Dear Neil and all interested,

The following are two paras in the 2014 version (which I still have on file). I would think they are differently in the 2017 version. Perhaps other changes too in other parts. Also I am told there is an explanation of sorts under ‘Acknowledgments’ in the new version. http://www.bps.org.uk/networks-and-communities/member-microsite/division-clinical-psychology/understanding-psychosis-and-schizophrenia

1.3 Our different cultures

People in different cultures describe problems in different ways. For instance, distress that in some

cultures might be described in terms of physical pain or discomfort might be thought of in others

as depression or anxiety. The ways that people explain their experiences might also vary between

cultures. Unpleasant or upsetting experiences are often explained using beliefs that are common in

that particular culture: examples might be ghosts, evil spirits or aliens. Sometimes explanations

used by people from ethnic minorities or from particular subcultures seem very strange to people

from majority cultures. This can lead to misinterpretations if the context is not understood. For

example, someone from a culture where many people believe in the possibility of demon possession

might believe that he or she is possessed. In trying to help someone, we need to take into account

not only their distress but also the circumstances that they find themselves in, their response to

those circumstances and their upbringing and cultural background

6.3 Inequality, poverty and social disadvantage

We all deal with many stressful events in our lives. The normal and inevitable cycles of childhood,

adolescence, gaining or not gaining qualifications, employment, relationships and the end of

relationships, disease and death affect us all. These major life events are often stressful. In addition,

ongoing stress can affect us – overwork, poor housing, financial difficulties, relationship problems

and so on. And all these pressures are worse if you’re poor.

Stress and poverty impact significantly on mental health, leading public health researchers to refer

to the ‘social determinants’ of mental health problems. In the words of a review for the World

Health Organisation: ‘No group is immune to mental disorders, but the risk is higher among the

poor, homeless, the unemployed, persons with low education…’ Recent research in London19

suggested that two of the three main risk factors for developing distressing psychosis were

deprivation and the experience of living in dense, urban environments. The researchers suggest that

‘the urban environment can modify brain function in adulthood in response to stress’. Interestingly,

the third risk factor was inequality – poor people living in neighbourhoods where richer people also

lived, tended to do worse than those living in neighbourhoods where most people had a similar

income. This finding is similar to those of researchers Richard Wilkinson and Kate Pickett, whose

book The Spirit Level 20 presented evidence that rates of mental health problems are higher in

unequal countries – those with larger gaps in income between rich and poor, such as the UK –

than in countries that are more equitable, for example Norway.

People from migrant groups, particularly people of African and African-Caribbean origin living in

the UK, are much more likely than White British people to be diagnosed with schizophrenia,21 even

though rates in their home countries are generally similar to those in the UK. At least part of the

reason for this is likely to be the social disadvantage and deprivation that they often experience.

This is a complex issue: people from these groups are more likely than others to experience distress,

but even where their actual experiences or ‘symptoms’ are similar, they are also more likely than

others to receive a diagnosis of schizophrenia.22

Best wishes,

Suman

Suman Fernando

From: Sanyal, Neil [mailto:[log in to unmask]]
Sent: 23 June 2017 15:35
To: 'SumanFernando2'
Subject: RE: RE-issue of "Understading psychosis and schizophrenia" Institutional racism

Here is the main text in the hyperlink:

Press Coverage, Discussion and Debate

Summary leaflet (2016)

Executive Summary

This report describes a psychological approach to experiences that are commonly thought of as psychosis, or sometimes schizophrenia. It complements parallel reports on the experiences commonly thought of as bipolar disorder and depression.

