Feature

Towards a more sensitive service

Mental health services have not responded to the needs of a multiracial community, says Melba Wilson. Black people with mental health problems need a caring, not a controlling response

The premium on culturally sensitive, mainstream mental healthcare for Black people in Britain cannot be underestimated when viewed against the reality of mental health for Britain’s Black communities.

That reality, according to one Black mental health campaigner, translates into Black people being the victims of “the poverty of a psychological response”. In other words, Black people who exhibit symptoms of mental illness more often than not meet a legal, controlling response to a problem requiring sympathetic methods.

In March 1989, a Guardian article quoted a senior Metropolitan Police official who told a MIND conference of a police survey which showed officers were “bending the rules” in detaining patient under the controversial section 136 of the Mental Health Act.

This is the section that gives a police officer the right to arrest a person causing a disturbance in a public place and take him or her to a place of safety to be assessed by a psychiatrist or social worker for hospital admission.

The police survey also showed, according to the Guardian report, that ‘Afro-Caribbean people were over represented among those detained’.

Similarly, the second Biennial Report 1985-87 of the Mental Health Act Commission refers to a MIND study which points out that the incidence of Afro-Caribbeans made subject to section 136 of the Mental Health Act was ‘three times the level expected’.

The report made a commitment to developing the MHAC’s work with Black and ethnic minority communities and called on health and social service authorities to appoint senior staff members to take responsibility in this area.

Yet as Dr S P Sashidharan pointed out in his recent healthmatters article (February 1990), ‘it is estimated that while 20 per cent of all psychiatric admissions are made under the act, for Black patients the equivalent figure is over 60 per cent’.

In response to these alarming figures, Dr Sashidharan points to an increasing awareness among Britain’s Black communities of the need for an alternative agenda of needs and priorities in mental healthcare. He noted a “substantial increase” in this respect of Black groups concerned with mental health issues.

The Unity Helpline is one such project. Located in Balham, south London and run by the Unity Centre of South London, a religious based group, it offers 24 hour telephone counselling service for ‘Black people suffering from, recovering from or at the risk of developing any form of mental ill health or stress’.

’We are here because Black people are suffering.’ said centre co-ordinator the Rev Harry Kudiabor, explaining the impetus behind the centre’s work. ‘I don’t blame whites 100 per cent: part of the problem is ignorance. But I am concerned about what we can do to help ourselves to come out of this mess.’

The helpline averages 250 calls a week, taken entirely by volunteers, Volunteers also work as personal counsellors, offering practical support and assistance to people using the centre on a drop in basis.

Unity used a holistic method of dealing with people, said Mr Kudiabor. “The complexity of our work originates from the complexity of human nature. We have an open-mindedness, because there is always something new to learn.

”We use a minimum amount of analysis and probing to enable the client to understand his or her symptoms. Instead, we concentrate our energies on building on those positive identifiable factors in an effort to build confidence.”

The valuable nature of Unity’s work has been recognised by Wandsworth council which, through its social services department, has helped set up and fund two hostels catering for 16 residents at a time. Links have also been developed with Wandsworth health authority, which makes regular referrals to Unity from Springfield hospital, a large mental illness institution in the area.

Colin Meadows, care services manager for mental health projects in Wandsworth, said the aim of the borough’s mental health service was to try and meet the needs of the community as a whole. But he added: ‘The service has had difficulty in attracting and recruiting Black people.’

He is aware of the suspicions that Black communities have of statutory services. ‘If, for example, you are a young, Black man whose only experience of the system is via the police section and in a closed unit, and you go into hospital on that basis you will be reluctant to seek help once you’re outside,’ he said.

Meadows reports “reasonable success” in Wandsworth. A drop-in cafe, part of a joint health/local authority community care initiative, is going some way towards making mental healthcare more accessible to the borough’s large and culturally varied community.

It is a “grassroots counselling approach”, said Meadows. “It’s a place where people can come in and talk to us on their own terms.” The resource centre offers group counselling, as well as individual sessions, and currently caters for about 20 people a week, a quarter of whom are Black.

Another Wandsworth HA initiative is the ethnic minorities study group, a two year initiative funded by the Department of Health and managed through the mental health unit. Its aim is to gather information that will enable better service delivery to Wandsworth’s Afro-Caribbean, African and Asian populations.

The objective, said co-ordinator Katie Ku, was to collect data on referrals, analyse and evaluate it. “We are concerned with the processes that underlie interventions which Black people receive once they have become engaged by the service.” The concern too, is “whether or not they are receiving as equal a mental health service as the indigenous population”. The project’s data will be used to compare service delivery to Black and white clients.

For example, said Ku, many Asian women were suffering from depression, but felt, for a variety of reasons, that they could not approach the mental health unit or their GP. The aim, therefore, was to prevent these potential clients falling through the net.

”We hope to start discussion groups, so that people can attend and help us gain a better understanding of local issues and concern.” said Ku. “Whatever information is gathered, we hope to take back to the mental health unit and formulate recommendations the unit can act upon.”

The project, whose first phase of information gathering is expected to be concluded in early 1991, employs three workers, two of them Black. One worker said the push for community care initiatives made their work all the more important. “Mental health services are going through change and we need to provide more sensitive services.” he said. “We can’t do that until we know what’s in the community”.

This would appear to be a view well worth emulating, not only as far as Black people are concerned, but on a larger scale in health and local authorities up and down the country, if community care is to become more than a buzzword for inaction.