We must radically transform our mental health services to rid them of institutional racism, writes Patrick Vernon
As we approach the tenth anniversary of the death of Sean Rigg, who suffered a cardiac arrest in police custody, this provides an appropriate time to reflect on mental health services and race in Britain. Despite progress on the issue, statistics from the 2017 race disparity audit remind us that the system is still failing, endangering the human rights of the people it is meant to protect.
Indeed, 29 per cent of black British women experienced a common mental disorder in the past week – a much higher rate compared to white British women – and even other BAME women. Moreover, a significantly higher proportion of black men experienced a psychotic disorder in the past year than white men. This overrepresentation of black people in the use of mental health services for the past 30 years or so has had many consequences for policymakers, care providers, and the black community itself.
A key problem is trust. Prejudice against black people in British society, particularly the trope that presumes us to be bad or dangerous, has informed our mental health system and institutions, preventing people from receiving the care they need and deserve. In many ways, this can be traced back to a lack of black representation in the NHS. The lack of diversity is damning among senior administrators and managers, as well as employees of mental health services.
Our health service is also reactive rather than proactive. This means we prefer to deal with problems after they have arisen, rather than tackling potential causes. This is nowhere more noticeable than in the case of mental health problems, as causal factors such as poor physical health, deprivation and social exclusion are rarely addressed until it is too late. These factors are all, incidentally, more prevalent in poorer and black communities.
What is clear is that there is collective system failure, compounded by a lack of leadership at all levels. The current models of service development are clearly not working. We need a new settlement.
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Race and restraint: it’s time we listened to the evidence
The Mental Health Units (Use of Force) bill, currently in committee stage, is one piece of legislation aiming to tackle this system failure. Introduced by member of parliament Steve Reed, and known as Seni’s Law, after Seni Lewis who died after being physically restrained in mental health care, it is designed to tackle the challenges surrounding using force to restrain mental health service users. If successful, the bill will limit the use of force in mental health units by increasing de-escalation training, ensuring that every use of restraint is recorded, and making sure that an independent review is automatically triggered when anyone is harmed using restraint.
This is a vital first step. Yet, more work and investment in the black community is required if we want to tackle racism in mental health services. Here’s how.
First, we need policymakers and service providers to honestly and candidly acknowledge that the current system is not working for black communities. The government, and institutions, then need to work with the black community, and black leaders, to regain trust. This would involve appointing more black leaders to management positions, and training staff to understand unconscious bias and structural racism – with the communities leading this training.
Second, we need true systems change. This means recognising that traditional models of care are not working for African and Caribbean communities, and seeking out new structures for care and support that take into account community trauma and structural and historical racism. This will only be achieved by reflecting on the existing system, and developing learning and training opportunities for the community to share lived experience and engage in the production of training for staff.
Finally, we need to continue to innovate and recognise the value of alternative forms of treatment when it comes to mental health care. This includes supporting the development of the evidence base for arts and wellbeing-based care – both of which are forms of support for which much anecdotal evidence exists, but which have not historically played a significant role in formal mental health care settings.
The Windrush scandal in 2018 reminds us that black Britain is still vulnerable. Our status in Britain is not settled. This can have a huge impact on mental wellbeing and community trauma. We need to make sure that black people can access the same facilities, and care, as everyone else. We should not have to fear death.
Patrick Vernon is director of Black Thrive. Find out more about their work at www.blackthrive.org.uk
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