inequalities in their treatment, their relative non‐engagement and adverse outcome.Declaration of interest: none.

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