recc participants reader

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Page

TheTenEssentialSharedCapabilities

Contents

Introduction. 2

Purpose. 3

Outline.of.the.programme. .3

Principles.&.Values. 5

Getting.the.best.from.the.programme 6

Further.development.of.RECC.training.materials9

Key.documents.in.RECC.training. 10

Session 1 Reecting on culture. 15

Session 2 Reecting on beliefs. 19

Session.3..Assumptions.in.practice. 27

Session 4 Reecting on communication 32

Session.5..Working.across.different.cultures. 41

Session.6..Race.equality.in.mental.health.services. 49

Session.7..Working.in.an.empowering.way. 59

Session.8..Working.with.families.and.carers. 65

Session.9..Understanding.discriminatory.situations. 76

Session.10..Identifying.needs.in.a.holistic.way. 83

Session.11..Holistic.approach.to.planning. 94

Session.12..Anti-discriminatory.risk.work. 103

ESC.Advanced.Module

Race.Equality.and.Cultural.Capability

Participant.Readerby Peter Ferns

Other Contributors:

Premila Trivedi

Suman Fernando

Dominic Makuvachuma Walker

REC

C-ESCADVANCEDM

OD

ULE


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PageIntroduction

Introduction.to.Participant.Reader

There are signicant and unacceptable inequalities in the access to mental health ser-

vices that black and minority ethnic patients have, in their experience of those services

and in the outcome of those services. Rates of compulsory admission are signicantly

higher for black and minority ethnic groups. Average lengths of stay in hospital are

longer. BME patients are more likely than white people to be prescribed drugs or ECT

rather than psychotherapy or counselling.

All this fuels the circle of fear that can deter BME patients from seeking early treatment

for their illness.

(Rosie Winterton, The Minister of State for Health, Jan 2005)

Welcome.to.all.participants.in.the.Race.Equality.and.Cultural.Capability.(RECC).training.

programme.It.has.been.recognised.that.services.for.BME.people.have.been.inadequate.

and.of.unacceptable.quality.for.some.time.and.this.has.been.backed.up.a.large.body.of.research.We.know.a.great.deal.about.what.the.problems.are.and.now.it.is.time.for.us.to.

start.to.do.something.about.these.well-established.problems.in.a.more.strategic.way.The.

RECC.programme.is.a.central.part.of.the.Governments.national.strategy.to.improve.mental.

health.services.for.Black.and.Minority.Ethnic.(BME).people.represented.by.Delivering.

Race.Equality.(DH,.2003).The.RECC..materials.are.an.extension.of.the.Essential.Shared.

Capabilities.(ESC).training.modules.providing.a.focused,.higher.level.of.training.around.

RECC,.especially.Module.5..Race.Equality.and.Cultural.Capability.In.this.introduction.

we.will.say.something.about.the.context.for.this.programme.in.terms.of.BME.mental.health,.

outline the whole RECC programme and describe how best to get the maximum benet out

of.this.learning.programme

The.programme.aims.to.support.a.whole.systems.approach.to.developing.services.that.are.

anti-discriminatory.and.culturally.appropriate.to.BME.communities.We.must.recognise.that.

training.alone.will.not.bring.about.fundamental.change.and.improvement.in.mental.health.

services.for.BME.people.We.also.need.to.ensure.that.learning.is.brought.into.practice,.that.

the.culture.of.organisations.promote.race.equality.and.value.cultural.diversity.amongst.its.

service.users.and.staff.and.that.leaders.design.and.develop.systems.and.structures.that.

support.good.practice.

This.Participants.Reader.is.designed.to.provide.a.series.of.pre-course.readings.for.

participants.attending.the.twelve.Sessions.of.the.Race.Equality.and.Cultural.Capability.

programme.The.pre-course.readings.will.enable.participants.to.prepare.thoroughly.for.

each.Session.and.get.greater.learning.from.the.group.exercises.It.is.recommended.that.

participants undertake these readings to get the maximum benet from the direct teaching

Sessions,.however.they.are.not.absolutely.essential.

The.Reader.is.one.of.three.sets.of.materials.that.will.be.given.to.participants.the.other.two.

sets.will.be.a.Practice.Development.Workbook.and.Handouts.in.each.training.session.It.

may.be.sensible.for.participants.to.have.one.ring-binder.to.keep.all.the.materials.for.RECC.

together.and.allow.you.to.cross-reference.materials.at.certain.points.in.the.programme.

RECC.-.ESC.Advanced.Module.