Hearing voices or feeling paranoid are common experiences which can often be a reaction to trauma, abuse or deprivation. Calling them symptoms of mental illness, psychosis or schizophrenia is only one way of thinking about them, with advantages and disadvantages.
There is no clear dividing line between ‘psychosis’ and other thoughts, feelings and beliefs: psychosis can be understood and treated in the same way as other psychological problems such as anxiety or shyness. Significant progress has been made over the last twenty years both in understanding the psychology of these experiences and in finding ways to help.
Some people find it useful to think of themselves as having an illness. Others prefer to think of their problems as, for example, an aspect of their personality which sometimes gets them into trouble but which they would not want to be without.
In some cultures, experiences such as hearing voices are highly valued.
Each individual’s experiences are unique – no one person’s problems, or ways of coping with them, are exactly the same as anyone else’s.
For many people the experiences are short-lived. Even people who continue to have them nevertheless often lead happy and successful lives.
It is a myth that people who have these experiences are likely to be violent.
Psychological therapies – talking treatments such as Cognitive Behaviour Therapy (CBT) – are very helpful for many people. In the UK, the National Institute for Health and Care Excellence recommends that everyone with a diagnosis of psychosis or schizophrenia should be offered talking therapy. However most people are currently unable to access it and we regard this situation as scandalous.
More generally, it is vital that services offer people the chance to talk in detail about their experiences and to make sense of what has happened to them. Surprisingly few currently do. Professionals should not insist that people accept any one particular framework of understanding, for example that their experiences are symptoms of an illness.
Many people find that ‘antipsychotic’ medication helps to make the experiences less frequent, intense or distressing. However, there is no evidence that it corrects an underlying biological abnormality. Recent evidence also suggests that it carries significant risks, particularly if taken long term.
The British Psychological Society believes that services need to change radically, and that we need to invest in prevention by taking measures to reduce abuse, deprivation and inequality.

· Understanding Psychosis and Schizophrenia - Launch Event

· The power point and pdf versions of the 2014 inaugural launch of the Understanding Psychosis and Schizophrenia document is free for PCMH members to use in service of disseminating and supporting the use of the document’s content. PCMH Members may wish to adapt the presentation to suit local needs. We expect the original author Anne Cooke and the Faculty to be referenced. We trust that the principles of keeping service users, carers and friends at the heart of your work, promoting a psychological framework as well the values of recovery, social inclusion and appropriate interdependence is adhered to in any amended presentations.

The above is what @I was referring to.

Neil

Neil Sanyal
Social Worker/AMHP
Adult Mental Health New Forest Substance Misuese Social Care Team
Lymington Area Office

Lymington

Hampshire
SO41 9YB
Tel: 01590 625120

[log in to unmask]

From: SumanFernando2 [mailto:[log in to unmask]]
Sent: 23 June 2017 14:16
To: 'Rachel Roche'; Sanyal, Neil
Subject: RE: RE-issue of "Understading psychosis and schizophrenia" Institutional racism

Dear Neil,

Hope the issue is now sorted out! I am having trouble with Internet Explorer so cannot check. I must say the explanation given could have been more specific. Some of the wording under the heading of ‘culture’ was changed I think. I was not directly involved in advising Anne on wording but I think she tried hard to get it right but had to submit to direction from DCP.

I believe at one time, DCP wanted any changes made to address all the seven ‘protected characteristics’ in equalities legislation—the discourse re ‘intersectionality’ too perhaps!

Suman

From: Rachel Roche [mailto:[log in to unmask]]
Sent: 23 June 2017 13:58
To: SumanFernando2; [log in to unmask]
Subject: Re: RE-issue of "Understading psychosis and schizophrenia" Institutional racism

Hi Neil,

You can download the doc from the website, by clicking on the image of the document.

http://www.bps.org.uk/networks-and-communities/member-microsite/division-clinical-psychology/understanding-psychosis-and-schizophrenia

Underneath this there is a statement that says

"This revised version published in 2017 includes amendments addressing the specific issues experienced by people from black and minority ethnic communities in relation to psychosis, and also the relationship between psychosis and social inequality more generally. Other critiques of the report will be addressed in future editions. This revised version of the original edition is dedicated to contributor Steve Onyett who sadly passed away in 2015. His contribution to improving mental health care was immense. We miss you Steve.

