As a non-clinician, but someone with an interest in the area, frankly this is yet another example of structural discursive violence - entire communities, their histories AND current experiences have been quite simply dismissed as irrelevant. The issue is not that every mental health phenomenon is raced, but rather, as everyone except perhaps the authors of the report seems to know, experiences of subjugation rarely occur on a single dimension. For people in groups who continue to be in racialised minorities, mental health intersects with a whole range of experiences of inequality. To ignore this is not simply an over sight, it IS the problem. The report is a very clear statement, in fact it is a powerful communication to all of us about the state of 'race thinking', and the and mental health, and the nature of those institutions which have the power to legitimate people's experiences. It looks likes, in 2014, after all the research and writing, activism and campaigning that professionals and service users have carried out, the authors of this report decided that some voices really do not need to be heard or even represented. I really hope that this is not the end of the matter.
Harshad Keval
-----Original Message-----
From: Health of minority ethnic communities in the UK [mailto:[log in to unmask]] On Behalf Of MINORITY-ETHNIC-HEALTH automatic digest system
Sent: 15 December 2014 00:03
To: [log in to unmask]
Subject: MINORITY-ETHNIC-HEALTH Digest - 12 Dec 2014 to 14 Dec 2014 (#2014-24)
There is 1 message totaling 748 lines in this issue.
Topics of the day:
1. Division of Clinical Psychology seems to exclude BME experience
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Date: Sun, 14 Dec 2014 19:21:59 -0000
From: Suman Fernando <[log in to unmask]>
Subject: Re: Division of Clinical Psychology seems to exclude BME experience
Perhaps we should not be too concerned about the ethnicity of who benefits as individuals and who does not from DRE and other activities (such as production of report) that are meant to improve mental health services - and these services are for everyone. The DCP report "Understanding psychosis and schizophrenia" is meant to help and guide service users and professional working in mental health services, and from what had been said at the launch of the report and on blogs, white service users and some clinical psychiatrists find it a great advance. In fact I too agree that the report says much that is useful to many people - but it ignores that our society consists of many different groups and in the case of diagnosis of 'schizophrenia' black people are adversely affected and there has been a vast literature exploring why. It's as if BME people do not exist and do not have needs and problems that are specific to them - perhaps mainly because they are seen as a different 'race' - i.e. because of racism. In fact I think that when this DCP report does refers rather obliquely (paragraph 6.3) to the fact that 'schizophrenia' is diagnosed more often in 'migrant groups' of 'African and African-Caribbean origin' the report play it all down as a problem - appears to have not bothered to look at the large literature exploring this issue of 'over-representation' and gives false information about this issue so that racism is not (according to the report) implicated. (The report says wrongly without a reference that the 'rates in their home countries are generally similar to those in the UK' - it seems the all-white authors of the report think that all black people have 'homes'
in other countries - implication being they should go where they come from!
[In fact if the authors had looked at the literature they would have found that the over-diagnosis is not in 'migrant groups' (as the report says) - most recent migrants being white people such as Polish people - but more so among black people born in UK even when compared to black people who were migrants; and the rates among black people in the West Indies is lower than that among white people in UK and much lower than among black UK.]
So, I agree with Paul's contention that that our MH systems seem to exclude people 'born into the body politic' (by which I assume BME service users who are experts by experience and professionals - black and white - who have worked out ways of improving practice over years of application) and those who challenge poor practice (in addressing race and culture I assume - again, whatever their ethnicity). What seems to have happened is that there is an exclusion of black voices and what are seen as 'black issues' and exclusion of people seen as not worthy of being part of British society. Re DRE, my view is that the Inside Outside report which preceded it did try to address racism but the DRE (although called 'Race Equality') changed the issue to one of 'culture' and so the strategies were about engaging 'different cultures' and the approach of empowering BME groups (of Inside
Outside) was changed to engagement of cultural groups. This was pointed out to Kamlesh Patel at the time but he did not listen but instead resigned from leading it and proper leadership never emerged etc. etc. leaving individuals at grass roots struggling to do whatever they could.
Best wishes,
Suman
Suman Fernando
WEBSITE: http://www.sumanfernando.com
From: Health of minority ethnic communities in the UK [mailto:[log in to unmask]] On Behalf Of Sanyal Neil
Sent: 12 December 2014 18:23
To: [log in to unmask]
Subject: Re: Division of Clinical Psychology seems to exclude BME experience
Sorry I have come to this thread so late on but I have been inundated with work pressures!