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PagePurposeandOutline

Purpose.of.the.RECC.programmeThe.RECC.learning.materials.are.designed.to.help.learners.develop.knowledge.and.

understanding.of.racism,.cultural.difference.and.recognise.the.impacts.of.discrimination.The.

learning.materials.will.also.enable.workers.to.develop.their.practice.skills.in.promoting.race.

equality,.working.positively.with.cultural.difference.and.effectively.dealing.with.the.impacts.of.discrimination.on.individual.and.institutional.levels

Outline.of.the.RECC.programmeThe.RECC.programme.consists.of.12.one.and.a.half.to.two.hour.training.Sessions.with.

twelve.workplace.tasks.attached.(one.for.each.Session).The.materials.provided.to.

participants.include:

. Participants.Reader.-.A.set.of.optional.pre-course.reading.materials

. Practice.Development.Workbook.-.A.series.of.work.task.templates.that.help.

participants.to.undertake.the.tasks,.get.supervision.from.their.line-managers.and.

gather.data.that.contributes.to.an.overall.report.to.senior.managers

. Handouts.and.Learners.Notes..Materials.that.support.the.teaching.on.each.of.

the.twelve.Sessions.and.are.given.to.participants.at.the.time.of.group.exercises

There.is.also.a.RECC.Trainers.Manual.and.template.for.a.Report.to.Senior.Managers.

available.The.twelve.teaching.Sessions.are.summarised.in.the.table.below.with.their.

learning.outcomes

Session 1 Reecting on culture

Dening culture more clearly and appreciating its complexity.

. Introducing.a.useful.model.of.culture.to.help.understand.it.at.different.levels. Making.links.between.culture,.power.and.oppression

Session 2 Reecting on beliefs

. Analysing.the.nature.of.cultural.change.in.mental.health.services

. Understanding.the.social.and.cultural.context.of.diagnosis.in.mental.health

. Raising.awareness.of.the.impact.of.personal.beliefs.and.values.of.practitioners.on.

their.practice

.

Session.3..Assumptions.in.practice

Encouraging reective mental health practice in relation to ones own beliefs and

values

. Appreciating.the.power.of.hidden.assumptions.to.shape.practice.in.mental.health.

work

. Understanding.how.circles.of.fear.develop.between.BME.service.users.and.

mental.health.practitioners

Session 4 Reecting on communication

. Identifying.ways.of.breaking.circles.of.fear.with.BME.service.users

. Appreciating.the.importance.of.good.communication.between.service.users.and.

practitioners.for.the.quality.of.mental.health.services.provided

. Understanding.the.use.of.power.and.authority.through.communication.in.service.settings



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Session.5..Working.across.different.cultures

. Identifying.the.barriers.to.good.communication.with.BME.service.users.in.mental.

health.settings

. Understanding.cultural.differences.through.a.model.that.avoids.cultural.

stereotyping.and.values.diversity.and.inclusivity Reecting on ones own differences in cultural beliefs and values.

Session.6..Race.equality.in.mental.health.services

. Analysing.the.impacts.of.individual.cultural.differences.in.teams.and.in.services.as.

a.whole

. Understanding.of.and.being.able.to.recognise.the.processes.involved.in.

institutional.racism

. A.clearer.understanding.of.what.promoting.race.equality.means.in.mental.health.

services

.

Session.7..Working.in.an.empowering.way. An.analysis.of.how.well.local.mental.health.services.promote.race.equality

. A.deeper.understanding.of.the.consequences.of.powerlessness.and.internalised.

oppression.for.BME.service.users

. Introduction.to.a.model.of.individual.empowerment.of.service.users

Session.8..Working.with.BME.families.and.carers

. Formulation.of.a.strategy.to.empower.BME.service.users.in.local.services

. Understanding.what.is.involved.in.BME.family/carer.empowerment

. An.appreciation.of.BME.community.empowerment.and.the.role.of.Community.

development.Workers

Session.9..Understanding.discriminatory.situations

. Looking.at.ways.of.empowering.BME.families.and.carers.in.local.mental.health.

services

. Understanding.the.importance.of.accurate.analysis.of.situations.involving.possible.

racial.discrimination.for.successful.interventions

. Using.a.whole.systems.approach.to.gathering.information.in.complex.situations.

with.BME.people

Session.10..Identifying.needs.in.a.holistic.way

. Analysis.of.a.complex.situation.involving.a.BME.service.user.in.local.mental.health.services

. Understanding.the.fundamental.principles.of.a.holistic.approach.to.mental.health.

assessment

. Critical.analysis.of.assessment.processes.in.local.mental.health.services.using.