Our previous public information document "Understanding Bipolar Disorder", edited by Steven Jones, Fiona Lobban and Anne Cooke is also downloadable for free."

Hope this helps.

Best wishes,

Rachel

On 23 June 2017 at 13:30, SumanFernando2 <[log in to unmask]> wrote:

Dear Neil,

Thanks for pointing this our - I am not really surprised I have not had time to study the substance of the link she sent me (with request to circulate) - been very busy and also with computer problems. I get the feeling that Anne herself is under the ‘rule’ of institutional direction (DCP exec I think).

May I send your e-mail to Anne Cooke for comment - either with or without you name?

Best wishes,

Suman

From: Health of minority ethnic communities in the UK [mailto:[log in to unmask]] On Behalf Of Sanyal, Neil
Sent: 23 June 2017 12:08

To: [log in to unmask]
Subject: Re: RE-issue of "Understading psychosis and schizophrenia" Institutional racism

Just tried to look at the Anne Cooke document via the link Suman sent below but only downloadable to BPS members. The headline summary in the link itself does not refer to anything related to BME issues or discrimination – one could have assumed that it was no different to the 2014 original. Indeed in the notes at the bottom there are instructions for people who do presentations on this document to use the original 2014 one she did at the original launch!! Perhaps it has been integrated into all the themes referred to in the summary. I certainly hope so otherwise Anne Cooke’s work since 2014 might have wasted!!

Perhaps I have misunderstood it all. If someone could enlighten me on how Anne Cooke has changed the slant of the original document to acknowledge the allegations of discrimination and ignorance of BME issues and agenda in the original document I would be grateful.

Neil

Neil Sanyal
Social Worker/AMHP
Adult Mental Health New Forest Substance Misuese Social Care Team
Lymington Area Office

Lymington

Hampshire
SO41 9YB
Tel: 01590 625120

[log in to unmask]

From: Health of minority ethnic communities in the UK [mailto:[log in to unmask]] On Behalf Of Hanif Bobat
Sent: 22 June 2017 22:27
To: [log in to unmask]
Subject: Re: RE-issue of "Understading psychosis and schizophrenia" Institutional racism

Dear Suman,

Since when have publishers not been commercially driven !!

Look forward to reading your new publication.

Sent from my iPhone

On 22 Jun 2017, at 11:11, SumanFernando2 <[log in to unmask]> wrote:

Dear All,

Readers may remember that in November 2014 the DCP (Division of Clinical Psychology) (part of BPS) published “Understanding psychosis and schizophrenia”. It was written by a number of clinical psychologists and issued by DCP with book-launches in London, Scandinavia and USA. There were protest from a few people (including three I believe on this list) on grounds of (for example) the report not addressing experiences of black people; being written entirely by white clinical psychologists with BME psychologists not even being told about it and not invited to its launch; and the DCP’s own Faculty of Race and Culture having been abolished without consultation just before the report was commissioned. There is some information on the story of the 2014 report on my website - http://www.sumanfernando.com/news.html

Anne Cooke the editor has asked me to publicise the fact that the report has now (June 2017) being -re-issued with changes to meet objections - www.understandingpsychosis.net

I know that Anne Cooke, with one or two people who have helped her, has been through a very difficult time indeed getting DCP to agree (and fund) the revised version. The problem of institutional racism (systemic racism) within clinical psychology appears to persist, but hopefully now there are psychologists working within the system to try and redress this. If some of us had not spoken up in public nothing would have changed at all. In my view, few professionals do actually want to be racist themselves but the systems we work with drive us into this sort of behaviour. Incidentally, I have used this story with several others in discussing institutional racism in a new book to be published in September 2017— https://www.palgrave.com/gb/book/9783319627274 (I am sorry it is initially so expensive - publishers these days are commercially driven ++).

Suman Fernando

WEBSITE: http://www.sumanfernando.com

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