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Rashid Rose: The over-representation of Blacks in the Mental Health System

The majority of Caucasians believed Africans to be inferior (Billinsley 1968) with the Encyclopaedia Britannia (1884) defined the word Negro as referring to Africans who “occupied the lowest position of the evolutionary scale”. Accordingly, it was legally and socially permissible for slave owners to subject slaves to any type of physical force (Myrdal 1962).

After the emancipation of the slaves in 1834 in the British Caribbean following legislation passed by the British, Black people became a social, economical and political liability for the white ruling class. The white ruling class have been struggling since to find a solution to this perceived problem of what to do with the thousands of Blacks in the Caribbean and South and Central America. 

In the aftermath of slavery, Africans experienced an increased struggle as they were given limited freedom and human rights (Woodward 1951).  Throughout the last 100 years, several methods were used to maintain control of the Black population, some of these methods were lynching, the refusal of voting rights and the denial of access to education and the misuse of the Penal and Mental Health system. 

 “After emancipation the slave owners lost 22 trillion dollars but over the next 75 years they will claw back 15 trillion through free labour. (Shawn Rochester ‘The Black Tax’). Rochester argued the ‘The Vagrancy Act’ was brought into force to re-enslave the free slaves because many of them had no place to live and depended on the “Share Cropping” work given to the free slaves via a contract. However for those who chose not to accept the terms of the contract they were left without any place to live and fell victim to the Vagrancy Act, many were subsequently forced to work for the same slave owners for free. Through the Vagrancy Act, the prison became a permanent home for many of those who refused to accept the labour contract. The imprisonment of Black men particularly became common and this process continues; “there are over 1 million black men in prison in the USA costing 30 billion per year”. The prisons later became an institution for medical conditioning and the use of certain diagnoses as a method to control behaviour.

Research is quoted showing “rates of psychotic disorder are high not just among the African-Caribbean community in the UK; they are high for all immigrant groups globally”. “Greater stigma of mental illness and over diagnosing of Schizophrenia in the African-Caribbean community is a barrier to early help-seeking behaviour”. Also, “unemployment, living alone, low levels of social support non-compliance with medication” (BMJ 2006; 333:648).

Schizophrenia is one the primary diagnoses found in Africans; this includes Black Caribbean and Black British. “In the worst cases, psychiatric authors conflated the symptoms of Africans patients with the perceived schizophrenia of civil rights protests, particularly those organised by Black Power, the Black Panthers, the Nation of Islam, or other activist groups. Ultimately, new psychiatric definitions of schizophrenic illness in the 60s impacted persons of many different racial and ethnic backgrounds. Some patients became schizophrenic because of changes in diagnostic criteria rather than in their clinical symptoms. Others saw their diagnoses changed to depression anxiety or other conditions because they did not manifest hostility or aggression”  (Metzl: 2010).

In the UK, people from ethnic minorities remain disproportionately represented in mental health wards with no signs of this reducing; the call for more collaboration between health and social care agencies by successive governments seems to have fallen on deaf ears. The 6th and last ‘Count Me In’ census found that 23% of 32,799 people receiving in-patient care in England and Wales were from ethnic minority groups, as of 31 March 2007. The most recent Mental Health report published by the UK government in 2019 stated Blacks are more likely to  be detained under the Mental Health Act than Whites. So what has changed since the 2007 census was published? Absolutely nothing. The census found admission rates to hospitals were at least two times higher than average for people from Black Caribbean, Black African and mixed white/black groups in 2010. Rates of detention were between 19% and 32% above average for these groups. The census has been undertaken annually since 2005 in support of the Department of Health’s five-year plan for improving mental health services for people from ethnic minorities. This project has now ended (Delivering Race Equality in Mental Health Care (DRE)).   The retention of Blacks is a strategy employed by respective ‘white’ governments to restrict the expansion and development of the Black race. “It is clear that the DRE programme has not had an impact on the experience of black people detained under the Mental Health Act, in fact the numbers in this census report are an indication that we have taken a step backwards”, (Professor Sashi Sashidharan consultant psychiatrist and member and panel member on the David Bennett Inquiry which led to the DRE programme).  The “Count Me In” census for England and Wales showed higher rates of admission for mental illness and more adverse pathways to care for some Black and minority ethnic groups and produced predictable accusations of institutional racism within psychiatry. Lee Jasper, chair of African and Caribbean Mental Health, stated: “This census confirms once and for all that mental health services are institutionally racist and overwhelmingly discriminatory. They are more about criminalising our community than caring for it.” In fact, the census clearly highlights the differences between various Black and minority ethnic groups and the need to avoid generalisations about these groups. It does not show a failure in the services providing treatment; not surprisingly it was the accusation of institutional racism, described as a “festering abscess within the NHS,” that made the headlines. Mr Jasper’s views are not alone in expressing such concerns. Several reports and inquiries have also alleged that psychiatry is institutionally racist the evidence that the census findings can be attributed to racism within psychiatry.

