What is considered as sane or insane behavior, mental health or mental illness, normal or abnormal behaviour is therefore always in relation to a white normative standard. These standards are applied to black people and result in increased rates of misdiagnosis. The Eurocentric approach does not take into account cultural and language differences and how black people express their inner feelings. For instance how can a white middle-class psychiatrist know how a young Afro / Caribbean man expresses grief, distress and anger or how a young woman deals with depression?
In the earlier days of Eurocentric practice, diagnosis like drapetomania ( enslaved Africans escape behavior ) was considered as a disease of mind. Dyaesthesia Aethiopica ( resistance to enslavement ) was seen as hebetude of mind. It was also argued that ‘freed slaves showed a much greater proneness to mental disorder because by nature the negro required a master’ (Thomas and Sillen, 1972). One author ( W.P. Rushton, 1987 ) claimed black people are genetically more likely to have lower I.Q’s, be more criminal, more likely to go mad and less sexually restrained than whites because of their differing evolution. This kind of misrepresentation of black people continued and matured in the Eurocentric approach. This has been very damaging to the health and welfare of blacks.
During the late 1960s and early 1970s official policy changed from one that ‘excluded’ black settlers by denying them the basic rights of citizenship, to one that ‘ incorporated’ them. Social unrest at the time lead to concessions through welfare, but rather than offering care, the psychiatric services have been seen as a basically custodial system which involves powers of custody and coercion. Psychiatry acts as social control.
Many blacks mistrust the psychiatric services which they see as coercive and unhelpful in their needs. The majority of decision makers at every stage of treatment, from the initial contact with patients to their ultimate discharge from treatment, are white. Black people who have been victims of discrimination and oppression in a culture that is full of racism have good reason to be suspicious and mistrustful to white society and the service they offer.
The vast bulk of people admitted into psychiatric care voluntarily seek help, the situation for the majority of black people is very different. Compulsory admission is very common. Links between psychiatry, police, prisons, courts, have identified it as a form of social control. Social Control has been made sense of in terms of the broad underlying inter-connections between psychiatry and other aspects of the welfare state, such as, education, social work and general medical practice.
A disproportionate number ( 4-6 times higher than whites ) from people of ethnic minority are diagnosed as suffering from schizophrenia or other forms of psychotic illness. Afro-Caribbean’s are particularly likely to be detained under section 136 Mental Health Act and there is a large number of young Afro-Caribbean males admitted under compulsory detention into psychiatric hospitals and 12 to 13 times more likely to be diagnosed as schizophrenic. For one group interviewed, there was a high level - 80% - of compulsory admission. Nearly half of this number were referred by the police, social workers and GP’s.
Police were reported to have initiated the referral of a further 20% of the sample via section 136 of the MHA compared to only 12% by social workers and GP’s. The police can remove a person who appears to be suffering from a mental disorder from the public to a place of safety which will be in most cases the police-station. Black patients feeling deeply embarrassed and upset about the police coming to their home and escorting them to hospital. The contact with the police leaves most distressed and disturbed and patient who were seen and discharged expressed resentment of this procedure and said the experience stayed with them for years.
The person can then be held for up to 72 hours and will be seen in that time from a social worker who is usually not trained to deal with the ethnic minority and experienced enough to give a proper assessment, which then will be passed on to the psychiatric hospital. With this assessment and the fact that the police was involved it is highly likely the diagnosis will be wrong.
There is also strong evidence that they are more likely than white patients to receive harsh and invasive forms of treatment such as intra-muscular medication, tranquilizers, chemotherapy and electro-convulsive therapy. They are also likely to be given more powerful drugs in higher doses. Section 62 allows a doctor to increase the dosage of medication over and above the maximum recommended dosage laid down by the British National Formulary. It has been stated that someone in a mental hospital has even fewer rights than a prisoner.
Hospitals like other organizations have a need for internal order and efficiency. Drug based treatment is relatively cheaper than labour-intensive psycho therapy and this is why drug based therapy is so important for them and the trend towards deinstitutionalisation or community care. The use of drugs helps to reduce the overall number of psychiatric beds and to increase out-patient services. ‘Community Care’ in reality means, once a month a visit from the ‘community psychiatric nurse’ to make sure you are taking your medication and sign on. White patients are more likely to receive treatments such as psychotherapy and counseling.
Social workers have to take into account class, marital status, geographical location, culture, race, gender, social experiences, and life events. It is taken for granted that the extended family will be able to care for their relatives. They need i.e an understanding of the rituals which surround bereavement to prevent misinterpreting behaviour at a Bengali community. For example the culture has burial procedures designed to allow people to grieve fully. These include not leaving the house for 40 days following the death of a husband. If his family ships the body home immediately after the death, the spouse is robbed of the grieving process, and the grief often manifests it self in depression (Vimala Uttarkar in Kendra Sone’s article ).
It is often believed that physical affection is not acceptable in Asian communities, particular not in front of children. Often Asians express fears that their religious and dietary needs will not be taken seriously in account if they are admitted to hospitals. The biggest threat for them is if the wider community know about the illness and us a result of that ostracized the family. Honor and reputation is very important for the Asian family and the strength of their feelings about it taken into consideration. Hospitalization on the Indian sub-continent and the Caribbean is commonly seen as a punishment because of the thought, that psychiatric hospitals are still seen as a mental asylum. Social Service fails to protect the interest and wishes of these clients and to inform them in their own language about the service they deliver and not in English only.
In recent years quit a few number of organizations and groups have come up to improve the service. In Brixton 1983 a befriending agency ( Afro-Caribbean Mental Health Association ) has been set up to solve practical problems and offering different types of therapy and counseling. Also aiming for user friendly service to clients with racial and cultural needs, better assessment and more access to non medical treatment.Nafsiyat another organization encourages patients to identify the source of their own illness and tries to develop individual treatment for each person.
Focusing on restoring the self image and self esteem of black people who have suffered from racism is the aim of the ‘survivor group’ in Bristol’s Inner City Mental Health Project.The Harambee Housing Association and the Core and Cluster Mental Health Project in Birmingham offers counseling and housing to people caught up in the vicious cycle of homelessness and psychiatric hospitals. The project deals with self-esteem , loss of communication skills, rejection by family, inability to seek help or support and lack of appropriate and stable accommodation. There should be a range of services run by black organizations to make many black clients feel better for reasons of language, identity and culture. They feel better cared for in such environment.
Social Service should review their procedures to ensure they do not discriminate against black clients. Consult community groups, black clients, professionals to discuss and create non-patronizing therapeutic programs, establishing equal opportunities practices, establishing forums that reflect and address racism within the client and staff groups. Professionals involved in mental health need more training, urgently. More energy and resources should be directed towards the most disadvantaged people. To identify the needs of the black community and provide an ethnically sensitive service.
Social workers should participate in any aftercare rehabilitative program which would prevent people from being returned to hospital again and again. After implementation of policies in 1978 from Social Service Departments, local authorities has been slow, patchy and without any strategy. No or little advance has been made since. A speedy response is required to change the present situation.
Bromley and Longino, 1972 Profession?
An Examination of Racism social Work
Lena Dominelli ( Article )
Thomas and Sillen, 1972 Psychology for Social Workers
Black Perspectives
Routledge and Lena Robinson p.137
W.P. Rushton,1987 Mental Health
Issue 2, 1992 ( Article )
Vimala Uttarkar Community Care 27.Feb.1992
Pratice: Mental Health
Kendra Sone ( Article )