the.principles.of.a.holistic.approach

Session.11..Holistic.approach.to.planning

The Five Service Accomplishments to help dene the desired lifestyle of BME

service.users

. A.holistic.and.anti-discriminatory.process.of.person-centred.planning.with.BME.

people

. Identifying.the.desirable.lifestyle.of.a.BME.service.user



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Session.12..Anti-discriminatory.risk.work

. A.critical.analysis.of.the.local.assessment.and.individual.planning.processes.in.

relation.to.cultural.appropriateness.and.person-centred.practice

Awareness of how race and culture issues can inuence risk assessment and

management. An.understanding.of.the.principles.and.process.of.anti-discriminatory.risk.work

The.Sessions.described.above.can.be.delivered.in.the.form.of.one.Session.per.week.or.at.

regular.intervals,.alternatively.the.programme.could.be.arranged.into.one-day.workshops.

with.time.for.work.tasks.in.between.each.workshop

The.material.for.each.Session.in.this.Reader.consists.of:

. three.learning.outcomes.which.can.be.used.for.evaluation.of.learning.by.

participants

a list of key words for the Session these denitions outline the way in whichthe.words.and.phrases.are.used.in.the.text.and.are.not.meant.to.be.dictionary.

denitions

. teaching.material.in.the.main.body.of.the.text.

quotes and research ndings in boxes

. interesting.related.facts.under.the.points.of.interest.boxes

reection points for readers to stop and consider some deeper questions about

the.text

. references.for.sources.of.information.quoted.in.the.Session

. suggestions.for.further.reading.and.research



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PagePrinciples

Principles.&.values.of.the.RECC.programme

1.Dealing.with.inequality.and.not.just.cultural.difference

Valuing.cultural.difference.without.dealing.with.inequality.and.racism.in.mental.health.servic-

es.will.not.work.Cultural.capability.without.a.strategy.to.address.institutional.and.individual.racism.based.on.an.analysis.of.power.dynamics.and.structural.inequalities.will.have.a.limited.

impact.on.discrimination.in.services

2.Having.a.deeper.understanding.of.culture

A supercial analysis of culture can lead to tokenism and cultural stereotyping a simple

understanding.of.culture.leads.to.simply.wrong.judgements

3.RECC.is.an.ordinary.part.good.practice

Race.equality.and.cultural.capability.are.not.special.or.different.approaches,.they.are.es-

sentially.about.good.practice.and.improve.mental.health.services.for.everyone

4.Services.will.improve.only.through.a.whole.systems.approach

There.must.be.a.coherent.strategy.for.change.based.on.a.whole.systems.approach.to.

achieve.sustained.and.continuous.improvement.in.services

5.Greater.BME.service.user.participation.leads.to.greater.appropriateness.of.ser-

vices

Genuine.participation.and.involvement.of.BME.service.users,.their.families.and.communities.

is.the.most.effective.and.rapid.way.to.achieve.mental.health.services.that.are.more.appropri-

ate.and.accessible.to.BME.people

6. Miscommunication often leads to unnecessary conicts

Everyone.needs.to.share.a.common.understanding.of.the.fundamental.concepts.in.equality.

and diversity work if we are to establish a constructive dialogue about difcult issues be-

tween.the.different.groups.involved.in.BME.mental.health

7.We.need.to.recognise.institutional.discrimination.as.a.problem.before.we.can.

begin.to.tackle.it.properly

Institutional.discrimination.is.often.covert.and.complex,.mental.health.practitioners.need.help.

in.recognising.when.and.how.it.operates.in.their.services

8. Know yourself rst before trying to understand others

You.can.only.understand.where.other.people.are.coming.from.in.terms.of.culture.only.if.you.

understand where you are coming from rst.

9. Unacknowledged prejudices grow in power and inuence

If.you.dont.face.up.to.the.prejudices.and.stereotypes.you.hold.they.will.become.even.more.

powerful.in.shaping.your.practice.

