Voices for change

June 22, 2005

A project in Bradford is leading the way in providing community mental health services for black and ethnic minority people. Adam James reports

.....

It was in 1998 that psychiatric patient David Bennett died after being pinned down by nurses in a clinic in Norwich, sparking an inquiry into racial discrimination in NHS mental health services

Seven years later, when speaking to Jeffrey Dawkin it's hard not to note some similarities with David Bennett.

Like David Bennett, Dawkin, aged 40, has been diagnosed with schizophrenia, and has been in and out of psychiatric hospital for more than 10 years. Like David Bennett he is a black Rastafarian and has experienced compulsory psychiatric detention and treatment.

"I was told that if did not take medication I would be injected," remembers Dawkin of one hospital admission. "I was held, my trousers were pulled down and an injection was applied."

Yet, while David Bennett's life ended in such tragic circumstances the fortunes of Dawkin, from Bradford, have taken a positive turn.

Over the last two years his confidence has grown dramatically to the extent that he has new friends and attends community meetings. For someone whose previous lonely existence six months ago meant he could not even summon the courage to walk to the shops on his own, these are massive steps.

It is cruelly ironic that Dawkin says he has benefited from the kind of project which the government hopes can help root out institutionalised racial discrimination in mental health services that, last year, the inquiry into David Bennett's death identified. Afro-Caribbean men - such as Dawkin and David Bennett - are between two and eight times more likely than their white contemporaries to be sectioned under the Mental Health Act.

Since its launch two years ago, staff at Bradford's Sharing Voices project have been linking with the city's black and ethnic minority (BME) community groups in a bid to vitalise a "community development" approach to mental health. As a result, self-help, creative, and fitness groups for the city's BME community with mental health problems have got off the ground.

Importantly, the project's emphasis is less about bringing mainstream psychiatric interventions into the community, but seeking answers to people's mental health problems and associated exclusion within the "untapped expertise" of the community.

Take, for example, Asian muslim women who have been victims of sexual and physical violence. For them, explains Sharing Voices manager Salma Yasmeen, spiritual succour can be vital for recovery. You're more likely to find such support from a mosque than a psychiatric ward.

"They were not asking for latest drug treatments, they were asking for practical support, for safe places. Issues of employment are also massive," adds Yasmeen.

Rehana Kosar, 33, is an example of someone who feels the work of Sharing Voices has enabled her to find a culturally-appropriate pathway to recovery .

Engulfed by severe depression after the deaths of her baby and father, Sharing Voices provided Rehana with community contacts to access the spiritual guidance she yearned for. As well as attending a mutual support group for Asian women, staff put her in contact with Muslim scholars. Now working part-time, she has nothing but praise for Sharing Voices.

"It was not medication or my family that helped me - it was Sharing Voices," she says.

What is intrinsic to the Sharing Voices team's philosophy is that severe mental health problems are rooted more in people's experience than their biology.

This perspective, explains Sharing Voices' chair, psychiatrist Dr Phil Thomas, has been reinforced during discussions with young Bengali mental health service users from the city.

"People talk about their distress without the language of psychiatry," says Thomas. "They refer to it in terms of racism and what it's about to be a young Muslim in a society where islamophobia is rife."

As part of the government's Delivering Race Equality plan, launched in January in response to the David Bennett inquiry, funding was released for 500 extra community development workers around the country. Their remit is, by 2006, to be in place to link up with black and ethnic minority community organisations that can act as partners in working to create less discriminatory, more inclusive, mental health services.

This is exactly what the two Sharing Voices community development workers claim to have successfully been doing over the last two years. No surprise, then, that Sharing Voices has been assured that, from March, monies from this new funding will pay for its two community development workers to continue their work.

"What we are doing is not revolutionary and it's not rocket science. It's about democracy and accountability, and putting power into local communities," enthuses Thomas.

Thomas hopes that such harnessing resources of support within local communities might - in the long run - decrease the disproportionate rate that BME people (who make up 60% of inner city Bradford) are compulsory detained in psychiatric hospital. This, again, is what ministers pledged in January to achieve nationally.

"It is difficult to say whether our project has led to less detentions, and of course the problems of compulsory treatment will not be vanished away. Community development takes years and is a long term investment," says Thomas.

Seventeen strategic health authorities (SHAs) were due to have now submitted to the Department of Health details of new projects which Health Minister Rosie Winterton wants to act as "hothouses of reform" in rooting out racial discrimination in mental health services. The West Yorkshire SHA, which encompasses Sharing Voices, is one.

Moreover, judging from Kosar's and Dawkin's testimony, managers of other SHAs would have been advised, before submitting, to telephone their colleagues at Sharing Voices for advice.

"Sharing Voices was a godsend for me," says Dawkin who now volunteers for the project. "It enabled me to get back into doing something worthwhile and engage more in the community."

Dawkin has now not been an psychiatric inpatient for two years. Something, it appears, must be working.

* A shortened version of this article appeared at societyguardian.co.uk

See also:
June 1, 2005: A way with the anti-racist will? - In a bid to root out racism in mental health services the government has launched a raft of initiatives. But will they be enough? Adam James investigates
April 4, 2005: Planned services heralded to be "hothouses of reform" in rooting out racism in mental health - announcement of new projects comes on heels of census to establish extent of discrimination against black and minority ethnic patients in NHS and private hospitals
Jan 11, 2005: We'll cut rate that black and ethnic minority people are detained in psychiatric hospital, vow ministers - promise unveiled in government five-year anti-racist action plan for mental health services

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