This is a brief update for my BAME mental health carer forum covering a mix of London boroughs between Oxleas NHS Foundation Trust and South London & Maudsley NHS Foundation Trust.
Obviously out of my 6 carer groups, this forum focuses and discusses on the unique experiences of Black Asian Minority Ethnic groups. I know some people want such groups to be specific, but to be fair a lot of the topics raised in this forum do focus on the afro caribbean element, although some members are mixed from the Asian community, which is growing as members from other MH NHS trust attend.
The speakers for the month of August were
Malik Gul – Ethnicity & Mental Health Improvement
Jacqui Dillon – Race and mental health
Cordwell Thomas – Black Thrive
Dawn Irving – Maudsley NHS Quality improvement
- Malik Gul presents on Ethnicity & Mental Health
Malik was really pleased to be among carer members of this forum. Malik felt the issue of race and mental health is not new, this is especially in the field of discrimination and racism in the services of our communities. Malik stressed that what we’ve had to endure as black and brown people has been known since we first landed in this country, But since the main kind of population of migration into this country, following the Second World War, and what is euphemistically known as the Windrush generation.
Since the days that we’ve arrived in this country, we have been discriminated against. Racism is built in to the very fabric of the systems that we all live in, and we must admit that it is a part of the system, and all of us in this conversation have experienced that. We’re all a part of it and we have all been discriminated against, in one form or another.
what Malik finds really interesting about the work he does, is that he has been working in Wandsworth at the Wandsworth Community Empowerment Network for the last 20 years.
It is now their 20th anniversary and the organization was founded in 2001. The thing is the organisation knows about the history of black discrimination. Many of us will know about David rocky Bennett, a black man, Rastafarian man, who was in mental health facility in Norfolk, and unfortunately there was a dispute on the ward, something really minor, Malik thinks it was about who could use the phone and who somebody jumped in front of the queue, or something like that. He was held down by the staff, and died in mental health services, what is worse is this is just one of the many cases of ethnic minorities dying not of mental health services, but within mental health services.
So the history of black people in mental health services being discriminated against is a story that we’ve all lived and experienced for the better part of 40 to 50 years. Malik felt that he has to us that nothing has changed.
Malik works very closely with Southwest London & St. George’s mental health trust, and also very closely with South London & Maudsley as well. In fact the new chief executive of SL&M is David Bradley who was the former chief executive of SWL&STG. Malik mentioned how he worked with him for about seven years and over the last 20 years, if you look at the figures for black people where it comes to over representation in medical health services for 20 years, it shows little to nothing has improved, and in fact, in some cases, things have got much worse. Malik mentioned that he has great admiration for David because he always had the foresight to work with the community and is bringing over ideas from his previous MH trust over to SL&M.
Malik challenged us that if you go on to the wards of Springfield hospital, as he does on a regular basis, about 50-60 70% of the people on the wards are for black and minority ethnic communities. Malik pointed out that we had to look at the over representation of black people in communities particularly in services particularly black, Caribbean, and black African.
Malik stated that he has to say that our mental health institutions are not the ones who are going to address this type of problem. He felt SL&M is not the solution to over representation of black people in mental health services, nor is Southwest London St. George’s mental health trust. Nor are any of the institutions that we are relying on to fix this issue. They are not going to address the over representation of black people in mental health services. It will have to be lead by the community, but there is a power problem, an owership problem a distrust problem. This overrepresentation in mental healths services has been going on for so long that the community has felt apathetic to any drive in order to change the status quo.
There was a very long discussion on what was needed to begin to address this issue, but the conclusion is it must from ethnic minorities, but controvesally we cannot expect the victim to solve the problem as we cannot expect the masters tools to change direction.
Jacqui Dillon presents on Race and mental health
Dr Jacqui wanted to talk a little bit about her own experiences, and on why Matthew invited her to the BAME forum. Jacqui Dillion is the former chair of the national hearing voices network, which is a user led charity that was set up about 30 years ago to provide an alternative to mainstream psychiatry.
Jacqui felt she is basically a survivor. she has used psychiatric services and one of the things that she often says about why she has worked as an activist in mental health for 25 years, is because her experiences of psychiatrists, which unfortunately was pretty devastating.
Jacqui felt that one of the things is if she managed to survive services, she would do all she can to try and change them. So that’s what she has been trying to do for about 25 years now. One of the things that she thinks is really important in terms of what we’re talking about today, in terms of the hearing voices network approach is that we do not advocate a Eurocentric model of the mind.
