Breaking the Circles of Fear

1. Breaking the Circles of Fear Improving mental health service delivery to African & Caribbean communities David RobertsonNational Organiser, Sainsbury Centre for Mental Health

2. Exploring circles of fear But what I realise now, after…the past three, four years, I begin to understand the culture and fear – that is a circle of fear because there is fear in the victims and there is certainly fear from the amount of police…It appears that the police were as afraid of my brother as he was afraid of them. Working for excellence in mental health services

3. The contextof the review • Three decades of psychiatric research • Inquiries/reports e.g. ‘Big, Black and Dangerous’, ‘Inside/Outside’, Bennett Inquiry, Roger Sylvester Inquest, Frank Bruno case • Race Relations Amendment Act, 2000 Working for excellence in mental health services

4. The context(II) • Compulsory admission under the Mental Health Act(MHAC, 1999; Davies et al., 1996) • Higher rates of re-admission(Glover, 1989) • Physical treatments(Littlewood & Cross, 1980) • Over-diagnosis of schizophrenia & under-diagnosis of depression or affective disorder(Cochrane et al 1971; Lloyd & Moodley, 1992, Bhugra & Bhal 1999, Raleigh 2000, Boydell et al 2001). Working for excellence in mental health services

5. The context(III) • Over-use of psychotropic medication(Lloyd & Moodley, 1992); • Admission to medium & high secure facilities(Jones & Berry, 1986, Bhui 2001); • Excessive admissions via courts(Robertson et al. 1996; Banerjee et al 1995, NACRO 1990); • Involvement of police in hospital admission & use of Section136/137 of the Mental Health Act(Turner et al., 1989; Rogers & Faulkner, 1987). Working for excellence in mental health services

6. Activities for the Review • Call for Evidence • Regional launches • Group interviews • Individual interviews • Site visits to mental health services • Implementation & dissemination Working for excellence in mental health services

7. Review (cont’d) • Explore the ‘circles of fear’ which exist between the Black community & services; • Identify impediments to change; • Understand Black service users experiences of treatment & care; Working for excellence in mental health services

8. Review (cont’d) • Identify positive practice; • Explore issues around race & culture; • Provide an analysis of the current situation; • Generate an agenda for change. Working for excellence in mental health services

9. Breakdown of focus groups (1st round) Working for excellence in mental health services

10. Breakdown of focus groups (2nd round) Working for excellence in mental health services

11. Key findingsBreaking the Circles of Fear (I) • There are ‘circles of fear’ that stop Black people from engaging with services • Mainstream services are experienced as inhumane, unhelpful and inappropriate • Care pathways for Black people are problematic and adversely influence outcome, treatment and engagement Working for excellence in mental health services

12. Key findingsBreaking the Circles of Fear (II) • Primary care involvement is limited and crisis-based community care is lacking • Acute care is perceived as negative and does not aid recovery • There is a divergence between professional and lay mental health discourses • Service user, family and carer involvement is lacking Working for excellence in mental health services

13. Key findingsBreaking the Circles of Fear (III) • Conflict exists between professionals and service users which is not addressed in positive ways • Black community mental health initiatives are not valued • Stigma and social inclusion are important dimensions in the lives of service users Working for excellence in mental health services

14. The Recommendations • Establishing the gateway function • Supporting the community • Improving access • Creating sensitive services • Workforce development • Capacity building Working for excellence in mental health services

15. The Strategy • Ensure that Black service users are treated with respect & that their voices are heard • Deliver early intervention & early access to services to prevent escalation of crises • Ensure that services are accessible, welcoming, relevant & well integrated with the community Working for excellence in mental health services

16. Strategy (cont’d) • Increase understanding & effective communication on both sides including creating a culture which allows people to discuss race & mental health issues • Deliver greater support & funding from the statutory sector to services led by the Black community Working for excellence in mental health services

17. About the Implementation Unit • Set up with funding from SCMH for 3 years • Small staff comprising programme manager, national organiser, research fellow & workforce development advisor • Integrated with other SCMH sections Working for excellence in mental health services

18. Priorities Focus on four major priorities: • Strengthening the Black user movement • Leadership development & capacity building programmes in black voluntary sector • Training & workforce development in statutory sector • Research & evaluation studies Working for excellence in mental health services

19. Working process • Building partnerships with Black voluntary sector & service user groups • Joint initiatives with statutory agencies • Setting up pilot projects and offering consultancy and support Working for excellence in mental health services

20. Desired outcomes Black service user empowerment: • Increase in numbers and sizes of Black service user groups • Continuity of service • An established Black user network/forum • Increased levels of involvement of Black service user groups, e.g., in policy development & service design, planning and management Working for excellence in mental health services

21. Desired outcomes (cont’d) Leadership development: • Increased levels of personal development for Managers in Black voluntary sector • Increased levels of professional development (knowledge & skills) • Increased management and leadership capacity in Black voluntary sector Working for excellence in mental health services

22. Desired outcomes (cont’d) Capacity building and Organisational Development: • Increase in numbers of individuals who access services earlier • Relevant and appropriate service and clinical interventions • Improved quality of life for service users • Greater levels of satisfaction with services • Increased investment in the Black voluntary sector Working for excellence in mental health services

23. Desired outcomes (cont’d) Training and workforce development: • Increased levels of knowledge and awareness on addressing issues of ‘race’ and culture • Increased ability to recognise own strengths and weaknesses • More appropriate and sensitive interventions • Increased levels of user and carer satisfaction with services Working for excellence in mental health services

24. Partnership with the Sainsbury Centre Work with us to implement key recommendations: • Improving inter-agency access and assessment • Training and workforce development • Research, evaluation and monitoring • Community development and capacity building • Engaging with service users and local communities Working for excellence in mental health services

25. Key areas for improvement • Reducing compulsory admissions to hospital • Improving risk assessment • Reducing reliance on medication • Improving engagement, recovery and outcomes Working for excellence in mental health services

26. Conclusion Why is it all getting so complicated. As a Black user all I want is access to meaningful services; access when I say I need access; to be listened to; be respected and accepted; to be informed about what is going on and to be enabled to hold on to my life. Simple! Working for excellence in mental health services