The International Handbook of Black Community Mental Health

Richard J. Major, Karen Carberry, Theodore S. Ransaw, Richard Majors, Karen Carberry, Theodore Ransaw

• Publisher: Emerald Publishing Limited
• Year: 2020
• ISBN:
  9781839099663
• Topic: Social Sciences
• Subtopic: Black Studies
• Index: Social Sciences

This is the first international handbook on Black community mental health, focussing on key issues including stereotypes in Mental health, misdiagnoses, and inequalities/discrimination around access, services and provisions. Making use of a cultural competence framework throughout, the book covers many of the classic mental health/developmental areas such as schizophrenia, mental health disorders, ASD and ADHD, but it also looks at more controversial areas in mental health, like inequalities, racism and discrimination both in practice and in graduate school training and the supervisory experiences of black students in universities. Unique among traditional academic texts addressing mental health, the book presents rich personal accounts from Black therapists and students. Many Black students who are training to become therapists or academics in mental health report negative experiences with white university staff in terms of a lack of support, encouragement, resulting in poor graduation outcomes.While institutional racism is a major issue both in society and universities, the editors of this Handbook take personal-level racism, microaggression and everyday racism as better models for understanding and analysing both these students; racialised interaction/communication experiences with white staff at university, as well as the racialised communications and inequalities in misdiagnoses, access to services and provisions in healthcare settings with white managers.

Part I

Race Relations

Chapter 1

Systemic Racism: Big, Black, Mad and Dangerous in the Criminal Justice System

Sharon Walker

Introduction

I have written elsewhere about the issue of black academics in the UK experiencing mental ill health (Walker, in press). Yet, it is only one emerging area in an existing phenomenon of black people disproportionately diagnosed with a mental illness in other institutions such as the criminal justice system (CJS). The Black Manifesto (2010) states:

we can objectively measure structural inequalities, discrimination and disparities in the criminal justice system, employment, education, poverty, health and housing. Disparate outcomes for Black and Minority Ethnic people in the UK have NOT been eliminated and, in fact in some areas, have increased. (p. 2)

The Black Manifesto note Britain’s pride in its historic contributions to setting global standards for democracy and the rule of law yet it has not managed as a country to reduce racism or the over representation of black people with mental ill health. Findings from the Angiolini Report of the Independent Review of Deaths and Serious Incidents in Police Custody (2017) highlighted evidence of racial disproportionality in police restraint deaths. Indeed, during a 12-day period in 2017, Shane Bryant, 29; Rashan Charles, 20; Edson da Costa, 25; and Darren Cumberbatch aged 32, died following arrest. Newspaper reports suggest the official investigation into the death of Cumberbatch underplays the deterioration in his mental health whilst in contact with the police (The Guardian, 2017). As there was alleged use of force and Cumberbatch was taken to hospital with injuries, a referral should have been made immediately to the Independent Police Complaints Commission however this did not happen until 10 days later, by which time Cumberbatch had succumbed to his injuries. Cumberbatch and the three other men were black. These racialised deaths have continued despite the documented history – which when publicised are often portrayed as isolated incidents – of black people dying in forensic settings as a consequence of the use of force or restraint. Well documented is also the over representation of black people detained under the Mental Health Act yet underrepresented in community treatment such as counselling or therapy (Cabinet Office; Race Disparity Audit, 2017), indicating the lack of support and intervention preventing deterioration in the mental health of black people. Dyer (2017) suggests this is the country’s ‘dirty secret’ that needs to be addressed.

I refer to ‘black people’ as those who identify their origins as Black British, Black Caribbean or Black African. Although Asian people face discrimination, they are not significantly disproportionally over represented in mental health or criminal justice statistics, which is the focus of this chapter. Still, many studies are not so discerning and do use the term Black and Minority Ethnic (BME) without making the distinctions between Black and Asian. However, these broader definitions are in line with that used in the government document Delivering Race Equality in Mental Health Care (Department of Health, 2005) which includes:

all people of minority ethnic status in England. It does not only refer to skin colour but to people of all groups who may experience discrimination and disadvantage, such as those of Irish origin, those of Mediterranean origin and East European migrants. (p. 11)

I also use the term racism as oppose to discrimination. Race is the basis for the oppressive behaviour based on colour or ethnicity whereas discrimination can occur on the basis of any type of perceived difference, for example, gender or disability. Stokely and Hamilton (1967) suggest ‘By “racism” we mean the predication of decisions and policies on considerations of race for the purpose of subordinating a racial group and maintaining control over that group’ (p. 20). My interest in the wellbeing of black people in the CJS is borne out of my experience as a black woman working within police custody suites in East London in the late 1990s, assessing people with mental health and substance misuse issues. This was followed by 10 years with HM Prison Service and National Offender Management Service as one of the few black female senior managers. I have subsequently developed my own thinking about the reasons for the over representation of black people with mental health issues and their experience in the CJS. Nonetheless, the process of writing this chapter has been an unexpected emotional toil. Reading report after report about black men who have been diagnosed with a mental illness, detained, injured and killed in twenty-first century Britain has been an emotional challenge. Knowing that this occurs at the hands of the police who have a duty to serve and protect and nursing staff that have a duty of care makes it even more appalling. The notion that successive governments have failed to implement recommendations from reviews and inquiries that might have saved lives is nothing short of diabolical. Despite the knowledge emergent from research, reports, reviews and recommendations, there is a continuance of the disproportionality faced by black people in mental health and CJS.¹

As I write I wonder what difference this chapter can make in the midst of the existing plethora of text that have failed to ignite a response from those with the power to end this phenomenon of what is essentially a legitimised racialisation of mental health and lawful killing of black men. That said, I continue, believing that I have a duty to contribute to the discourse until these experiences are no longer a ‘dirty secret’ which remain unresponded to. In this chapter my discussions focus largely on the experiences of black men as they are more likely than woman to encounter the phenomena of a mental health diagnosis, detention and death in a forensic setting. I will briefly explore reasons given by other researchers for the over representation of black people with mental health issues before offering my own theoretical interpretation which is a combination of systemic racism influenced by post-colonial conceptualisation.

