way with the anti-racist will?
says it is committed to rooting out racism in mental health services.
It has drawn up a five year action plan and is to establish "hothouses
of reform" services to drive forward change. But will this
all be enough? Adam
is now seven years since black Rastafarian David Bennett lay dead
on the floor in Norvic psychiatric clinic in Norwich.
38-year-old, diagnosed with schizophrenia, had punched another patient
who, in turn, called him a "black bastard". After hitting
a nurse David Bennett was restrained. He suffocated after being
pinned down by around four nurses for at least 25 minutes.
the shock and outrage came inquiries and government responses. First
an internal Norfolk Mental Health Care Trust inquiry, then a government
report, entitled Inside Outside, which laid out initial ideas on
how to improve mental health services for black and minority ethnic
(BME) people. In December 2003 an independent inquiry into David
Bennett's death highlighted a "festering abscess of institutionalised
racism" in NHS mental health services. Finally, in January
of this year, the government issued a five year action plan - Delivering
Race Equality In Mental Health Care - detailing how it plans to
root out anti-discriminatory practice.
action plan wants service providers to reduce the disproportionate
rate that BME people are treated and detained in hospital. It also
laid out how to create a workforce capable of delivering "appropriate
and responsive" mental health services to BME people.
reveal that black people represent 30% of patients in medium secure
services and 16% of high secure services. They are more than six
times likely than white patients to be detained. Women born in India
and East Africa have a 40% higher suicide rate than those born in
England and Wales.
the time has now come for the aspirations within the action plan
to be realised. The ball began firmly rolling at the end of last
month when 17 strategic health authorities - "implementation
sites" - were due to submit details for pilot projects which
the government wants to pave the way in creating non-discriminatory
mental health services.
want the implementation sites to be hothouses of reform, and to
bring about innovation and new thinking," says professor David
Sallah, the National Institute For Mental Health's director of BME
mental health programme.
already there are strong concerns as to whether the action plan
has the teeth to enforce such innovation.
example, no specific targets - such as by how much to reduce rates
of detention of BME people - have been set. Target-weary service
managers may be relieved, but critics are dismayed. They fear a
lack of targets issues a green light for providers to get away with
not ensuring real change.
Sashi Sashidharan, chair of the expert group which drew up Inside
Outside, fears the lack of targets indicates government reluctance
to tackle full on racism in mental health services.
welcome that people say they are all for action," says Prof
Sashidharan. "But where do you focus your action? The action
plan does not commit services to specific action. 'Target' is a
bad word these days. But nevertheless there should be clear benchmarks."
Sallah disagrees, emphasising the Healthcare Commission, backed
up by the Race Relations Act, will be a "lever" for implementing
the action plan.
is despite the commission deciding to drop 18 "prompts",
as laid out in the action plan, which were to be a means to monitor
race equality performance. The prompts were too prescriptive, said
measures for assessing the action plan have now been subsumed into
general "must do" measures for assessing how providers
meet core standards throughout the NHS. This document - entitled
Criteria for Assessing Core Standards - was emailed to service providers
at the beginning of May with more detailed guidance on mental health
whole idea of targets is highly disparaged in the public sector,"
says Prof Sallah, also director of research, ethics and consultancy
at University of Wolverhampton's school of health.
me it is about working with people to reach a level of change rather
than trying to set targets
It can be demoralising for those
who do not get there [reach targets]."
on targets it may be, but the action plan has set primary care trusts
(PCTs), SHAs and other providers a raft of initiatives to implement.
example, all mental health staff should be trained in "cultural
sensitivity", PCTs must create BME befriending schemes on psychiatric
wards, the needs of asylum seekers and refugees must be met, and
PCTs must ensure that BME inpatients have culturally appropriate
initiatives are supported by PCT funding for 500 community development
workers. Their role is to help harness existing expertise and knowledge
within BME communities.
the last count, 100 of the 500 were already in place. Two, for example,
are already working for a pioneering Bradford City Teaching Primary
Care Trust-funded project called Sharing Voices. For two years Sharing
Voices staff have been successfully working with BME community organisations
to use their "untapped expertise" in endeavouring to mould
culturally-sensitive mental health services in an inner city with
a 60 per cent BME population.
good start, perhaps. In the bigger picture, however, the draft mental
health bill is looming.
health professionals have condemned as "draconian" plans
laid out in the draft bill - also criticised in March by a joint
parliamentary committee. They fear it will widen conditions under
which people can be detained. Psychiatrists will be jailers as much
as doctors, they say.
Mike Shooter, president of the Royal College of Psychiatrists, called
the planned legislation "one of the most racially discriminatory
laws ever seen in the UK" because Afro-Caribbean men in particular
face a disproportionate risk of mistaken diagnosis and detention.
Sashidharan asks how can this be squared up to the aspirations within
the action plan. "The draft bill is a very serious matter for
BME communities," he says.
Sallah, however, is more tight-lipped. "The government needs
to respond to the parliamentary committee. It's best to wait and
see what comes out of that response," he says.
Bennett's death may have focussed minds pushing for change. But
these minds have strong differences of opinion on how to implement
version of this article appeared in Public
Government's Delivering Race Equality in Mental Health Care Action
4, 2005: Planned services heralded to be "hothouses of reform"
in rooting out racism in mental health - announcement of new
projects comes on heels of census to establish extent of discrimination
against black and minority ethnic patients in NHS and private hospitals
11, 2005: We'll cut rate that black and ethnic minority people are
detained in psychiatric hospital, vow ministers - promise unveiled
in government five-year anti-racist action plan for mental health
29, 2005: Government again under fire over plans to change mental
health law - parliamentary committee warns that planned legislation
would erode civil liberties
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