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11 October 2007

Big, black and dangerous?

Institutionalised racism is widespread in the mental health service, yet the government refuses to f

By Tom Marchbanks

When a dispute over a telephone call turned racist, it set off a chain of events which led to David “Rocky” Bennett’s death. Soaked in his own urine, he died less than two hours later in a struggle with four psychiatric nurses.

David’s undignified death, in the hands of his carers, took place after an argument with a fellow inpatient at The Norvic Clinic. It is one of 22 black male deaths in psychiatric custody over the last 29 years.

For many, David’s story draws an uncomfortable parallel with that of Stephen Lawrence’s. Like Stephen’s, his death led to an independent inquiry, which found institutionalised racism widespread in the mental health service.

It is an accusation of tremendous consequence for the black community who, as in criminal justice system, are over represented in the mental health system. A 2006 census on admissions to mental health institutes found that Black Caribbean or African groups are three or more times likely to be incarcerated, rising to 18 times the average for the group, “other black men”.

Since the David Bennett Inquiry published its findings in 2003, campaigners insist little has been done. Harmet Athwal of the Institute of Race Relations believes “there is still a fear and stereotype associated with the black man which leads to the continued institutional racism in the mental health service.”

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The racism manifests itself – according to Professor Suman Fernando – in the diagnosis and risk assessments of black patients. Generally they are seen as primitive or troublesome, given high doses of medication and more likely to be set upon by staff. It is this unnecessary use of force, he says: “That is often a cause of death.”

The Department of Health admits there is a problem. “Black and minority ethnic patients are more likely to experience compulsory psychiatric treatment, to be diagnosed as violent and detained in secure Mental Health Units, less likely to receive diagnosis and treatment at an early stage, and less likely to receive psychotherapy and counselling, ” a spokeswoman said.

Despite this startling assessment, the government denies it is a result of racism. “We just don’t believe that institutional racism is a helpful label to apply – the solutions lie in the hands of individuals, not just institutions.”

It is a heads in the sand response; one that seems to delegate responsibility, rather than admit to what Professor Fernando describes as a “paternalistic, old fashioned and condescending“, system of mental health treatment.

In 2005, the government set up the Delivering Race Equality strategy to ensure parity in mental care and as a response to the Bennett Inquiry. Seen largely as simply throwing money at the problem, Matilda MacAttram, Director of Black Mental Health UK says “it has had absolutely no impact in improving the ethnic inequalities in inpatient care.” “The whole situation is a crisis,” MacAttram adds “one that hits a small community already disadvantaged, doubly hard.”

This week’s World Mental Health Day focuses on ‘Mental health in a changing world: the impact of culture and diversity’.

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