11

Session 3 Session 3

AgendaAgenda StereotypesStereotypes Circles of FearCircles of Fear Communicating with service users in a clinical setting.Communicating with service users in a clinical setting. UK immigration UK immigration Population StatisticsPopulation Statistics Count me in Census 2009Count me in Census 2009 Themes of EqualityThemes of Equality Personal empowermentPersonal empowerment The RELATE modelThe RELATE model©©

22

Task : Divide yourself into small groups Task : Divide yourself into small groups , discuss and writing down your , discuss and writing down your thoughts for these 2 questions.thoughts for these 2 questions.

1. What are the common stereotypes of Black 1. What are the common stereotypes of Black people, White people and Asian people?people, White people and Asian people?

2. List other marginalised groups who were subjected 2. List other marginalised groups who were subjected to systematic forms of discrimination / abuseto systematic forms of discrimination / abuse

3. What are the common stereotypes of marginalised 3. What are the common stereotypes of marginalised people e.g. gay men, lesbians, young people, gypsiespeople e.g. gay men, lesbians, young people, gypsies

4. What do the stereotypes tell you about the 4. What do the stereotypes tell you about the underlying beliefs in relation to each marginalised underlying beliefs in relation to each marginalised groupsgroups

33

““Especially the African Caribbean males on the ward, Especially the African Caribbean males on the ward, they do feel the vibes. They feel that people are they do feel the vibes. They feel that people are shrinking away from them if they are trying to shrinking away from them if they are trying to

express themselves. What they see as expressing express themselves. What they see as expressing themselves, others perceive as sort of anger and themselves, others perceive as sort of anger and

almost threatened violence.”(quoted in McLean et al. almost threatened violence.”(quoted in McLean et al. 2003)2003)

In a study comparing black and white patients, black In a study comparing black and white patients, black patients were perceived as being more dangerous, patients were perceived as being more dangerous,

despite exhibiting lower levels of aggressive despite exhibiting lower levels of aggressive behaviour. (Bhui, 2001)behaviour. (Bhui, 2001)

Black African suspects are more likely than white Black African suspects are more likely than white suspects to be arrested, tried by courts and six times suspects to be arrested, tried by courts and six times

more likely to be in prison and be given longer more likely to be in prison and be given longer sentences. (The Parekh Report, 2002)sentences. (The Parekh Report, 2002)

44

BME women remain marginalised within current BME women remain marginalised within current policy debates. They are often viewed exclusively, policy debates. They are often viewed exclusively,

in stereotyped ethnic images – for instance, as in stereotyped ethnic images – for instance, as ‘loud and difficult to manage’ in the case of ‘loud and difficult to manage’ in the case of

African-Caribbean women, or in the case of Asian African-Caribbean women, or in the case of Asian women, as having problems that are rooted women, as having problems that are rooted

exclusively in ‘cultural conflict or practice’ within exclusively in ‘cultural conflict or practice’ within the family. This results in their needs as women the family. This results in their needs as women

being ignored and overlooked. being ignored and overlooked. (Keating, Robertson & Kotecha, 2003)(Keating, Robertson & Kotecha, 2003)

55

Examples of some common stereotypes

Gypsy and Travellers are dirtyGypsy and Travellers are dirty Short people are aggressiveShort people are aggressive Blonde women are not cleverBlonde women are not clever Chinese people are secretiveChinese people are secretive Black people are irrational & aggressiveBlack people are irrational & aggressive Irish, stupid and drunkIrish, stupid and drunk Homeless people are lazyHomeless people are lazy Children do not know what is good for themChildren do not know what is good for them Mental Health service users do not know what is good for themMental Health service users do not know what is good for them Men can’t multi-taskMen can’t multi-task All Jews have dark hair, large noses and love moneyAll Jews have dark hair, large noses and love money Gay men responsible for spreading AidsGay men responsible for spreading Aids BME people look after their own, therefore do not need servicesBME people look after their own, therefore do not need services Young people who wear hoodies are dangerousYoung people who wear hoodies are dangerous Lesbian women have hairy legsLesbian women have hairy legs Black people who are in management; made it because of their colourBlack people who are in management; made it because of their colour

66

Count me in CensusCount me in Census

Annual, 1day count of inpatients, introduced March 2005 Annual, 1day count of inpatients, introduced March 2005 Joint initiative Joint initiative with the:-with the:-

the Care Quality Commission (formerly Healthcare Commission)the Care Quality Commission (formerly Healthcare Commission) the Mental Health Act Commission (MHAC) the Mental Health Act Commission (MHAC) the Care Services Improvement Partnership the Care Services Improvement Partnership National Institute for Mental Health in England (NIMHE).National Institute for Mental Health in England (NIMHE).