Over-representation in Mental Ill Health and Custody

Sharpley, Hutchinson, McKenzie, and Murray (2001) note how after the large-scale migration of people from the Caribbean to the UK in the 1950s, only a decade later research indicated an over representation of those migrants being diagnosed with schizophrenia. To contextualise the scale of the over representation, Xanthos (2008) states that in any given country schizophrenia typically affects 1% of the population. Yet Hickling (2005) identified a 6- to 18-fold elevated rate of diagnosis amongst the black population in the UK. A larger scale study reported a year later found a ninefold increase in the risk of black people developing schizophrenia with an increased risk of 1.4 for South Asians when compared to the white British population (Fearon et al., 2006). Tortelli et al. (2015) found statistically significant higher incidence rates in the black Caribbean group, present across all major psychotic disorders, including schizophrenia and bipolar disorder. Stevenson and Rao (2014) found despite

controlling for the social and economic factors known to influence wellbeing, there appears to be a residual, non-random difference – with people from Black and Minority Ethnic (BME) communities reporting lower levels of wellbeing than their White counterparts. (p. 12)

Since 2005, the Care Quality Commission conducted an annual census in relation to people from specific ethnic backgrounds experiencing mental ill health. Their last survey concluded that people from Ethnic Minorities remain disproportionately represented on mental health wards with no signs of this reducing (Care Quality Commission, 2011). The census identified that rates of hospital detention were between 19% and 32% above average for people with mental ill health from black Caribbean, black African and mixed white/black groups. This was two times higher than the average for 2010. Supporting these findings, the Health and Social Care Information Centre (2016) found Black or Black British people were the highest proportion of ethnic minority groups who had spent time in mental health hospitals in the year 2014/2015.

The over representation of mental ill health amongst black people also permeates throughout each juncture of the CJS. The Ministry of Justice (2015) state:

In general, Black, Asian and Minority Ethnic (BAME) groups appear to be overrepresented at most stages throughout the CJS, compared with the White ethnic group … with little change in relative positions between ethnic groups. (p. 7)

Thornicroft (2006) found 10% of black patients in forensic settings have not committed a crime, they have been admitted to these units from general psychiatric wards. A decade later the European Commission against Racism and Intolerance Report (ECRI, 2016) noted an increase whereby black people are 50% more likely to be referred to the psychiatric services via the police than white people. Singh et al. (2014) argue that ethnicity acts as a predictor of the high levels of mental health detention amongst black people. A variety of reports and research demonstrate this point. For example, the Bradley report (2013) identified

BME communities are 40% more likely than White Britons to access mental health services via a CJS gateway (Bradley, 2009). Black people, in particular, are more likely to experience higher compulsory admission rates to hospital, greater involvement in legal and forensic settings and higher rates of transfer to medium and high security. (p. 4)

The findings from the Bradley report echo what was reported 10 years prior in the Bennett Inquiry (2003). They reported that black patients are more likely to be restrained, more likely to be secluded and more likely to be prescribed medication than any other group. These patients are also less likely to be given psychological treatment rather than physical treatment. Fitzpatrick, Kumar, Nkansa-Dwamena, and Thorne (2014) noted

The most egregious inequalities in mental health care continues to be the overrepresentation of black men at the ‘hard end’ of services at point of arrest, in prison and within secure treatment. In its most extreme form this is represented by repetition of deaths in custody under restraint. (p. 8)

INQUEST (2015) suggests deaths of people in mental health detention make up 60% of the overall death in any type of custodial setting. They posit the high incidence of these deaths are amongst black people and are concerned that institutional racism is a contributory factor.

Findings from INQUEST’s casework demonstrate the disproportionate number of people from BME communities die in or after detention in police custody following the use of force. From 1990 to 2017 there have been a total of 94 BME deaths in police custody, 13 of which have been shootings within the Metropolitan Police Service. In other constabularies in England and Wales there have been 76 BME deaths; three of which have been shootings. During the same period there have been 247 self-inflicted BME deaths and 203 non- self-inflicted deaths (excluding natural deaths) in prisons in England and Wales (INQUEST, 2017). The Angiolini Report confirmed

The Government has acknowledged that there is ‘significant overrepresentation of Black, Asian and minority ethnic (BAME) individuals in the criminal justice system’ and that ‘disproportionate number of people who have died following the use of force were from BAME communities’. (p. 84)

The combination of these statistics demonstrates the over represented of black people in relation to mental health, the CJS and the likelihood of death (excluding natural causes) when in the CJS. A variety of reasons for this racialisation of mental health have been offered by different researchers.

Reasons for Over Representation

Sharpley et al. (2001) found theories explaining the reasons for increased rates of black people diagnosed with mental health issues ranged from genetic predisposition, migration factors, cannabis use, social disadvantage to racism. Singh et al. (2014) suggest racial discrimination still remains the most studied variable in mental health disadvantage for Bla...