Fear, black people and mental illness: A vicious circle?
Corresponding Author
Frank Keating PhD
Sainsbury Centre for Mental Health, London, UK
Correspondence Frank KeatingSenior Research FellowSainsbury Centre for Mental Health134–138 Borough High StreetLondon SE1 1LBUKE-mail: [email protected]Search for more papers by this authorDavid Robertson MA
Sainsbury Centre for Mental Health, London, UK
Search for more papers by this authorCorresponding Author
Frank Keating PhD
Sainsbury Centre for Mental Health, London, UK
Correspondence Frank KeatingSenior Research FellowSainsbury Centre for Mental Health134–138 Borough High StreetLondon SE1 1LBUKE-mail: [email protected]Search for more papers by this authorDavid Robertson MA
Sainsbury Centre for Mental Health, London, UK
Search for more papers by this authorAbstract
The relationships between black communities and the mental health (MH) services are fraught. Paradoxically, black communities receive the MH services they don't want, but not the ones they do or might want. Black people mistrust and often fear services, and staff are often wary of the black community, fearing criticism, and not knowing how to respond, are fearful of black people, in particular, young black men. The situation is fuelled by prejudice, misunderstanding, misconceptions and sometimes racism. The present paper describes the findings of a study to explore the issues in greater depth. The study was premised on a belief that there are ‘circles of fear’ which lead to poorer treatment of black communities. A purposive sampling approach was used to seek out groups and individuals in whom the ‘circles of fear’ were likely to be evident. The findings suggest that there are fears which impact negatively on the interaction between black communities and MH services. Two major themes emerged in this study, i.e. the sources of fear and the consequences of fear. Sources of fear included perceptions of MH services, attitudes to mental illness and diagnosis, and experiences of hospital care. The impact of fear included limited trust, limited engagement and delayed help-seeking behaviour. The study concludes that these fears mar the interactions between these communities and MH services, affect help-seeking behaviour adversely, and lead to restrictive and punitive interventions. Progress will only be made in breaking the ‘circles of fear’ if there is a systematic change in the experience of black services users at each point in the care pathway.
References
- Audini B. & Lelliot P. (2002) Age, gender and ethnicity of those detained under Part II of the Mental Health Act 1983. British Journal of Psychiatry 180, 222–226.
- Banerjee S., O'Neil-Byrne K., Exworthy T. & Parrot J. (1995) The Belmarsh Scheme: a prospective study of the transfer of mentally disordered remand prisoners from prisons to psychiatric units. British Journal of Psychiatry 166, 802–805.
- Barnes M. & Bowl R. (2001) Taking Over the Asylum. Palgrave, Basingstoke.
- Bhugra D. (2002) Ethnic factors and service utilization. Current Opinion in Psychiatry 15, 202–204.
- Bhui K. (1997) Service provision for London's ethnic minorities. In: S. Johnson, R. Ramsey, G. Thornicraft, C. Brooks, P. Lelliot, E. Peck, D. Chisholm, B. Audini, M. Knapp & D. Goldberg (Eds) London's Mental Health, pp. 143–166 . King's Fund, London.
- Bhui K. (2001) Over-representation of Black people in secure psychiatric facilities. British Journal of Psychiatry 178, 575–575.
- Burnett R. & Mallet R. B (1999) The first contact of patients with schizophrenia with psychiatric services: social factors and pathways to care in a multi-ethnic population. Psychological Medicine 29 (2), 475–483.
- Churchill R., Wall S., Hotopf M., Buchanan A. & Wessely S. (2000) Shaping the new mental health act: key messages from the department of health research programme. Centrally Collected Information: What Can the Data Tell Us? Department of Health, London.
- Corrigan P.W., Green A., Lundin R., Kubiak M.A. & Pen D.L. (2001) Familiarity with social distance from people who have serious mental illness. Psychiatric Services 52 (7), 953–958.
- Department of Health (2003) Delivering Race Equality: A Framework for Action. Department of Health, London.
- Fernando S., Ndegwa D. & Wilson W. (1998) Forensic Psychiatry, Race and Culture. Routledge, London.
- Goater N., King M., Cole E., Leavey G., Johnson-Sabine E., Blizard R. & Hoar A. (1999) Ethnicity and outcome of psychosis. British Journal of Psychiatry 175, 34–42.
- Harrison G., Owens D., Holton A., Nelson D. & Boot D. (1988) A prospective study of severe mental disorder in Afro-Caribbean patients. Psychological Medicine 18, 643–657.
-
Hayward P., & Bright J.A. (1997) Stigma and mental illness: a review and critique.
Journal of Mental Health
6 (4), 345–355.
10.1080/09638239718671 Google Scholar
- Keating F., Robertson D., McCulloch A. & Francis A. (2002) Breaking Circles of Fear. Sainsbury Centre for Mental Health, London.
- Kent G. & Keohane S. (2001) Social anxiety and disfigurement: the moderating effects of fear of negative evaluation and past experience. British Journal of Clinical Psychology 40, 23–34.
- Krueger R.A. (1994) Focus Groups: A Practical Guide for Applied Research. Sage, Thousand Oaks, CA.