In response to Paul's questions and thoughts about what DRE threw up I found myself agreeing with his central tenet that all it did was bring some marginalised BME workers into mainstream management jobs. In fact through five years of hard work I put into DRE from my CMHT base in Hampshire I got to know several of those people he is referring to. However, they are not white female staff but BME female staff who have gone on to take prominent positions in NHS organisations. Other BME people involved in senior positions in DRE have gone on to make good careers in the private health sector and I'm glad they have managed it. Meanwhile, the actual BME people who DRE was meant to have helped are not much better off than they were prior to 2005 when it started.
On the point of IAPT where Paul says he wonders if most of the staff are white females. In Hampshire that is exactly the case for the Step 3 project run by Southern Health Trust and was the case for the Step 2 project run buy Solent Mind. However, the manager who took over recruitment of that project a year after it started managed to recruit a whole cross section of BME people to reflect languages and cultures represented in our local populations and this was a great (and unusual) success. This was only because that manager (a white British ex-qualified CPN), who I have known for 15 years, is dedicated to Equality and Diversity issues. So the whole point is that where White British workers have taken the issues on board they can achieve brilliant results that can meet the mental health needs of BME populations.
I agree with all the other people on this thread about the recently published DCP report. I think they have contemplated not covering BME issues and needs because this government have driven the E&D agenda to the very edges of policy and legislation and financial cuts have achieved the rest!!
They may well have thought that E&D no longer needs to be covered any longer.
Neil Sanyal
From: Health of minority ethnic communities in the UK [mailto:[log in to unmask]] On Behalf Of Paul
Sent: 07 December 2014 19:59
To: [log in to unmask]
Subject: Re: Division of Clinical Psychology seems to exclude BME experience
Dear Colleagues,
I am not surprised, but recognise the journey travelled over the past 30 years is odd. The body politics erratic swings to the left and right seem designed to facilitate xenophobia, whilst specific demographics remain locked into marginalisation.
The DRE programs so called mainstreaming agenda appears to have produced the outcome of sanitising particular forms of institutional racism. BME grassroots work has been systemically devalued by so called mainstream institutions, charities, educational institutes, and, BME driven definitions of the terrain have been systemically fragmented and confused.The DRE program appears to have done little more than generate a career path for some marginalised workers to the mainstream. I would hazard a guess that most of these were white and female, with a liberal scatter of black males playing roles on par with security guards/ traffic wardens. What would a look at the staffing of IAPT programs reveal? more sanitising of racist practices! Is it any wonder that BME people cannot trust mainstream institutions, with such a track record of flaws, and pervasive dissonance, regarding the integrity of white male led institutions.
Today white females and recent migrant males are used to give an appearance of equity in mental health institutions. Whilst the experiences of people who were born into the body politic, and have instinctively challenged poor practice remain on the edge.
UK institutions need to face up to the challenge, or, become scientifically and historically redundant. Human society is not white european, neither is science. Science without a sound evidence base has little future. Where teams of so called eminent researchers cannot effectively evidence their work, because the politics of the day obstructs their perspective, they have chosen the path of scientific redundancy (I.e. contracts first science second).
Please please please could someone tell me I am mistaken, that I have carelessly overlooked significant phenomena. Please tell me there is a dynamic DRE legacy of Community Development Workers knowledge, significantly impacting on outcomes for mental health stakeholders. Please tell me I have overlooked important factors, and that the emerging' parity of esteem'
agenda will be shored up for all mental health service users, not just the usual suspects.
_____
From: Suman Fernando
Sent: 05/12/2014 19:04
To: [log in to unmask]
Subject: Re: Division of Clinical Psychology seems to exclude BME experience
Good to have your views David and to have Mark's. The editor of the report has apologized for excluding BME voices and says that she will send us a formal apology from DCP that can go on websites, blogs etc. You may wish to follow Phil Thomas' blog in which several member of DCP have joined in at- http://www.madinamerica.com/2014/12/dcpbps-report-understanding-psychosis-sc
hizophrenia-fatally-flawed/
Thanks David very much for the link to your monograph. I have seen it before but forgotten (memory!) and it will be very useful when / if I come to collaborate with DCP is somey over a new report. It describes the current state of scientific knowledge set in context. Our point that DCP report remains within the box of 'scientific' psychology is a good point, since people have been claiming apparently (at the launch of the report) that it breaks new ground with a new paradigm etc.
