Blacks failed by our 'racist' system of care for mentally ill

Sufferers from ethnic minorities are more likely to be locked up than given proper treatment, reports Sophie Goodchild

Frank Bruno is not the first black celebrity whose life has been blighted by mental illness. Trisha Goddard, the chat show host, has admitted that she has been in a psychiatric hospital and has twice attempted suicide. Mercury Music Prize winner Ms Dynamite has also talked openly about her depression.

Their cases made headlines because of their public profile, but for every Frank Bruno or Ms Dynamite there are thousands of black men and women who pass through Britain's mental health system, and their largely negative experiences go unreported.

Ethnic minority groups in Britain are far more likely than their white counterparts to be diagnosed with psychiatric disorders. Women born in India and East Africa have a 40 per cent higher suicide rate than those born in England and Wales. Young African-Caribbean men are particularly vulnerable. They are up to 10 times more likely than white people to be diagnosed with schizophrenia.

Mental health reformers say these alarming statistics are indicative of the fact that black people are victims of a system which is institutionally racist, that their more severe symptoms are often misinterpreted by psychiatrists who wrongly perceive these patients as dangerous.

Psychiatrist Dr Aggrey Burke, a specialist in deprivation and mental illness in ethnic minority families, said psychiatrists pigeonhole black people as difficult and therefore in need of restraint, not healing. "You look at Frank Bruno - 10 police officers to restrain him," said Dr Burke, a senior lecturer in the department of mental health sciences at St George's Hospital medical school in London.

"This is partly due to seeing blacks as dangerous. There is this mind-set that the black population is tricky, difficult to deal with. The Government has not attempted to understand the root issues which are poverty and deprivation."

Dr Burke also criticises the huge disparity in the standards of treatment that can be expected by white people and those from ethnic minorities. Afro-Caribbeans are seven times more likely than white people to be sent to medium-secure units. The majority of patients on any locked secure hospital ward in London will be young, black men. Instead of receiving therapy, they will be given the "liquid cosh", the term used to describe the powerful sedatives used to subdue psychiatric patients.

The fact that many health practitioners are biased towards containing black patients instead of curing them was highlighted in a report called Inside Outside which was the first Government-backed study into the mental health care provided for black and ethnic minorities. It found that the service was institutionally racist, that the whole issue of ethnicity within mental health services had become marginalised or even ignored and that these problems were getting worse.

The report confirms fears that mentally distressed black people are more likely to be locked away. For example, it reveals that rates of compulsory admission are markedly higher for black and minority ethnic groups in comparison with whites and that black and ethnic minority patients are more likely than white people to be assessed as requiring greater degrees of supervision, control and security.

So damning were the findings of Inside Outside that they prompted a special debate in Parliament and led the Conservatives to call for an independent inquiry into ethnic minority care.

The author of the report was Professor Sashi Sashidharan, a member of the Government's Mental Health Task Force. In his opinion, the situation has reached crisis point. "The issue is that people from black and ethnic minority communities are severely disadvantaged because mental health services have paid little attention to their needs," says Professor Sashidharan, medical director of North Birmingham Mental Health Trust.

"The point I tried to get across is that the situation is pretty dire and we've known about it for a long time. There has been very little in the way of acknowledgement from the Government. That is what is more appalling. There is very little enthusiasm for improving services for black people."

Unless action is taken now to address the mental health needs of ethnic minorities, Professor Sashidharan warns that suicide rates will escalate and social problems such as drug abuse and crime will multiply. "Frank Bruno's experience of being locked up in a psychiatric hospital is indicative of what is happening to black people in general terms," he says. "There are hundreds of young black men with huge potential who are being dragged into psychiatric hospitals with little benefit. That's the tragedy."

While black people are over-represented in the mental health system, they are under-represented in the psychiatric profession. The Royal College of Psychiatrists says that 24 per cent of its 9,000 members describe themselves as non-white. However, unofficial estimates indicate there are fewer than a dozen Afro-Caribbean psychiatrists and around 50 are African.

Professor Sashidharan does not think more black psychiatrists would necessarily improve patient/practitioner relations although it could help to solve inequality in treatment. He is urging the Department of Health to set NHS improvement targets for ethnic minority mental health services. So far, ministers have rejected this proposal. But the pressure on them is mounting especially with the imminent publication of the draft Mental Health Bill. Campaigners fear that the Bill's current emphasis on dangerousness will lead to the locking up of even more black people.

Earlier this month, the Afiya Trust, which campaigns against inequalities in health care for ethnic minorities, called on the Government to back a national network for black and minority ethnic mental health."We have got a crisis on our hands, a public health crisis," says Peter Scott Blackman, director of the Afiya Trust. "The fact there are so many black people represented comes out of poverty, low aspirations and institutional racism. And we can't pretend it's not happening because the figures are getting worse every day."

Additional reporting by Diana Espirito Santo

Factbox

¿ 51 per cent of patients in a London psychiatric hospital were black yet less than 17 per cent of the British population are from ethnic minorities

¿ 28 black people per 100,000 of the population end up in secure units compared with four white people per 100,000

¿ 100 African-Caribbean and African mental health patients were interviewed in a study and almost half had been given a diagnosis of schizophrenia

¿ 88 per cent of black people in a survey said they had been forcibly restrained under the Mental Health Act

'Six police piled on top of me'

By Sophie Goodchild

First Paul Grey heard the roar of feet along the corridor. Then about six policemen, wearing helmets and carrying riot shields, burst through the doors of the psychiatric ward where he was a patient. "Get down!" they shouted, then piled on top of him and pinned him to the floor.

"I'm 5ft 9in but only weighed about 9st 7lb at the time," said Mr Grey, 33. "I was on the floor and they were on top of me. Terrorists or hijackers get better treatment. The mental health system is not about working towards recovery, it's all geared around fear." He says he cannot remember what occasioned the police's heavy-handed intervention.

Now a successful businessman in North London, Mr Grey was 20 when he was diagnosed as a manic-depressive. He spent 10 years in psychiatric hospitals. Instead of therapy, he was put on drugs which had disturbing side effects.

"Mental health services are not focused on recovery but on containment. I wasn't offered any other treatment apart from medication which made me put on two stone."

"It was torture being on the stuff [drugs]. My tongue would fall down my throat and once the nurses in the hospital had to give me an injection to stop me choking.

"There should be clear strategies for calling the police. There should be an emergency number that people can call and someone sent out who is a buffer between the person who is mentally distressed and the police."

Mr Grey said his recovery was achieved through his own determination to achieve well-being - a term that he says is rarely used by the medical profession.

"The medication doesn't heal and the hospitals are not about healing. They are not places for recovery. I've always been ambitious and I started to focus on my own dreams and hopes and understand who I was."

In his opinion, services for ethnic minorities are getting worse, rather than better. "Madness was in Britain long before black people came here. It's a problem that affects everyone, but black people have been wrongly stigmatised."