The census aims to:-The census aims to:-

1. Obtain accurate mental health & learning difficulties inpatient figures in 1. Obtain accurate mental health & learning difficulties inpatient figures in England and Wales.England and Wales.

2. Improve recording and monitoring of data on the ethnic group of 2. Improve recording and monitoring of data on the ethnic group of patients.patients.

3. Provide information to achieve the Government’s five-year plan 3. Provide information to achieve the Government’s five-year plan Delivering Race Equality in Mental Health Care (DRE) - aims improvement Delivering Race Equality in Mental Health Care (DRE) - aims improvement mental health services for black and minority ethnic communities.mental health services for black and minority ethnic communities.

77

Count me in Census 2009 Count me in Census 2009 (published January 2010)(published January 2010)

Minority ethnic groups inpatients admissions –Minority ethnic groups inpatients admissions –

2005 20%2005 20% , , 2008 22%2008 22% (Increase in Other White (Increase in Other White group)group)

Admission rates for Admission rates for Black groupsBlack groups were over were over 3 3 timestimes higher higher

Over 9Over 9 times times higher in the Other Black group. higher in the Other Black group. (No change from previous Census’s)(No change from previous Census’s)

88

Count me in Census 2009Count me in Census 2009

ReferralReferral GPs and community mental health team referrals - lower GPs and community mental health team referrals - lower

among some Black and White/Black groups, criminal among some Black and White/Black groups, criminal justice system referrals - higher. justice system referrals - higher.

DetentionDetention Detention rates - higher Black Caribbean, Black African, Detention rates - higher Black Caribbean, Black African,

Other Black & White/Black Caribbean Mixed groups.Other Black & White/Black Caribbean Mixed groups.

Higher detention rates under section 37/41 (imposed by Higher detention rates under section 37/41 (imposed by courts, except Black African).courts, except Black African).

Detention rates – also higher in the Other White and Detention rates – also higher in the Other White and Pakistani groups.Pakistani groups.

99

Census 2008Census 2008

SeclusionSeclusion 4% of inpatients had an episode of seclusion- 4% of inpatients had an episode of seclusion-

higher for Other Black group (No change)higher for Other Black group (No change)

RestraintRestraint higher among the Other White and White/Black higher among the Other White and White/Black

Caribbean Mixed groups.Caribbean Mixed groups.

1010

CensusCensus 20092009

Length of stayLength of stay 29% of patients had been in hospital for one year or more, 29% of patients had been in hospital for one year or more,

and 20% for over two years. and 20% for over two years.

Black Caribbean and White/Black Caribbean Mixed groups – Black Caribbean and White/Black Caribbean Mixed groups – Longest staysLongest stays

Chinese, South Asian and White British groups - Shortest Chinese, South Asian and White British groups - Shortest stay.stay.

Black Caribbean, White/Black Caribbean Mixed and Other Black Caribbean, White/Black Caribbean Mixed and Other Black groups- more likely to be on a medium or high Black groups- more likely to be on a medium or high secure ward.secure ward.

1111

Reinforced prejudices

provoke more coercive

responses

Inappropriate service response due to inaccurate assessments of risk and needs

Dangerous Harmful Service ServicesUsers

Staff Service Users

Stereotypical view of Black PeopleRacismCultural IgnoranceStigma of Mental Health distress

No contactNon ComplianceCrisis Escalates

HARM TO SELFHARM TO OTHERS

The diagram above highlights the challenges which may be faced by ‘black men’ accessing the mental health services

A Perspective - Circles Of Fear

1212

““There is a risk that, in places like X, people may never There is a risk that, in places like X, people may never develop the awareness and skills to deal with Black people develop the awareness and skills to deal with Black people because there are so few of them”because there are so few of them”

Assumptions such as this may seem rather innocuous and Assumptions such as this may seem rather innocuous and commonplace but they can have very serious consequences . commonplace but they can have very serious consequences . This quote was made by a consultant psychiatrist at the This quote was made by a consultant psychiatrist at the Norvic Clinic in Norfolk where David ‘Rocky’ Bennett, a young Norvic Clinic in Norfolk where David ‘Rocky’ Bennett, a young African Caribbean man, who died while being restrained. African Caribbean man, who died while being restrained. The psychiatrist had made the statement in response to The psychiatrist had made the statement in response to questions from the Panel of Inquiry about ‘racial issues’ at the questions from the Panel of Inquiry about ‘racial issues’ at the Clinic Clinic

(‘Independent Inquiry into the Death of David Bennett - (‘Independent Inquiry into the Death of David Bennett - December, 2003).December, 2003).

