Can mental health services help rev
erse the
deterioration?
'It seems that every year the statistics tell
us the same things. Black people are
admitted to psychiatric hospital proportionately more often than their white
counterparts.
Black people enter mental health services proportionately more often via the criminal justice system.
A higher percentage of black
people using mental health services have a diagnosis of schizophrenia.
Can mental health services help reverse the
deterioration? Based on the evidence of
the last 100 years, apparently not.
Some
geneticists believe that the source of mental health disparities between Black
people and others lies primarily in biological causes.
Other theorists identify the relationship
between biological and environmental causes as being responsible and that the
patterns of utilisation of mental health services are in effect a mirror,
reflecting this interaction. Often,
added to this mix is the particular psychological make up of the
individual.
Failure of the current bio-psychosocial model to turn the tide
The
failure of the current bio-psychosocial model to turn the tide can insidiously
lead to hopelessness about the role that mental health professionals can play in
making a difference.
As
Barak Obama said in Dreams from my father:
‘They had lost whatever confidence they might have once had in their ability to reverse the deterioration they saw all around them. With that loss of confidence came a loss in the capacity for outrage'.
I, and many others like me - remain outraged by the disparities and am convinced that the interaction that is at fault is not so much that between the individual psychology, the biology and environment but between flawed problem-solving and ineffective action.
With regard to flawed problem-solving, take for example the evidence that black people enter services with a greater degree of complexity and need.
If the genesis of Black people's needs are a result genetics (a biological propensity towards something considered to be an illness) and damage as a result of poor socioeconomic backgrounds it is not clear how mental health services are supposed to make a positive difference to the disparities in service utilisation.
The questions around service impact are further compounded by the findings from Professor Swaran Singh's study of formal admissions under the Mental Health Act 1983. It showed that as you look at the cohorts of people who are admitted for a second, third and fourth time - the proportion of Black people increases with each successive admission.
Pharmacological
interventions have not led to aggregated improvement
It is a reasonable
deduction then that mental health services have not been able to prevent
further deterioration or even maintain the differences as they were at the
point of entry.
The range of pharmacological interventions have not led to aggregated improvement.
The new ‘approaches' such as recovery in mental health services and
technologies such as Cognitive Behavioural Therapy (CBT)
have not had the effect of maintaining levels of disparities, much less
reducing them.
These
points beg the question as to whether the thinking about the causes is right? If the diagnosis (i.e. the definition of the
‘problem') is incorrect there is a good chance that the wrong treatment will be
provided and that it won't work.
I'm not
sure that it is possible to have an effective response that does not include in
the analysis of the ‘problem' the toxic effect of the interaction that occurs
when black and white people co-exist.
How can the damage resulting from slavery - that is passed on
intergenerationally in verbal and non-verbal ways - be overlooked?
We are yet to see a
model of delivery that is proportionate to the level of need
With
regard to effective actions, we are yet to see a model of delivery that is
proportionate to the level of need.
Mental health services believe they are fair in providing an equal
response to BME people at the point of entry into services because the same
criteria and processes are used uniformly.
Black
people have more adverse experiences prior to entering services.
If these have no continued relevance to their
experience and outcomes in mental health services, then surely the burden of
responsibility for the deteriorating outcomes within services (indicated in
Singh's research) rests more heavily on the shoulders of mental health
services.
If these prior experiences are believed to have continued relevance
then surely the responsibility of services must be to respond in proportion to
needs. As Trevor Phillips stated in Fairness and Freedom: The Final Report of the Equalities Review (2007).
‘The strong evidence of differential health
outcomes should point to
a reponse by healthcare professionals that recognises
and provides for such differences.'
The
conference on 22nd June 2009 will be an opportunity to hear what
that proportionate response could look like.
Click here for information on a discount to this conference for BMH UK readers.
Go to Hari Sewell's webiste for full details on the conference and his publications
About the writer
Hári
Sewell is a Writer, Independent Consultant and Trainer. Also an associate Editor of Journal of Ethnicity and Equalities in Health and Social
Care and he sits on the editorial board of Journal of Integrated Care.
Hári chairs the National Social Care Strategic Network, a membership organisation for senior managers responsible for social work and social care in integrated mental health services.
He is a member of the Government's review of health inequalities post 2010, led by Sir Michael Marmot.
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