The African Caribbean Experience of Mental Health
By David Burke
Key Themes: mental health services and racial prejudice, judicial review, social injustice, institutional racism, social mistrust, hope for the future?
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African Caribbeans are 44% more likely to be sectioned, 29% more likely to be forcibly restrained, 50% more likely to be placed in seclusion, and make up 30% of in-patients on medium secure psychiatric wards.
This is the stark reality of the African Caribbean experience of mental health in the UK, one which is comparable to the mental health system in South Africa during apartheid, according to Lee Jasper, Chair of the African Caribbean Mental Health Commission.
Combining anecdotal evidence from African Caribbean service users and the opinions of African Caribbean mental health professionals, Crisis in the Community explores the reasons behind the disproportionate rates of mental health among a community that comprises only 1% of the country’s population.
It recounts in full the tragic death of David Bennett at the Norvic Clinic in 1998 and the subsequent independent inquiry which identified institutional racism within mental health services.
And it looks at what is being done - and what still needs to be done – to break the culture of fear and mistrust among African Caribbeans towards the mental health system.
About the Author
David Burke is from Mullingar in Ireland and has been living in the UK since 1990. As a journalist he contributes regularly to Rock’n’Reel and Mental Health Today magazines, and works as a Subtitler with Red Bee Media. Married to Shirley, he has a son, Dylan, and stepdaughter, Francesca.
“This is a crisis that’s destroyed a generation of African Caribbeans. Look at our community. Look at the children on the streets. Look at what’s happening. Of all immigrant groups, look at the state we’re in. Mental health services have done incredible amounts of damage to Black people in Britain today.”
These indignant words are spoken by Matilda Macattram of Black Mental Health UK, an organisation dedicated to raising awareness of what is broadly accepted as the disproportionate treatment of Britain’s African Caribbean community within the mental health system.
In January 2005, the Department of Health published a five-year action plan, Delivering Race Equality in Mental Health Care, the aim of which was to achieve equality and tackle discrimination where it exists in mental health services in England. The five-year action plan set out the Government’s response to the recommendations made by the independent inquiry into the death of David ‘Rocky’ Bennett, a 38-year-old African Caribbean inpatient in a medium secure psychiatric unit in Norwich. It emphasised the need for more appropriate and responsive services, a programme for engaging the community and better information from improved monitoring of ethnicity. The intention was to help providers of mental health services to ensure they were meeting the standards defined in National Standards, Local Action. Two core standards were particularly relevant: that healthcare organisations must challenge discrimination, promote equality and respect human rights and that organisations must enable all members of the population to access services equally. One of the key components of the plan was the inception of a national yearly census of inpatients in mental health hospitals and facilities in England and Wales. The objectives of Count Me In: The National Mental Health and Ethnicity Census were to obtain reliable information about the number of inpatients using mental health services and to encourage all providers of mental health services to have accurate, comprehensive and sustainable procedures for collecting, recording and monitoring ethnicity that would permit them to collect data of a high quality on the ethnicity of patients. A third objective was to investigate the extent to which providers of mental health care have implemented culturally sensitive, appropriate and responsive services with effective care planning and local evaluation, influenced by information on the ethnicity of patients.
As Professor Sir Ian Kennedy and Professor Lord Kamlesh Patel wrote in the foreword to the initial report, “It is wrong and intolerable if someone is categorised as mentally ill and hospitalised solely on the basis of colour or ethnic origin. It is equally wrong and intolerable if someone who is mentally ill and would benefit from care in hospital did not have that benefit because those charged with such decisions are anxious that they may be accused of racial prejudice. Patients should receive care appropriate to their needs, reducing the need for hospitalisation and detention where appropriate.”
The census, conducted jointly by the Healthcare Commission, the Mental Health Act Commission and the National Institute for Mental Health (England), collected details of ethnicity, language and religion, as well as a range of information about how each inpatient came to be in hospital and details of their care. The first annual results revealed an alarming pattern of disparity in how the system deals with African Caribbeans. In short, the findings illustrated that African Caribbeans were three times more likely than the average to be admitted to a psychiatric hospital, 44% more likely to be detained under the Mental Health Act, twice as likely to be referred through the courts, 50% more likely to be placed in seclusion once in hospital and 29% more likely to experience incidents involving physical restraint. Furthermore, they were 70% less likely to be referred by a GP for counselling and other non-institutional rehabilitation treatments.
The figures made for stark reading. Evidently the mental health system was, as had been suggested by activists within the African Caribbean community for at least three decades, failing to deliver equitable care to said community. This was acknowledged by Professor Christopher Heginbotham, Chief Executive of the Mental Health Act Commission, who asserted that the results, “Challenge many assumptions about the nature of care”. He continued, “Black and mixed heritage groups expressed views and perceptions that suggest services are failing seriously to provide relevant, supportive, respectful care and that service users are wary of professional attitudes. These matters cannot be left to resolve themselves; all commissioners and providers of mental health services must take heed, and the actions listed in Delivering Race Equality should be given urgent attention.”
Lee Jasper, Chair of the African Caribbean Mental Health Commission, was less euphemistic; for him, the conclusions depicted a mental health service that was comparable to one, “In an institutionally racist state”. He added, “Those facts are horrendous. What’s missing from the Government is any acceptance that institutionalised racism is driving these figures. Would you send your mother, if she were Black, to a mental health institution? Not on these figures. I’d take them to a church or find some other means. The figures are so bad they are reflective of a mental health system almost in an apartheid state. I’d like to compare these figures with the mental health system in South Africa during apartheid.”
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