By Sam Gilder
“In this country in fifteen or twenty years time the black man will have the whip hand over the white man.”
Those were the words of Conservative MP Enoch Powell on 20th April 1968. His ‘Rivers of Blood’ speech contained criticism of the proposed Race Relations bill of the same year, which aimed to give equal access to healthcare for immigrants from the Commonwealth. He prodded at anxieties already existent in the conscience of the British public since the influx of Black and Minority Ethnic (BAME) immigration at the start of the decade.
This was 1960s Britain, credited for its revolutionary culture but rife with racial discrimination. With an emphasis on mental health care, this article aims to provide evidence as to how although racial discrimination in our public services may not be as overt, imbedded racism towards BAME groups underpins a service with ever-growing importance.
This allows a better understanding of how institutional racism is present, and how failures at the turn of the twenty-first century up until now lead to its unacceptable continuation.
Institutional racism is classed as the collective failure of an organisation to provide an appropriate and professional service to people because of their colour, culture or ethnic origin. In 1999, the Macpherson Committee published its findings on racial discrimination in the UK following the murder of Stephen Lawrence in 1993. The Macpherson Report made it evident that at the end of the 20th century, British society was institutionally racist.
The Department of Health’s National Service Framework for Mental Health set out its findings on institutional racism within the mental health service in the same year. It outlined ‘Combined evidence suggests that services are not adequately meeting mental health needs, and that BAME communities lack confidence in mental health services.’
The way in which this issue transcended into the early 2000s highlights the lack of work being done to change how BAME individuals are treated in British psychiatry. Two years after the findings of the Macpherson Report, the 2001 Race Relations Act required a ‘race equality duty’ from 43,000 public authorities. This meant public services could attempt to address racial inequality and promote equal opportunity. This would suggest some sort of progress. Despite this, of the 570 health trusts asked to produce a race equality scheme, 40% had not published a scheme at all and only 6% had given detail of the ethnicity of their workers.
The questions asked by the Race Relations Act in 2001 had not been answered.
Moving further into the 2000s, a 2007 survey of 32,023 patients in mental health wards found that across 238 NHS and private healthcare hospitals, 21 % of patients represented BAME groups, whilst only representing 7% of the population.
Kwame McKenzie and Bhui Kamaldeep (2007) claimed that some BAME groups were ‘less likely to be offered psychotherapy, more likely to be offered drugs, and more likely to be treated by coercion, even after socioeconomic and diagnostic differences are taken into account’.
In April 2009, the Care Quality Commission (CQC) was formed out of the Healthcare Commission, the Commission for Social Care Inspection and the Mental Health Act Commission. Following the result of the 2010 General Election, it was now David Cameron and Nick Clegg’s coalition government facing this challenge.
The CQC came forward with its new strategy in 2010. Named ‘No Health without Mental Health’, it specifically aimed to “improve outcomes and reduce inequalities”.
In 2011, 12 years after the findings of the Macpherson Report, the No Health without Mental Health programme revealed there was still more work to be done. In outlining their strategy, they stated:
“African-Caribbean people are particularly likely to be subject to compulsory treatment under the Mental Health Act. South East Asian women are less likely to receive timely, appropriate mental health services, even for severe mental health conditions.
Tackling the inequalities for BME communities has been a central focus for a number of years. However, the outcomes have in some ways been disappointing.”
These ‘disappointing’ outcomes were still present in 2014, highlighted by a participant in Birmingham and Solihull Mental Health NHS Foundation Trust’s 300 Voices project, which attempted to engage with African and Caribbean men aged between 18 and 25:
“I don’t think the mental health system at the moment is geared up for dealing with people of colour and certainly African and Caribbean males. The system does not know how to deal with us, so as a consequence, when they should pick up early this is not being dealt with. Going further along the line, the issues are getting worse as there are no systems in place to deal with them.”
Solutions to the problems outlined are by no means clear-cut, however, this catalogue of error and misunderstanding throughout the twenty-first century has characterised the lack of positive change. One suggestion is to reframe psychiatric systems and diagnosis, moving to a model that is less ethnocentric, meaning solutions to mental health problems can work better for the diverse British public. This would follow similar calls by many which condemn the eurocentrism of the British education system, highlighting how these issues have stretched across our public services for many years.
There have also been suggestions from the Royal College of Psychiatrists for the Department of Health and Social Care to keep track of policies far more carefully, and to see how they impact the mental health of all patients so that any negative consequences, especially regarding BAME patients, can be swiftly dealt with.
Commentary of recent developments in the mental health sector help to elevate how much change is needed and how little has been done to help BAME patients in twenty years. Hopefully more histories of the past two decades continue to add to both our understanding of modern institutional racism and how this has been underpinned by decades of inequality.
Commission for Racial Equality, Annual Report and Accounts 2006/7, Published by TSO., 1999.
McKenzie, Kwame, and Kamaldeep Bhui. “Institutional racism in mental health care.” (2007): 649-650.
National Service Framework for Mental Health, Department of Health, September
No Health without mental health: A cross-government mental health outcomes strategy for people of all ages. HM Government. Published 2nd February 2011.
Suman Fernando Cultural Diversity, Mental Health and Psychiatry: the struggle against racism (2003).