Suman
From: Health of minority ethnic communities in the UK [mailto:[log in to unmask]] On Behalf Of Ingleby, J.D.
(David)
Sent: 05 December 2014 16:39
To: [log in to unmask]
Subject: Re: Division of Clinical Psychology seems to exclude BME experience
Dear all,
This is indeed a very odd publication. In itself, the view of psychosis that it puts forward is a very sympathetic one, but it's also amazingly blinkered. The report is an "update" of one published in 2000, but it manages to ignore major developments that have taken place since then. Not only (as many on this list have pointed out) the heightened controversy about racism and psychiatry in the UK, but also a whole line of European and North American epidemiology focusing on "psychotic symptoms" and social factors.
In 2008 I wrote a monograph trying to relate the latter two developments to each other. Maybe the attempt was not very successful, but my review did manage to show that the association between membership of a marginalised ethnic group, diagnoses of psychosis and coercive methods of treatment could be found not only found in England but also in a whole swathe of countries including Belgium, the Netherlands, Denmark, Sweden, the USA and Israel.
(The monograph is available at http://bit.ly/12ys4cM .)
From the start, the "hearing voices" movement has always represented a welcome challenge to biomedical reductionism, but this report remains safely within a psychological silo. There is a tiny section (6.3) on "inequality, poverty and social disadvantage", but that's the only glimpse we get of the wider world outside.
Sad to say, this is entirely typical of psychology today. Mrs. Thatcher ("there's no such thing as society") would have loved it........
A good weekend to all -
David
________________________________________
Van: Health of minority ethnic communities in the UK [[log in to unmask]] namens M & M Johnson [[log in to unmask]]
Verzonden: vrijdag 5 december 2014 12:14
Aan: [log in to unmask]
Onderwerp: Re: Division of Clinical Psychology seems to exclude BME experience
I am ABSOLUTELY AMAZED by this report - thanks Suman et al for bringing it to our attention.
I have been out of the country - and finding that in some respects, Italy seems to be getting further ahead in its recognition of Diversity in health care than UK which is swimming backwards rapidly.
Having read the report - very rapidly - I cannot quite see what its point is? I guess it is written from the point of view of Clinical Psychology rather than psychiatry, and maybe as much for 'users' & 'Carers' as for professionals, although there are some bits about what 'we' should do.
There is also a VERY slight nod in the direction of culture - in that a Maori quote is used (p13) and reference to normative / ethnic minority cultures of explanation (p14). On p33, somewhat insultingly, I suspect, the labels 'lunatic'/'psycho' are contrasted with racist labels used. The only reference to the issues that concern US, seem to be on about page 45, where the AESOP research (2006) is properly cited, and also a S Fernando (2003).
It seems amazing in view of the disproporionate labelling that they do refer to among AfC/Black people, that they don't then proceed further along this line. Maybe Clinical Psychology is still the white-island that I recollect Zenobia Nadirshaw discussing many years ago at the BPS! She is still active and must demonstrate that there should be some awareness of these issues in the discipline - but...
Where are all the other references on the subject? Dinesh seems to be the only other BME-focused author cited, and only briefly on the subject of religion (which they never really get to grip with: there are actually several faiths to consider!)
Overall, I feel this was a very weak report, and would not have passed MY peer review scrutuny! Not that I was asked.
On the point made by Anil and others about BME exclusion from research:
well, this is a very well described and discussed issue - ever since Mahvash Hussain-Gambles paper etc, and others since then I have tried to suggest that any treatment trialled only on a white / selective population should carry a health warning, but maybe we are not ready to recognise what the majority world population is - perhaps because it isn't the market for the majority of pharmaceuticals. hey ho
Institutional racism, as per the Macpherson definition, is very clearly evident, but unfortunatly, not yet criminalised!
Best wishes in the struggle
Mark J.
Prof. Mark R D Johnson
Emeritus Professor of Diversity in Health & Care, MSRC / CEEHD, De Montfort University, Hawthorn Building The Gateway, Leicester LE1 9BH
(Editor) Diversity & Equality in Health & Care http://www.ingentaconnect.com/content/rmp/dehc
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End of MINORITY-ETHNIC-HEALTH Digest - 12 Dec 2014 to 14 Dec 2014 (#2014-24)
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