Breaking the circle: racism and mental health

Following five years of delivery of a race equality initiative in the mental health system, do black service-users feel any more confident in the system? Kelly Mullan investigates

It's a plain fact. Black and minority ethnic (BME) people in need of mental health care experience worse outcomes than white people. The previous Government spent 20 million per year from 2005 to 2010 on the Delivering Race Equality programme (DRE) but according to the human rights campaigning group Black Mental Health UK (BMH UK): "Detention rates of black people under the Mental Health Act are at an all time historic high despite having the same rates of mental illness as other ethnic groups."

Using data from the DRE's Count Me In Census, BMH UK claim that African Caribbeans are 44 per cent more likely to be sectioned, 50 per cent more likely to be placed in seclusion, 29 per cent more likely to be forcibly restrained and make up 30 per cent of inpatients on medium secure wards.

Julie Jaye Charles, founder and CEO of the Equalities National Council, says: "I had to fight for services in a predominantly white area. Why? It's simple. It's racism. Years ago racism was people calling you a nigger, calling you a black whatever, but since the Race Equality Act and the Stephen Lawrence Inquiry it's more underhand. Racism is there but it's not explicit which can be very frustrating for individuals.

"BME men in the mental health system are very often seen as aggressive. BME males are more often arrested than their white counterparts and they're more often put into the criminal justice parts of the mental health system."

Patricia Chambers is a service-user working to support other service-users in a work and recovery programme in London. She says: "When I go out to the wards and visit people quite often it's 100 per cent black including the staff. That's the same for male and female. That kind of thing is evidence in your face of institutional racism in mental health. And there are quite a few documents and papers out there that will give you the reality of racism in the system, like Circles of Fear done by the Sainsbury Centre."

The phrase "circles of fear" neatly describes the relationship between BME communities and mental health services. Inherent racist beliefs that black people are more likely to be violent mean psychiatrists and nurses fear black people and consequently they are more likely to be overmedicated or restrained. This means black communities are apprehensive about seeking support and mental health problems can spiral into crisis, making the police more likely to get involved.

Ambrose Koryang from Cope Black Mental Health in Birmingham says: "Yes there is institutional racism. I trained as a psychiatric nurse and I've witnessed it first-hand, being informed by my assessor that Mr X needs this high dose of medication as he can be dangerous and erratic, whereas when Mr Y comes in with similar symptoms he will be talked to and engaged with before being medicated. Black patients would be initially medicated before anyone talked with them and then it was quite pointless because under the influence of medication they couldn't communicate effectively.

"Individuals from African Caribbean backgrounds tend to have a lack of trust in mental health services, based on stories they have heard or based on knowing family members or friends who have used services to their detriment. All this exacerbates illness so there is no intervention until a crisis point and people end up in hospital."

Marcel Vige from Diverse Minds says: "There's a self-fulfilling prophecy: if particular groups of people come to services late then there is a greater likelihood that you will see them in crisis, so psychiatrists will believe that certain groups will be more prone to acting dangerously. Broader preconceptions about the dangerousness of certain groups are reinforced. You can see the logic of using medication as a quick, effective way of managing behaviour.

"That raises the question of managing/containing or therapy and which takes precedence? If you only see people when they are in crisis or if you don't have experience of dealing with people from a particular cultural group then you can misinterpret and misdiagnose. Users might not feel supported and that leads to frustration. When you think of all these different factors coming together, well then medication can seem like the most sensible short-term option. One things leads to another: there's a knock-on effect."

Paul Grey has written a book, Change Starts from Within, about his experiences of the mental health system and says: "You have to define what 'institutional racism' means.

When you go into the system you go there for help and hope, not to analyze racism. So what is it? [Sir William] Macpherson [who headed the Stephen Lawrence enquiry] says it's 'collective behaviour that unwittingly leads to poorer outcomes for certain groups'. The mental health system isn't evil but there's a collective failure in training and operational management. There are unwitting attitudes and behaviours. If all that you hear about one group is negativity then that filters through into ideas and theories and philosophies and into training and operational management.

"Often my first point of contact with services was through the police. I'd be running down the road or doing some crazy thing and the police would come out. They'd cuff me and take me to a police cell and I'd spend hours there before going to hospital and being assessed and then being taken to another unit and being assessed there. It was a laborious process."

Matilda MacAttram of BMH UK says: "The use of police cells as places of safety is routine. We have high profile cases of deaths in custody to show that a police station is not a place of safety for people who need mental health care. We are calling for an end to the use of police cells as 'places of safety'."

As Disability Now goes to press, campaigners are planning to mark the two-year anniversary of the unexplained death in custody of Sean Rigg, a physically fit and healthy 39-year-old with schizophrenia, at Brixton Police Station. On 21 August 2008 Sean Rigg was arrested on suspicion of a public order offence and restrained in the back of a police van. He died 91 minutes after being taken into police custody and his family has yet to receive an explanation of what happened.

Marcel Vige says "The question to ask isn't 'is there institutional racism?' but given that it's present, how can we counteract it?"

"The Delivering Race Equality programme was introduced in 2005 in response to the report into the death of David Bennett," says Matilda MacAttram. "Over five years and with £20 million being committed year on year, not one single objective has been met. Access to psychological therapy hasn't happened. Reducing detention rates hasn't happened. Overmedication, forcible restraint and the death rate have got worse."

DRE's key aims were to reduce rates of admission, detention and seclusion among black and minority ethnic groups. The annual Count Me In Censuses show these goals have not been achieved.

Maltida MacAttram says: "We know that community-based services work. If there was a commitment to address the problem, that's where spending would have gone. Instead I've seen at least ten community-based services close their doors because of lack of funding. We don't know where that £100 million went but it didn't go to the people that needed it."

Julie Jaye Charles was involved in DRE and set up The Ambassadors Programme to engage the skills of service-users in making change. "I saw DRE as a chance to take a holistic approach to mental health with a social model of disability approach but money wasn't spent in the right places. Disability in the social model is about how society treats us but the social model didn't really come into the DRE programme at all. It was very medical, very health. I had to fight for about three years to get ideas like 'independent living', 'personalisation' and 'social model' heard.

"I think that if independent living had been part of the agenda from the beginning there would have been more linkage with other public sector departments like housing, employment and education.

"Psychiatric input is important but so is having a roof over your head, so is getting into employment, so is getting into education. Psychiatry helps, therapy helps, but then where do they go when they walk out of that building? What happens to them? I think a focus is needed on independent living as a whole."

Marcel Vige from Diverse Minds says: "If you look at the grassroots work and the community development work, DRE has been useful in a lot of localities. Where it failed is that there hasn't been consistency. There are pockets of good practice but no co-ordination to make them all pull in the same direction."

Paul Grey says: "A five year programme was never going to solve problems that have been around for decades, but we have the best national health service in the world and we need to invest in it. If we value staff maybe they will value the people they work with."

Given the cost-cutting agenda of the coalition Government, the financial arguments for effective community services might win where humanitarian arguments have been ignored. BMH UK is waiting to meet with health ministers to put their case.