Contributor: James Ogunleye
The Mental Health system is failing Black people
For Douglas Fenton, the journey to the psychiatric institution began, as with many black men, at the age of 19. Douglas, a promising young man, had been involved in a tiff with his kid sister when a nosy neighbour called in the police. He was charged with assault. On the advice of his lawyer, he pleaded not guilty, attributing his aggressive behaviour to mental illness. But this reason was all the judicial authority needed in its judgement: he promptly was bundled into psychiatric hospital to begin a ?career? that was to span over a decade.
In 1997, at just 33, he was dead - another statistic in a long and scandalous list of able and young Black people who have needlessly died in Britain?s psychiatric hospitals.
Douglas? anguish may have been relieved by death, but, for thousands of young Black mental patients, many of whom are held against their will, the agony continues. Indeed, since the 1980s, the rate at which Black people have been shoved into psychiatric hospitals has been frightening. World Health Organisation (WHO) statistics indicate that approximately 12 per cent of the African-Caribbean population in Britain is mentally ill, many in secure psychiatric units in various part of the country. Put in cold figures, that is twelve thousands, out of just over a million people. In comparison, a mere 1 per cent of the white population is mentally ill.
In the London Borough of Hackney, which has a Black population of 49,000, a disturbing 40 per cent of mental health patients aged between 18 - 65 - a survey in 1992 revealed - were Black men. In all the three high-security psychiatric hospitals in England, Black inmates account for 16 per cent. The picture is equally dark in the medium-security hospital, where one in three inmates is Black. ?There is no doubt that Black people are over represented in psychiatric hospitals [and] on locked wards,? said David Ndegwa, a forensic psychiatrist at Homerton hospital in east London.
Paul Boateng, a Black government minister whose brief includes mental health, seems to agree with Ndegwa. He observed recently: ?[The figures] throws up the perception that Black people are more vulnerable to mental health problems. It stigmatises and stereotypes.?
So why are Black people sent to mental institutions en-mass? The answer is as puzzling as the problem itself. ?There are a lot of weird theories going round to show why Black people are predisposed to mental illness - particularly to Schizophrenia,? explained Geraldine Huka, a front-line mental health legal campaigner and director of London-based Forward Project, in a January interview with Black Perspective. ?The most popular one is the flu virus [that] causes a Schizophrenia gene to African Caribbean people that came to Britain in the 1960s. Rather than [for the authorities to] hold their hands up and admit that there might been issues around misdiagnosis; that there might be issues around social factors - such as poverty, poor housing, unemployment and lack of education - it?s been put back on the [Black] victim to justify the diagnosis rather than the other way round,?
Yet the issues of misdiagnosis and social problems are real. Firstly, on social factors, the Black community has remained prostrate, pinned down by afore-mentioned problems of poverty, crime, poor housing, poor education, unemployment, single parenthood, virtually nil political power and institutionalise discrimination. None of these problems have been more devastating than that of Black youth unemployment. According to Office for national Statistics, unemployment amongst young Black male is 40 per cent, compared with 17 per cent for whites. In inner city boroughs like Hackney and Lambeth, the rate of joblessness amongst Black youths has ballooned to 80 per cent, and still rising.
In keeping with the old adage, the devil has found work for the idle hands of countless young Black males via street crimes and drug dealing. Once they get arrested it is only a matter of time before some of them find themselves in mental hospitals. ?Some of our Black patients have had chequered backgrounds and very difficult upbringing,? a mental health worker at the Maudsley Hospital, in south east London told Black Perspective. ?Some naively claim to have mental illness so as to escape prison. These [young Blacks] are not genuine mentally ill people. Most of the classic mental cases are whites. The white patient who finds himself in a mental hospital is mentally ill; he knows he?s mentally ill; his family knows he?s mentally ill, they knew his characteristics when he was young,? our source explained.
Indeed, in the 1980s, one popular route into psychiatric institutions was through section 136 - cynically dubbed the ?police route? - of the Mental Health Act 1983. This section empowers a social worker or a police officer to take somebody who, in their opinion, is behaving in a ?mentally disordered? fashion to a ?place of safety? Experts say Black men are seventeen times more likely than white men to be admitted into psychiatric hospitals under the afore-mentioned compulsory police power.
(a psychiatric unit).
In the mid-1980s, it was so bad that a young Black male needed to do little more than talk to himself in a public place to earn a police arrest under section 136! Recently, a born-again Christian was nearly arrested and passed off as a Schizophrenic when a neighbour heard her ?speaking in tongues? and phoned the police. Luckily, she came round before the police arrival!