- Kuckhartz U. (1998) Winmax Scientific Text Analysis for the Social Sciences User's Guide. Software for Qualitative Data Analysis, Berlin.
- Laurance J. (2002) Pure Madness. How Fear Drives the Mental Health System. Routledge, London.
- Lee S. (2002) The stigma of schizophrenia: a transcultural problem. Current Opinion in Psychiatry 15, 37–41.
- Link B.G. & Phelan J.C. (1999) Public conceptions of mental illness: labels, causes, dangerousness, and social distance. American Journal of Public Health 89 (9), 1328–1333.
- Link B.G. & Phelan J.C. (2001) Conceptualizing stigma. Annual Review of Sociology 27, 363–385.
- Lloyd P. & Moodley P. (1992) Psychotropic medication and ethnicity: an inpatient survey. Social Psychiatry and Psychiatric Epidemiology 27 (2), 95–101.
- Macaulay A.C., Commanda L.E. & Freeman W.L. (1999) Participatory research maximises community and lay involvement. British Medical Journal 319 (7212), 774–778.
- Malanda S., Meadows J. & Catalan J. (2001) Are we meeting the psychological needs of Black African HIV-positive individuals in London? Controlled study of referrals to a psychological medicine unit. Aids Care 13 (4), 413–419.
- Mercer K. (1984) Black communities’ experience of psychiatric services. International Journal of Psychiatry 30 (1 & 2), 22–27.
- Miles M.B. & Huberman A.M. (1984) Qualitative Data Analysis: A Sourcebook of New Methods. Sage, Thousand Oaks, CA.
-
Milliken F.J.,
Morrison E.W. &
Hewlin P.F. (2003) An exploratory study of employee silence: issues that employees don't communicate upward and why.
Journal of Management Studies
43 (6), 1453–1476.
10.1111/1467-6486.00387 Google Scholar
- Nazroo J. (1997) Ethnicity and Mental Health. Policy Studies Institute, London.
- Nolan P. (2000) History of psychiatry, patients and hospitals. Current Opinion in Psychiatry 13, 717–720.
- Pain R. (2001) Gender, race, age and fear in the city. Urban Studies 38 (5 & 6), 899–913.
- Parkman S., Davies S., Leese M., Phelan M. & Thornicroft G. (1997) Ethnic differences in satisfaction with mental health services among representative people with psychosis in South London: PRiSM Study 4. British Journal of Psychiatry 171, 260–264.
- Patel N. (1999) Ethical Guidelines for Research on Issues of ‘Race’ and Mental Health. Mind Publications, London.
- Prins H., Backer-Holst T., Francis E. & Keitch I. (1993) Report of the Committee of Inquiry into the Death in Broadmoor Hospital of Orville Blackwood and a Review of the Deaths of Two other Afro-Caribbean Patients. ‘Big, Black and Dangerous?’ The Special Hospitals Service Authority, London.
- Ramon S. (2000) Participatory mental health research: users and professionals working together. Mental Health and Learning Disabilities Care 3 (7), 224–228.
- Sandamas G. & Hogman G. (2000) No Change. A Report by the National Schizophrenia Fellowship Comparing Experiences of People from Different Ethnic Groups Who Use Mental Health Services. National Schizophrenia Fellowship, London.
- Sathyamoorthy G., Minghella E., Robertson D., et al. (2001) Improving Primary Care Access to Services for Young Black Men with Severe Mental Illness. Final Report for the Hackney Primary Care Project. Sainsbury Centre for Mental Health, London.
- Sayce L. (1998) Stigma, discrimination and social exclusion: What's in a word? Journal of Mental Health 7 (4), 331–343.
- Sharpley M., Hutchinson G., Murray R. & McKenzie K. (2001) Understanding the excess of psychosis among the African-Caribbean population in England: review of current hypotheses. British Journal of Psychiatry 178, 60–68.
- Silverman D. (2000) Doing Qualitative Research: A Practical Handbook. Sage, Thousand Oaks, CA.
- Sivanandan A. (1991) Deadly Silence: Black Deaths in Custody. Institute of Race Relations, London.
- Sparks R., Girling E. & Loader I. (2001) Fear and everyday urban lives. Urban Studies 38 (5–6), 885–898.
-
Spector R. (2001) Is there a racial bias in clinicians’ perceptions of the dangerousness of psychiatric patients? A review of the literature.
Journal of Mental Health
10 (1), 5–15.
10.1080/09638230020023570 Google Scholar
- Strauss A.L. & Corbin J. (1998) Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. Sage, Thousand Oaks, CA.
- Thornicroft G., Davies S. & Leese M. (1999) Health service research and forensic psychiatry: a Black and White case. International Review of Psychiatry 11 (2/3), 250–257.
- Wright S., Gray R., Parkes J. & Gournay K. (2002) The Recognition, Prevention and Therapeutic Management of Violence in Acute Inpatient Psychiatry: A Literature Review and Evidence-Based Recommendations for Good Practice. United Kingdom Central Council for Nursing, Midwifery and Health Visiting, London.