3.2 Racism in mental health services
Research has shown that people from particular minority ethnic groups are over-represented in some psychiatric diagnostic categories compared with others. One of the most hotly debated issues concerns what appears to be the relatively high number of African-Caribbean men who receive a diagnosis of schizophrenia, compared with white or other minority ethnic groups. Given what you have seen about the difficulties in defining mental health and illness, it will be no surprise to learn that the diagnosis of schizophrenia is problematic in general. However, just as worrying is the over-representation of African-Caribbean men in terms of the kinds of services they are likely to receive once they become mentally distressed. They are more likely than other groups to be forced into services against their wishes, for example through compulsory admissions to hospital. Once in hospital, they are more likely to be physically restrained by staff and to receive particularly high doses of powerful medication. A tragic example of such experiences was the death of David ‘Rocky’ Bennett whilst under restraint in hospital in 1998.
The following quote is an extract from the strongly critical statement made by the official panel of inquiry into Rocky's death.
There have been many conferences, consultations and papers written during the last twenty years about the problems that the mental health services face. Some of these have dealt with the problems experienced by the Black and Minority Ethnic communities. Time and again regrets at the existing state of affairs have been expressed. Time and again promises of improvement have been made. While it would be unfair to say that nothing has happened, it is true to say that not very much and certainly not enough has happened. Unless there are sufficient resources and sustained management, which is both dedicated and committed, these problems cannot be solved. At present people from the Black and Minority Ethnic communities, who are involved in the mental health services, are not getting the service they are entitled to. Putting it bluntly, this is a disgrace. The NHS is national. Final responsibility lies fairly and squarely with the Department of Health. Other institutions may advise and may contribute to what should be done. But, individually or collectively, they have little power to require that changes be made. We are told that the Department of Health is determined to carry out the necessary improvements. We very much hope that this time they will. But, in view of the history we reserve judgment about whether this time these good intentions will be translated into action and that that action will be sufficient to cure this festering abscess, which is at present a blot upon the good name of the NHS.
The fact that black and minority ethnic people generally have a much poorer experience of mental health services than their White counterparts has been endorsed in a report from the National Institute for Mental Health in England (NIMHE) called Inside Out: Improving Mental Health Services for Black and Minority Ethnic Communities in England. In its statement of underlying values and principles, NIMHE highlighted the following:
We must begin by acknowledging the problems of mental health care as it is experienced by Black and Minority Ethnic groups:
that there is an over-emphasis on institutional and coercive models of care;
that professional and organisational requirements are given priority over individual needs and rights;
that institutional racism exists within mental health care.
To change this it is essential to place progressive community based mental health at the centre of service development and delivery. Those who use mental health services are identified, first and foremost, as citizens with mental health needs, which are understood as located in a social and cultural context.
Department of Health, 2002, p.7
In terms of explaining some of the negative patterns in the way services operate, one powerful argument presented in some studies is that black people are less likely than their white counterparts to seek support voluntarily from services. Because many black people have such poor experiences of mainstream services, they are less likely to seek and benefit from support during the early stages of their experience of mental distress, for example, through their GP. When they do eventually come into contact with mental health services, they are therefore more likely to do so because they have become very distressed. Consequently, there are ‘circles of fear’ in operation, where mutual distrust has built up between many black and minority ethnic service users and the mainstream services that are supposed to meet their needs (Keating et al., 2002).
As you can see from the statement from NIMHE above, community-based mental health now occupies a central place in terms of achieving change. An indepth analysis of the general role of communities and social networks is outside the scope of this course. Instead we are going to look more closely at the role of social workers in multidisciplinary teams in community-based mental health services.