Racism in mental health practice

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Racism in mental health practice

Post by lingua_franca » Fri Jan 27, 2017 4:32 am

A while ago there was an interesting documentary on the disproportionate number of black people who are admitted to secure mental health wards, most commonly for psychosis. A young person in the PICU where I worked, who was black, was the one who drew my attention to it - he wanted to know my thoughts. I was already aware that men of Afro-Caribbean heritage are more likely to attract a schizophrenia diagnosis than their white counterparts, and I had also noticed that our ward sometimes got referrals from 136 suites that made it sound as if the Incredible Hulk was coming, but who turned out to be young black men who in some cases presented no differently to the white teenagers who were admitted and in many cases were considerably less aggressive in their behaviour. A few even had our entire team wondering why on earth anybody thought they had needed a PICU placement at all. I understand that there are all sorts of reasons for inappropriate referrals (bed availability, etc.) and that someone's behaviour can become much calmer and safer in the space of days or even hours (if the effects of illegal drugs are wearing off, for example), but even before I saw the documentary I was still wondering if police, AMHPs, or other professionals might be quicker to perceive these young people as more aggressive on the basis of ethnicity. It was making me feel uncomfortable about my job, wondering if I was doing more harm than good by working in such an environment. Being put on the spot for my thoughts by a black teenager was an eye-opening experience. I don't really have a specific question I wanted to ask, I just wanted to know people's thoughts on anti-oppressive practice in inpatient care, and how we can try and create a better culture.
"Suppose a tree fell down, Pooh, when we were underneath it?"
"Suppose it didn't," said Pooh, after careful thought.
Piglet was comforted by this.
- A.A. Milne.

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Re: Racism in mental health practice

Post by miriam » Fri Jan 27, 2017 4:59 am

It is well established that black males are perceived as more masculine in many ways than any other demographic. For example, they are very unlikely to be perceived as gay or teased for not following traditionally male interests. Perhaps related to this, they are also perceived as being more aggressive than any other demographic.

I think there are probably multiple factors at play here, from skewed news coverage of black male violent criminals on US television, to a lack of positive role models of black men (apart from Barack Obama, of course), to the higher likelihood of other risk factors for crime or mental health problems such as socioeconomic disadvantage, lack of engagement in education/employment/social activities and higher rates of substance abuse. Because of the increased levels of first, second and third generation immigrants amongst people of colour, many will have parents who have experienced trauma/conflict or will have experienced it themselves, there may have been moves across countries and cultures, and more will have norms of physical punishment and a lack of nurture. I seem to recall there is also a reduced proportion of actively involved father figures for black children. And there may also be slightly higher genetic risks of some conditions.

Put increased risk factors and reduced protective factors together with negative perceptions and stereotypes and you get a toxic combination where young black men are much more likely to be suspected of crime, to go to prison or to end up with mental health diagnoses.

All we can do is to treat people respectfully, make ourselves aware of cultural issues, and try to not make negative assumptions about anyone we meet. We can also act as positive role models, advocates and where it fits our role/qualifications/motivations involve ourselves in community outreach and education programs.

As an aside I watched a good TED talk from a woman passionate about highlighting positive role models for young black men.

See my blog at http://clinpsyeye.wordpress.com

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Re: Racism in mental health practice

Post by lakeland » Fri Jan 27, 2017 9:37 am

This is quite an interesting paper click. I'm not sure I agree with everything (I do think services are geared up for white British people and internalised racism is a huge problem), but it has also inspired some responses (here and here) that provide a counter-argument.

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