According to the World Health Organisation (WHO) it is rather surprising to discover the primary diagnoses for Black Caribbeans was also schizophrenia, a view held by many white psychiatrists who apparently do not understand the cultural complexities of Blacks. Services providing treatment need to be careful and pay more attention to the impact and the consequence of pronouncing a diagnosis such as schizophrenia; such diagnosis do not only impact the individual but also impacts the wider community.

Moving forward one possible solution to decrease the misdiagnosing in the Black mental health population will be the introduction of Black Psychology implemented by Black Psychologists.  The creation of the teaching of Black Psychology some 50 years ago in the USA was a necessary step because the psychology introduced by white practitioners could never adequately define Africans.  The training and development of Black Psychologists and Psychiatrists is an attempt to bring about a better understanding of the journey of Blacks over the past 400 years. Research such as “An intersectional approach for understanding discrimination and psychological well being among African American and Caribbean Black youth” published by the American Psychological Association needs to be looked at. 

Trisha McKenzie Mavinga a trans -cultural psychotherapist is a good example, she recognises the need to actively carve out safe places for Black Women especially to look at their experiences and to address their issues on this basis. Some organisations working to bring about change are The Black African and Asian Therapy Network (BAATN). They help to connect Black people with counsellors of the same or similar ethnic origin. Other organisations to look at are the Caribbean Alliance of National Psychological Associations founded June 5th 2013. 

References:

Chelsea Kwakye– Mental Health extract from Taking up Space pg 126-127

Qre Ogunbiyi – Academic So White from Taking up Space pg 72-73

Joseph L. White (1932-Present) Helped found the Association of Black Psychologists and establish the first Black Studies Program during the 1968 strike at San Francisco State University

“Vagrancy Act of 1866. Contributed by Brent Tarter. The Vagrancy Act of 1866, passed by the General Assembly on January 15, 1866, forced into employment, for a term of up to three months, any person who appeared to be unemployed or homeless”

The BMJ British Medical Journal : BMJ 2006; 333:648


Rashid Rose was a Broadcast Journalist for Ahlebait TV Sky 745 from 2014 to 2018. He is a member of the following professional bodies: Former Chair of Wycombe MIND Mental Health, Founder and chair of the St. Vincent & the Grenadines Health Care Foundation, Founder and chair of the Afro-Caribbean Mental Health Foundation. Rashid is a member of BME Bucks Minority Education Concerns and founder of The Forum, addressing the concerns of the BME communities nationwide. He is chair of the Caribbean Peoples Foundation, Co-Founder of the African Caribbean Muslin Alliance and Co-Founder of the African Caribbean Muslim Federation. Rashid is employed by the Buckinghamshire NHS as a mental health Project manager. He has received an NHS award for Mental Health and Well Being in the South Central Health and Social care in 2010 as well as an NHS award for Mental Health and Well being in the South Central Success in Partnership working in 2010. Rashid received his BA (Hons) in Community Management University of Luton in 1998.

Rashid Rose: The Over Representation of Blacks in the Mental Health System

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