The decline in the number of arrest under s136 in recent times, had been offset by a rise in the number of new cases under s137. Explained Huka, who has represented an array of Black mental health patients over the years: ?Section 137 means that somebody has committed criminal offence and when they get to court he?s found undesirable, by reason of his mental illness, to be sent to prison, so they send him to psychiatric hospital, because he pleads guilty to [or found guilty of] the offence.
Even the general practitioners (GPs) are allegedly adding to the problem. To be able to assess mental illness, a doctor needs to be a section 12 doctor (under the 1983 MHA), and GPs who are not qualified under s12 have allegedly been too quick to refer Black patients to mental hospital. ?In many ways, a lot of the GPs don?t have a clue of what they are doing,? said Huka. ?So to that extent, they are in no better position than many lay people - otherwise they should not even be in a position where they are making a diagnosis.?
But misdiagnosis at the GP level pales into insignificant when compared to with what is taking place at the hospital level. Here misdiagnosis, discrimination and racism are the norm. Our source at Maudsley hospital told Black Perspective that he often watched in frustration as many in his Black dominated wards are misdiagnosed, due essentially to the acceptance of stereotypes. He said discrimination against Black patients ? who?s actions are often labelled as ?agitated behaviour? ? is very obvious in the case of, for instance, treatment of the patients. He cited the example of a Nigerian who was injected with large doses of powerful drugs because the hospital staff claimed they needed ?20 people? to restrain him. The result? ?He sleeps in bed all day,? said our source. ?With such powerful doses, patients soon embody the characteristics of mentally ill persons.?
One alleged killer treatment favoured for Black people is ECT ? electroconvulsive therapy treatment - which critics say make patients become ?abnormal.? This treatment is increasingly favoured in the ?tretment? of Black people as against counselling which is more readily available to White patients. A recent survey of mental health users by MIND, a leading mental health charity, showed that only 33 per cent of Black users received counselling, compared with 75 per cent of whites.
Every year, in Britain, according to MIND, more than 100,000 ECT treatments are administered, and over 50 deaths a year may have been caused by over-prescribing psychiatric medicines. And such misdiagnosis had been very palpable amongst Black patients. One of the latest victims is Venon Cowen, who was cut down in her prime after being sedated with ECT in November 1996. Venon, 32, who suffered hallucinations and ?heard voices? since her teen-age, was admitted in mid-October 1996. Within three weeks of being admitted, she had dead. According to her mother, Etta Cowen, Veron was so sedated that ?she could neither eat, drink nor move [in the days preceding her death].? The hospital put Veron?s death down to a blood clot in her lungs. But her mother was nor convinced, insisting her daughter was ?healthy physically? before she went into hospital. ?[Veron] was put in seclusion and went downhill. And I know that some of the drugs she was on can thicken the blood,? Etta told an inquest last September.
A best, says Huka, ECT treatment ?makes the patients abnormal.? She added: ?Very often I wonder if there?s nothing wrong with you and you are in a psychiatric hospital. And then on top of that you?re taking drugs against your will. Do you really think it won?t have any effect on your psyche??
The view that mentally ill Black people constitute a safety hazards to the general public is really not new and has been reinforced by some recent events. In July 1996, toddlers at the St Luke?s Infants School in Wolverhampton were enjoying their lesson in a quiet afternoon when Horrett Campbell, 32, a Black mental health patient, tore down the barrier and burst in to the classroom. Within seconds, he had hacked down five toddlers were in a frenzied machete attack. In 1992, Christopher Clunis, a Schizophrenic, stood next to Jonathan Zito like any normal person at a London Underground station in north London. Without warning, he stabbed Zito to death.
If mental patients were a menace to the public they can also a menace to themselves. Here, Ben Silcott?s case comes to mind. A few years ago, Silcott was so mentally disturbed that he went into lion enclosure after hearing voices. But for the timely intervention of the Zoo keepers, Silcott would have been made mince meat of by the beasts.
Every year in Britain, according to MIND, over 4,000 mentally ill people take their own lives. Against this background, the government?s response has come mainly through the NHS and Community Care Act 1990, which removes the psychiatric care into the community, but which the health secretary, Frank Dobson now admits is falling the patients. Another initiative is the five-year old Care Programme Approach (CPA). The CPA ?requires health authorities to ensure that all psychiatric in-patients about to be discharged from hospitals and all new patients accepted by the specialist psychiatric services receive a systematic assessment of their health and social care needs; a care plan; and a regular review of their progress.?
Recently, the government launched an anti-social exclusion unit at 10 Downing Street, to address the issue of social exclusion in the country. Observers say if the policy is well thought-out, it could just be what is needed to tackle the social causes of over representation of Black men and women in psychiatric institutions. But how such policy would work in practice is a matter for conjecture.