10.Values.are.central.to.mental.health.practice

Value.judgements.come.into.all.decisions.we.make.in.mental.health.service.as.we.are.deal-

ing.with.people.and.trying.to.improve.the.quality.of.their.lives



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PageGettingthebestoutotheRECCprogramme

Getting.the.best.out.of.the.RECC.programme

Allow yourself some time to undertake the programme.-.If.the.programme.

is.being.run.as.a.series.of.short.Sessions.over.a.period.of.twelve.weeks.you.will.

need.to.allow.yourself.approximately.half.an.hour.to.do.the.pre-course.reading,.two.hours.for.the.teaching.session,.two.hours.for.the.work.task.and.one.hour.for.

a supervision session with your line-manager a total of ve and a half hours per

week.per.Session

Prepare for each Session.-.Try.to.do.the.pre-course.readings.as.this.will.enable.

you.to.get.a.lot.more.from.the.groupwork.exercises.There.are.sometimes.small.

exercises you should undertake as part of the self-reection boxes in the text

.the.results.of.some.of.these.exercises.will.also.be.used.in.the.Session

Come to the Session with an open mind.-.RECC.training.can.bring.some.

strong emotions and difcult practice issues making it challenging on a personal

as.well.as.professional.level.Practitioners.may.have.some.poor.past.experiences.

of.training.around.this.issue.or.come.to.the.Session.with.negative.expectations.If.

this.applies.to.you.try.to.be.as.positive.about.the.training.as.you.can.as.the.RECC.

programme.aims.to.be.constructively.challenging,.not.punitive.or.accusatory.

towards.participants,.by.engaging.them.in.a.collaborative.exploration.of.the.issues.

and.not.presuming.to.have.all.the.answers.to.dealing.with.discrimination.in.mental.

health.services

Be determined and diligent in completing the workplace task.-.The.workplace.

task.set.is.designed.to.help.you.apply.your.learning.in.the.workplace.this.will.have.a much greater impact on the quality of your practice as well being of real benet

to.your.BME.service.users..your.organisation.will.also.achieve.better.value.for.

the.resources.it.commits.to.sending.its.staff.onto.the.RECC.programme.Make.

sure.that.you.use.the.built-in.supervision.session.with.your.line-manager.to.help.

you.complete.the.tasks.successfully

Work in a co-operative and supportive way with colleagues.-.The.programme.

is.a.rare.opportunity.to.bring.together.practitioners.from.statutory.and.voluntary.

sector.organisations.together,.possibly.with.BME.service.users,.families.and.

carers.If.the.course.is.successful.it.will.enable.as.much.learning.from.your.fellow.

participants.as.it.does.from.the.trainers.or.the.materials.It.is.possible.to.undertake.the.work.tasks.co-operatively.as.a.pair.or.in.a.buddy.system.with.another.worker.

to.support.you.in.completing.your.task

Co-operate with any evaluation activity being asked of you.-.Evaluation.can.

feel.like.an.added.luxury.in.some.training.events.but.it.is.essential.for.the.RECC.

programme.to.be.continually.improved.and.made.more.relevant.to.the.needs.of.

local.mental.health.services.The.RECC.materials.are.meant.to.be.added.to.and.

shaped.by.local.issues.so.that.they.are.relevant.to.local.BME.communities

.



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PageGettingthebestoutotheRECCprogramme

Suggested.ground-rules.for.RECC.groupwork

We.have.found.that.the.more.diverse.the.group.of.participants.is,.the.greater.the.potential.for.

learning.particularly.where.voluntary.sector.organisations,.BME.service.users.and.family/car-

ers are all involved with practitioners in statutory services. Qualied staff can benet as muchas unqualied staff from the workshops and the materials will complement most forms of

professional.training.in.mental.health.Greater.diversity.in.the.participant.group.does.require.

more.careful.handling.of.the.group.dynamics.and.it.is.useful.to.set.a.clear.learning.agree-

ment with ground-rules for the group at the start of the rst Session and reviewed at every

workshop.

We.have.found.the.following.checklist.useful.in.negotiating.learning.agreements:

Condentiality to allow people to share openly what is going on for them at work

and.in.their.practice

. Respect.for.each.other.even.though.people.may.disagree.with.the.each.others.

opinions

. Engaging.in.constructive.challenge.to.make.sure.that.people.open.up.issues.for.

debate rather than close them down through personal conict.

. Listening.to.each.other.and.giving.people.space.to.express.their.views.to.avoid.

miscommunication.as.much.as.possible

Making assumptions and beliefs more explicit to allow people to reect on their

own.views.as.well.as.understand.other.peoples.views.more.accurately

. Offering.data.and.evidence.for.personal.views.to.allow.a.clearer.discussion.to.

take.place.and.increase.learning

It.is.important.for.the.trainers.to.impress.upon.participants.that.they.will.be.expected.to.be.

reective about their practice as this will lead to the greatest learning for them. Everyone

should.participate.in.the.workshop.on.an.equal.basis.with.each.other..there.should.be.no.hi-

erarchies.between.people.in.the.workshop.whether.service.users.or.practitioners,.particularly.

where front-line workers may have managers present or unqualied voluntary sector people

are.working.with.statutory.sector.professionals.

