Among other enquiries and reports, the 1985 Mental Health Act Commission’s First Biennial Report 1983-85 and the 2006 ‘Count Me In’ report (Health Commission, 2007 cited by Patel and Heginbotham, 2007) have concluded that the Mental Health services were riddled with institutional racism. It is a widely accepted reality that Black people are more than likely to be admitted to and detained in the mental health service compared to White people. Patel and Heginbotham (2007) point out that Black groups are between 3 and 5 times more likely to be admitted to psychiatric hospitals than the national average.
Even more worrying is the fact that second and third-generation blacks (Black British, the Black other category) were 14 times, (rising to 18 times for males) more likely to be admitted (BBC News, 2007, Patel and Heginbotham, 2007). While different enquiries have confirmed the statistically significant differences in admissions and detentions in the mental health services between Black and White people, no plausible explanations have been given. As such the perception of the mental health service as being inherently racist continues to cloud the service.
Does the high incidence of diagnoses of psychosis and detention under the Mental Health Act among black people prove institutional racism? This observation alone does not prove anything beyond suggesting that there is an epidemic of mental illness in black communities.
The high rate of mental illness among black people may be due to an exposure to such social pressures as unemployment, use of drugs and dysfunctional households. Mental health problems are scarcely discussed within black communities and black people are more likely to suffer in silence for fear of disclosing their illness. Arguably, there is a high preference for unconventional treatments (such as spiritual interventions, exorcism, prayer, etc) as opposed to GPs in black communities.
If the services are racist, is that because of racist practitioners or is it the wider societal provision structures? Patel and Heginbotham (2007) argue that accusations of institutional racism should not be misconstrued for racism by individual psychiatrists. Accusations of institutional racism are counter-productive as they may be misinterpreted and lead to black service users losing confidence in the mental health service.
Furthermore, such accusations may make it difficult for white practitioners to handle black patients; for instance black service users may be discharged early (at times against clinical judgment) to avoid longer detentions which may be interpreted as a product of racism.
While there are undoubted discrepancies in the treatment of black people, I believe the wider society, of which the mental health service is a product, is the greater enemy. The fact that second or third-generation black people have an even higher prevalence of admission and detention in mental health services is stark evidence of a racially fractured British society. Successive British governments have failed to create a truly inclusive society. There are many insular communities living side by side with the mainstream British society. These societies lack understanding of each other hence there is general mistrust.
It is argued that Black people are twice as likely as white people to be referred to a psychiatrist by the police or a court rather than their doctor (GP) (BBC News, 2007). The BBC News (2007) also asserts that black people often get in touch with the mental health services when their condition is more serious thereby requiring detention. These two observations in particular raise the issue of socialisation and cultural views of mental ill-health thus the choice of treatment. As already stated, black people would rather use alternative treatments and only arrive in the formal system late, at which point their condition will be deemed serious.
However, I will hasten to ask if the seriousness of the mental condition and need for detention as defined by the mainly white culture based assessment tools is understood in the same way in the Black community as it is by psychiatrists? I strongly believe there is a possibility that socialisation and cultural difference impacts on our perception, interpretation and tolerance of violence or aggression or threatening behaviour. In that sense, I believe it is highly likely that the high incidence of detentions of black patients within the mental health services may be resulting from the misinterpretation of these patients’ rather unfamiliar disposition.
The mental health service is perhaps unwittingly racist because the standards of measurement are set on the basis of the dominant culture of Britain thus, do not always address the needs of minority ethnic groups. In contrast, the mental health legislation of the Northwest Territories of Canada accommodates the native population’s spiritual beliefs. In particular, the mental health legislation includes consultation with a first nations elder before a potential patient can be detained (Forchuk and Jensen, 2003). The first nations elder’s role is to rule in or out a possible spiritual link of the patient’s symptoms.
Admittedly, efforts have been taken to make the services more inclusive in order to improve black people’s experience of the mental health service. The mental health service should be seen in the context of the wider society not in isolation. Expecting the services to go against the wider social tide, whatever it is, will be too optimistic. The multicultural nature of the UK population demands that a wider participation should be encouraged from all socioeconomic groups involved in the system: patients, families, practitioners and students.