The role of ethnicity in pathways to emergency psychiatric services for clients with psychosis
There is a combination of cultural, economic, social and political reasons which explain why mental health has long been neglected in the Caribbean region. On average a country from the Caribbean spends only 4. These groups are vulnerable to mental health issues regardless of gender, age, sex, race, ethnicity or religion, as they share similarities, but also differences in cultural norms and values. Some consider themselves to be modern and others keep in tradition, which is where the social complexity of mental health lies. Social stigma and taboo are still big issues surrounding mental health in the Caribbean and to overcome this, cultural change has to occur, but this can be a long and arduous process.
It has been suggested that Caribbean countries need to reform their mental health policies and practices. In many instances, governments leave a huge gap in supporting the needs of these countries and many grassroots and community-led organisations have to assume responsibility as key actors in providing mental health care, support, treatment and intervention.
This is evident in Suriname and Guyana , two countries with the highest rates of suicide in the world.
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Suicide and mental health are indirectly linked through disorders such as depression, schizophrenia and bipolar disorder, as suicide can become the reactionary response to these issues. Grassroot community organisations and local NGOs such as the Guyana Foundation and Swarnapath fill this void, and despite their informality, the results are impressive and display the power of community cohesion and resilience. The trouble is that these organisations are small and lack the resources to accelerate their aims on a grand scale. Innovation can help in different ways from developing a platform of advice for patients to integrating the mental health care and support from smaller organisations into the primary health system.
There is scope to deploy new systems and technologies which could drastically improve the mental health of citizens. Different types of innovations already exist for this purpose:. These innovations identify and treat mental health problems, but also raise awareness and reduce social stigma - a critical reason for the persistence of mental health issues.
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But we must not only be reactive in our approach in responding to mental health, we need to be preventative as well. The reality is that practical and preventative action by all actors involved is necessary to make an impact or change the effects that mental health has on the region. Many people in the Caribbean have access to technology such as smartphones, but innovation and apps will not solve the mental health crisis in the Caribbean.
They should be used as tools to aid the issue. The consultant told him he was suffering from bipolar disorder and listened as he told her about his family, his ambitions and his disappointments. Every person with a mental illness is an individual with singular circumstances, but as group there are common experiences that unite, says Sidney. Frustration with the mental health sector united black people of all backgrounds. By the time the Orville Blackwood report in set out what they already knew, black families and carers were forming befriending groups.
Community-based groups operated from psychiatric wards, old community centres, libraries, parks, trips to the seaside, wherever they could find a space to talk. Raj came to the movement after 20 years spent in and out of hospital. She was born in London. She worked in a science lab.
After many years of revolving door admissions, and during a period of relative stability, Raj attended a conference about mental health. She met people who expressed concerns about psychiatry, human rights and the disempowering ways in which they were being treated within mental health services. They chimed with her experience. But as far as I was concerned I was still quite confused and felt very out of it at times. Raj attended a few black mental health events in Brixton, south London in the s.
There was lots of activism around race and mental health and the over-representation of young Black men in psychiatric hospitals. One of these was Orville Blackwood, a young Black man who had died in Broadmoor as a result of being restrained. His mum was amazing. She was going around with this picture of her son and she was so passionate. Raj joined a mixed user-led group based primarily at a psychiatric hospital in London which, though feisty and active, never discussed race.
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We had too much to lose. But as confidence grew, some of the black people in the group set up a separate black group. They made waves. They were accused of being racist. Raj grins. Everybody was getting a bit freaked out. Raj laughs again, remembering the noise they made. Yet there was this commonality too.
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Partly because we had been through the system, but partly as well because we had all experienced racism. In and out of wards since her teenage years, Raj picked up on some of the inequalities within mental health care. But she wanted to take her thinking a step further, and had been working on a theory for some time about the revolving door within mental health for black communities.
You start out in an overtly racist society, she says, which means you are more likely to live in poverty or be unemployed or suffer violence, factors that can influence poor mental health. Then you enter the mental health service, which is infused with the same implicit assumptions and prejudices of wider society, which drives you further into illness. A network of black-led user groups developed, spreading from London to cities like Manchester, Birmingham, Liverpool, Glasgow and Edinburgh.
Black people within psychiatry, practice and academia, were rising to senior positions, and working within charities such as MIND. An amendment to the Race Relations Act in charged all public authorities with a statutory duty to eliminate unlawful racial discrimination. Soon afterwards, a group of psychiatrists, campaigners and patients contributed to Inside Outside, a report published by the Department of Health in The report, authored by Professor Sashidharan, then medical director of North Birmingham Mental Health Trust, set out a framework for race equality within the mental health service.
The Inside in the title referred to the need for change within the mental health sector and offered measurable ways to effect that change. Outside was about engaging community groups, removing the stigma around mental health within black communities and empowering patients. Those involved believed Inside Outside was commissioned to form part of national policy on reforming mental health services.
This never happened. Instead, Professor Sashidharan was replaced, and a new team brought in to write another report, which some described as a watered down version of Inside Outside. Another contributor told me that perhaps it was because the changes proposed would be too difficult to make. Both asked not to be named. David Bennett died after being physically restrained —a team of nurses sat and lay across his body and held his head face down for 25 minutes — at a psychiatric hospital in Norwich. Two years later, in , the Department for Health published its response to the David Bennett inquiry and a plan to revamp the mental health services in light of the two Inside Outside reports.
This was Delivering Race Equality, a five-year action plan to improve the care given to minorities with mental health needs. For many it did not go far enough. The main delivery component of Delivering Race Equality was around these community development workers.
We had put in place key performance indicators, all that kind of stuff, all of that was dropped. They are going to go to your black communities who are very difficult to engage with. However watered down the programme was, it was a rare opportunity, and so Raj, like others in the black community, threw themselves into making the best of it. Over decades one common flaw in reports and investigations into the treatment of black people by the mental health sector was the lack of hard data. The Delivering Race Equality programme promised an annual Count Me In census to record the number of inpatients across England and Wales on March 31st each year, noting the ethnicity of people detained under the Mental Health Act and the reasons they had got there.
The first census confirmed what black communities knew.
Most minority groups — including white Irish people — experienced higher than average rates of detention compared to the white British population, the rates of compulsory detention among people of African descent outstripped all other groups. Black people were three times more likely to be referred to hospital and 44 per cent more likely to be detained when they got there. Referrals were more likely to come from the courts or the police for black men and this group was more likely to be kept in seclusion or physically restrained.
Many in the psychiatry profession felt that the conversation around Delivering Race Equality unfairly accused them of racism. Such unease inhibited progress. Ian, who has worked for a range of NHS and charitable mental health bodies since the mid-nineties, says it took him two years to convince the NHS Trust he worked for to let him implement race equality and culture awareness training. Most of the patients on the ward were black.
The only black members of staff were cleaners or nurses. The entire board, the people with power who were responsible for commissioning, was white. In November the architect and national director of Delivering Race Equality , Kamlesh Patel, resigned from his role.