1313

1414

The Themes of equalityThe Themes of equality

Theme 1 ~ Theme 1 ~ Valuing Cultural DiversityValuing Cultural Diversity

Theme 2 ~ Theme 2 ~ Preventative ApproachesPreventative Approaches

Theme 3 ~ Theme 3 ~ Autonomy & AdvocacyAutonomy & Advocacy

Theme 4 ~ Theme 4 ~ Holistic ApproachHolistic Approach

Theme 5 ~ Theme 5 ~ Participation & InformationParticipation & Information

Theme 6 ~ Theme 6 ~ Safeguarding RightsSafeguarding Rights

1515

The Themes of Institutional The Themes of Institutional DiscriminationDiscrimination

AssimilationAssimilation Under Reaction or Over ReactionUnder Reaction or Over Reaction Disempowering & StereotypingDisempowering & Stereotyping Service Led (rather than service user Service Led (rather than service user

led) Approachesled) Approaches Poor Access to servicesPoor Access to services Erosion of RightsErosion of Rights

1616

Reflect on the Poem and description in Reflect on the Poem and description in Handout 7. Break into small groups and Handout 7. Break into small groups and discuss these questions.discuss these questions.

1.What is your reaction to the poem?1.What is your reaction to the poem?

2.What could help people to cope or deal 2.What could help people to cope or deal with a situation of powerlessness?with a situation of powerlessness?

3.Where does this fit into the RELATE 3.Where does this fit into the RELATE

modelmodel©©??

1717

The ‘spiral of oppression’ ( by Premila Trivedi, 2001)

1818

A model of personal A model of personal empowermentempowerment

1919

The RELATE Model©

© Caroline Hounsell, 2008

2020

British asylum laws :-British asylum laws :-

Asylum SeekersAsylum Seekers are those people who are awaiting a decision. The Home are those people who are awaiting a decision. The Home Office National Asylum Support Service (NASS) generally offer accommodation in Office National Asylum Support Service (NASS) generally offer accommodation in a town outside the area of South-East England & London while their case is a town outside the area of South-East England & London while their case is considered.considered.

Refugees with Exceptional Leave to RemainRefugees with Exceptional Leave to Remain (ELR) do not qualify as (ELR) do not qualify as ‘having a well-founded fear of persecution’) but are recognised as being in great ‘having a well-founded fear of persecution’) but are recognised as being in great danger if they return home. Usually offered ‘temporary protection’ & the right to danger if they return home. Usually offered ‘temporary protection’ & the right to live here for up to 4 years.live here for up to 4 years.

Refugees with Indefinite Leave to RemainRefugees with Indefinite Leave to Remain (ILR) meet the UN terms, (ILR) meet the UN terms, and have no time limit on their right to live in Britain. Majority of their rights are and have no time limit on their right to live in Britain. Majority of their rights are the same as a British passport-holder, and many settle here permanently.the same as a British passport-holder, and many settle here permanently.

Refugees and those with ELR have the full entitlement to NHS Refugees and those with ELR have the full entitlement to NHS treatment available to all legal residents in Britain, and do not have to treatment available to all legal residents in Britain, and do not have to pay fees. Asylum seekers whose cases have not yet been determined pay fees. Asylum seekers whose cases have not yet been determined (including those with appeals pending) are also entitled. Those whose (including those with appeals pending) are also entitled. Those whose applications have failed where appeal processes have been exhausted applications have failed where appeal processes have been exhausted and are entitled only to free emergency treatment.and are entitled only to free emergency treatment.

2121

ImmigrationImmigration Restrictive immigration Restrictive immigration

rules mean immigrants rules mean immigrants have been refugees or have been refugees or asylum seekers. asylum seekers.

Facing all the problems Facing all the problems that settled community that settled community BME people face but there BME people face but there are additional challenges are additional challenges for mental health services for mental health services in providing for their in providing for their needs. needs.

(quote based on Fernando, 2003)(quote based on Fernando, 2003)

Many tortured before Many tortured before arrival & many have gone arrival & many have gone through difficult & through difficult & traumatic experiences in traumatic experiences in the course of getting here. the course of getting here.