She felt that this is one of the problems that Malik talked really passionately and eloquently about on the huge over representation of black, Asian, and other minority ethnic people using the mental health services. One of the things that’s really important about the hearing voices approach is that this space within that approach is to both acknowledge the live reality of racism and oppression, which in her experience is often taboo in traditional settings, a lot of people flinch and are very frightened, and can get quite defensive about acknowledging that black and Asian people are massively over represented in services, and what’s at the heart of all things, which ian macpherson talked about in the macpherson report.
Our colonial history is built into the fabric of the these institutions, and things like unconscious bias that professionals come with, and often they’re not aware of their own biases, and then making treatment decisions based on some quite racist assumptions that have been intertwined with such systems.
Jacqui feels a lot of despair, about the over representation of many different people from different ethnic backgrounds, although she is really uncomfortable with the term minority ethnic groups, because since she lives in Hackney people from black, Asian and other minority ethnic communities are 50% of her community. So she finds the description a bit reductive and these kind of acronyms we use can be a little bit dehumanizing.
Jacqui also felt she hasnt seen things improve, there used to be an organization’s called family health, ISIS, which she worked with, about 17 years ago with someone called Dennis who she did a lot of work with in terms of trying to bring the hearing voices approach to FHI as an alternative to traditional psychiatry. She was sad to hear that Family Health ISIS is now closed as with many community groups looking to set up protected spaces for those who are vulnerable and what remains are these massive mental health trusts overpowering the voices of the vulnerable.
One of the things she would like to see is a move away from locating people’s problems solely within themselves and seeing that we’re all part of a system. Jacqui feels that one of the problems with the biomedical model, is by saying that people have illnesses, what we’re doing is we’re kind of saying, madness and distress don’t really make sense and limiting away the causes of such illnesses such as the pressure of society, racism, isolation from the community, no safe places, lack of resources, lack of community, lack of understanding and so on.
Jacqui felt that we give illnesses these bizarre names like schizophrenia, which she thinks, further mystifies what are actually very human ways of coping with devastating and overwhelming experiences. So she personally does not subscribe to that kind of biomedical language and feels that it is really unhelpful. There’s actually tons of research that has shown that using medicalized language actually increases stigma and decreases people’s empathy. Jacqui mentioned that someone put on the zoom chat about how trauma informed her, Jacqui felt this was more interesting about how something like trauma informed care can develop, but talking about language is a problem where the term trauma can minimises experiences. We have a long way to go in psychiatry before we even get to the idea of recovery.
If you want to know more of Dr Jacqui Dillon’s work see the link below.
Cordwell Thomas presents on Black Thrive
Next to present was Cordwell thomas on his role within the organisation Black Thrive. Cordwell spoke about what Black Thrive is doing to promote and also promote what the imbalance of what Malik and Jacqui clearly stated, and also the questions coming from what carer members raised, Cordwell felt there is a concern on black individuals within the black community, having a say in their mental health and promoting the services and shaping the service to be fit for purpose. Cordwell wanted to go into a small conversation about the Patient Race Equality Framework.
On Cordwell’s role, he has several hats. He has a full time role mainly within the community, one of which is on the Black Thrive committee. On the Black Thrive committee, there are various agencies from public services, these are ranging from social workers, public health officers and directors, where they also have the police and many more. So fortunately they also have directors and decision makers who are on the table of Black Thrive and they shape the way they engage with communities and how those services engage with black communities in particular.
So, within that role Cordwell helps to represent the community, but within Black Thrive, he is an independent advisor, which enables him to liaise with South London & Maudsley NHS, and also help develop services within SL&M. In particular those services that have been disproportionately affecting black individuals within the community, like individuals from Caribbean descent.
With such roles it is what brought him to this forum to have a conversation with us, because one of his roles, actions or projects, is to be the lead person from the black community driving the trusted friend project,
Cordwell mentioned that he presented with a colleague from SL&M the trusted friend project, a couple of weeks ago at the Lambeth Carers Hub peer group, which Matthew attended. from that forum Matthew requested us to speak about trusted friend for this forum. Basically what it’s about is if you imagine a situation where you’re in a strange environment, ie as if you’re now a psychiatric inpatient, at one of SL&Ms hospitals, if you imagine yourself in a strange environment and you do not have a voice. Now the role of the trusted friend is to ease and promote that de escalation. So the impatient ward may go through all their various roles of de escalation on an issue, however the trusted friend will come on the ward and be that middle person that liaises with the ward staff and say what the wishes of the individual are.
There was most in-depth discussions about other Black Thrive projects, but for now this was the brief update of the Bromley, Lewisham & Greenwich MH carer forum for August 2021