Saturday, March 24, 2018

Tackling institutional racism in mental health services

I’ve posted before on Institutional racism and reform of the Mental Health Act. The Royal College of Psychiatrists has recently produced a position statement on ‘Racism and mental health’. Racial bias, of course, is not new in mental health services. There is also a history of attempting to tackle discrimination, which the College statement essentially ignores. True, it does make reference to the Blofeld report following the death of Rocky Bennett under restraint in my own NHS Trust. I worried at the time that the focus on institutional racism deflected from the other main issue about the dangers of restraint (see my BMJ response). Face down restraint should probably have been completely banned in mental health services (see previous post).

This history is relevant to the current reform of the Mental Health Act, because, in a way, its aim could be said to be to reverse the trend for increased coercion associated with the last reform. As Inside/Outside said, "[I]t is essential to place progressive community based mental health at the centre of service development and delivery". Services are failing to provide an appropriate and professional service to people because of their colour, culture and ethnic origin. This situation needs to be legislated for in any new Mental Health Bill, focusing on reducing coercion.  


DBDouble said...

Duncan, please do post it for me - thanks. The original was longer but this would do.


I appreciate the two photos (the first including me) but others may not. When I was invited to a meeting “to discuss mental health legislation and practice review at 10 Downing Street on Thursday 15 February” like others, I assumed that it was to meet politicians— if not the PM then at least a Minister or at the very least an Undersecretary. But nothing of the sort! (The agenda did indicate it was not going to be but that was only sent out about 24 hours before the meeting!) There were about 20 or so black people representing various NGOs, three (black) psychiatrists, one white researcher and Simon Wessely sitting at the table, with three or four white civil servants (?) sitting behind us. The meeting was chaired by a Vice Chair of the MHAct Review. Each person was called on to say their piece about BME issues in MH and what we hoped the Review would achieve. Then we had a general discussion of sorts—including talk about racism and its effects in the MH system. We were then dismissed and told that we could take photos outside the door of number 10—in fact this photo-opportunity appeared to be the main purpose of getting us all together! (Photo at the top of the blog.) No minutes of the meeting have been sent out —at least not to me. Reflecting on the meeting, it struck me how colonial the whole set up was, reminiscent of native dignitaries (perhaps hoping for imperial honours for serving the British Empire) being summoned to the governor’s residence to be patronised, perhaps vetted (the photo at the bottom of the blog). It certainly felt like an insult to black people as a whole, but maybe it was not, unless unwittingly so (using the word ‘unwitting’ as in the definition of institutional racism given by Macpherson in the report on the police failure to properly investigate the murder of Steven Lawrence). Was it a message to BMEs / Blacks to mollify us (after all we were allowed into Downing Street) or was it just a joke to humour us—black people love this sort of occasion of course! If Downing Street can do this, the big question is what exactly is the present occupant of Number 10 up to in getting a Review of the MHAct? Is it going to be like last time when the Labour Govt had a review and then totally rejected the advice of the 1999 Review by Genevra Richardson and her team? The Govt then produced its own plans (Draft Mental Health Bill, 2004) to extend sectioning with community treatment orders, abolish the treatability clause so that people sectioned for having ‘personality disorders’ (a very problematic ‘diagnoses’) could be kept in psychiatric custody for indefinite periods even when there is no ‘treatment’ available, and so on; and pushed their ‘reforms’ through in spite of wide-spread opposition. Is Mrs May going to do the same thing? We have to wait and see- and Simon needs to bear in mind what happened last time.

Best wishes,


Suman Fernando
Honorary Professor, Faculty of Social Sciences & Humanities
London Metropolitan University, UK

Professorial Fellow, Institute of Mental Health
University of Nottingham

at European Centre for Migration & Social Care (MASC)
University of Kent
Also Consultant Psychiatrist, Chase Farm Hospital, Enfield, Middlesex

NEW BOOK: out Sept 2017:

DBDouble said...

I'm sure we should be wary of Theresa May's motives when she says she is prepared to tear up human rights if they get in the way (see article). What does parity of esteem mean anyway?

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