Refugees and asylum Refugees and asylum seekers feel intensely seekers feel intensely insecure in their political insecure in their political and social position within and social position within the UK. the UK.

They face intense hostility They face intense hostility & overt racism worse than & overt racism worse than black immigrants in the black immigrants in the 1960s and 1970s.1960s and 1970s.

2222

Asylum Seekers & RefugeesAsylum Seekers & Refugees

17 %17 % of asylum seekers - limiting physical illness of asylum seekers - limiting physical illness 2/32/3 have experienced significant anxiety and depression have experienced significant anxiety and depression

(BMA 2002; Carey Wood et al 1995). (BMA 2002; Carey Wood et al 1995).

Detaining asylum seekers in removal centres compounds Detaining asylum seekers in removal centres compounds the psychological damagethe psychological damage

Prospect of dispersal exacerbates mental health problems Prospect of dispersal exacerbates mental health problems & reduces opportunities for developing community & reduces opportunities for developing community networks. (Watters 2002), networks. (Watters 2002),

Dispersal was to areas with low concentrations of Dispersal was to areas with low concentrations of refugees, leading to high visibility and an increase in refugees, leading to high visibility and an increase in racial abuse. racial abuse. (Watters C, 2002)(Watters C, 2002)

2323

StatisticsStatistics

The South Asian community The South Asian community largest ethnic minority group largest ethnic minority group living in Britain, 4% of the living in Britain, 4% of the population (2001 Census).population (2001 Census).

• Indian (1.8%), Indian (1.8%), • Pakistani (1.3%),Pakistani (1.3%),• Bangladeshi(0.5%) and Bangladeshi(0.5%) and • other Asian (0.4%). other Asian (0.4%).

(DH, 2007)(DH, 2007)

1.0% of the population is 1.0% of the population is Black Caribbean descent Black Caribbean descent living in the UK (2001 Census)living in the UK (2001 Census)

0.8% - People of Black African 0.8% - People of Black African descent isdescent is

0.2% - People of Black Other. 0.2% - People of Black Other.

The African-Caribbean The African-Caribbean community mainly lives community mainly lives within the inner cities, within the inner cities,

Over 50% are British born. Over 50% are British born.

BMEBME groups can experience groups can experience poorer health, have reduced poorer health, have reduced life expectancy & have life expectancy & have greater problems accessing greater problems accessing health. health.

For mental health, major For mental health, major concerns include disparities & concerns include disparities & inequalities in terms of rates inequalities in terms of rates of mental ill health, service of mental ill health, service experience & service experience & service outcome.outcome.

2424

Divide yourselves into 3 groups – A, B & C.Divide yourselves into 3 groups – A, B & C.

Group A – Handout 8Group A – Handout 8Group B – Handout 9Group B – Handout 9Group c – Handout 10Group c – Handout 10

Read your handout section and prepare to present Read your handout section and prepare to present what you have found back to the whole group in a what you have found back to the whole group in a

short presentation. short presentation.

You can deliver this presentation as creatively as You can deliver this presentation as creatively as you like.you like.

2525

Organise yourselves into two groups. Write a short radio script of about Organise yourselves into two groups. Write a short radio script of about 5mins around the basic scenario below using all the stages of the RELATE 5mins around the basic scenario below using all the stages of the RELATE

modelmodel©©. After you have written and practiced your short play you will . After you have written and practiced your short play you will ‘perform’ this 5mins RELATE radio play to the rest of the group. ‘perform’ this 5mins RELATE radio play to the rest of the group.

Situation: Situation: A forensic unit:A forensic unit:

Ahmed (a BME patient) complains to Jon (a staff nurse) that another Ahmed (a BME patient) complains to Jon (a staff nurse) that another White patient, Billy, has been repeatedly addressing him using racist White patient, Billy, has been repeatedly addressing him using racist

names.names.

RELATERELATE Model Model©©

RRecognise the discriminationecognise the discrimination EExpress your concern xpress your concern LListen to the responseisten to the response AAccurately educate with facts and ccurately educate with facts and

feelingsfeelings TTalk to relevant authoritiesalk to relevant authorities EEnable self sportnable self sport

2626

Session 3 Session 3

AgendaAgenda StereotypesStereotypes Circles of FearCircles of Fear Communicating with service users in a clinical setting.Communicating with service users in a clinical setting. UK immigration UK immigration Population StatisticsPopulation Statistics Count me in Census 2008Count me in Census 2008 Themes of EqualityThemes of Equality Personal empowermentPersonal empowerment The RELATE modelThe RELATE model©©