Finally,.no.training.programme.however.good.can.guarantee.service.improvement.Training.

can.provide.some.useful.tools,.the.knowledge.and.value.base.to.use.them.effectively.and.

ethically;.but.it.cannot.in.itself.change.practice.Individual.practitioners.must.take.personal.

accountability.for.the.quality.of.their.practice.Good.leadership.driving.the.right.culture.to.pro-mote.race.equality.and.cultural.capability;.the.right.systems.and.structures.to.support.good.

practice.and.drive.the.behaviours.for.RECC.can.certainly.help.However,.the.system.consists.

largely.of.the.actions.of.individual.practitioners.and.they.have.the.power.and.authority.to.

have a big inuence on the experience of BME service users of services for better or worse.

The.RECC.programme.is.a.valuable.and.rare.opportunity.for.practitioners.to.take.an.honest.

and reective look at their practice with BME people in a supportive and positive learning

environment.It.can.make.a.real.difference.to.your.practice.and,.most.importantly,.lead.to.

better.quality.mental.health.services.for.BME.people.in.your.area.Do.not.let.the.opportunity.

pass.you.by

References

DH.(2003),.Delivering.Race.Equality:.A.Framework.for.Action,.DH,.October.2003



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PageFurtherdevelopmentsoRECCmaterials

Further.development.of.RECC.training.materials

The.aim.of.these.materials.was.to.produce.something.suitable.for.all.mental.health.prac-

titioners regardless of qualication level or work experience. They were also intended to

incorporate.other.forms.of.equality.as.much.as.possible.The.materials.are.arranged.into.twelve.learning.sessions.of.approximately.one.and.half.hours.duration,.delivered.as.a.series.

of.regular.short.sessions.for.practitioners.or.combined.to.form.a.variety.of.workshops.or.

programmes.

As.part.of.a.whole.systems.approach.to.training,.several.of.the.exercises.were.designed.to.

generate.data.and.evidence.of.practice.for.managers.The.purpose.of.feeding.through.such.

data.to.leaders.is.to.enable.them.to.make.better.judgements.about.policy.and.procedures.

and.ultimately.design.better.systems.and.structures.to.support.and.deliver.anti-discriminatory.

practice.In.this.way.leaders.will.get.an.invaluable.insight.into.the.culture.of.the.organisation.

and.the.views.of.service.users.and.staff.about.the.quality.of.services.It.is.one.of.the.central.

design.principles.to.present.BME.service.user.perspectives.and.interests.throughout.the.pro-

gramme.Finally,.following.each.session.there.are.suggestions.for.small.workplace.projects.

designed.to.link.learning.in.that.session.to.practice

One.of.the.most.innovatory.aspects.of.the.RECC.training.is.that.it.has.been.designed.to.be.

delivered.in.partnership.with.BME.service.user/survivor.trainers..Co-training.between.BME.

service.user/survivor.trainers.and.other.mental.health.trainers.adds.more.complexity.to.the.

implementation.of.RECC.training.but.it.is.essential.in.achieving.its.fundamental.goals.We.

have.found.that.issues.of.power,.institutional.discrimination,.service.user.experience.and.cul-

tural.appropriateness.have.been.discussed.and.dealt.with.much.more.effectively.when.BME.

service.user/survivor.trainers.are.involved.than.when.they.are.not.It.is.our.aim.to.include.training.for.trainers.as.part.of.the.implementation.process.for.RECC.along.with.the.estab-

lishment.of.a.pool.of.BME.service.user/survivor.trainers.that.may.be.called.upon

.

Future.levels.of.RECC.trainingAlthough.the.RECC.materials.are.pitched.at.around.foundation.level.training.but.beyond.

the.ESC.materials,.a.second.level.of.RECC.is.being.developed.to.focus.on.RECC.skills.

development in specic areas of practice such as assessment and person-centred planning,

working.with.interpreters.in.interviews.and.in.service.areas.such.as.Children.and.Adoles-

cent.Mental.Health.Services,.forensic.services,.drug.and.alcohol.services.and.elders.A.third.

level.of.training.is.being.developed.for.team.leaders.on.managing.diverse.teams.and.taking.

on.a.leadership.role.in.promoting.RECC.Finally,.a.fourth.level.is.being.planned.for.senior.managers.and.service.planners.which.will.focus.on.systemic.approaches.to.RECC,.chang-

ing.organisational.cultures,.designing.systems.to.promote.RECC.and.creating.sustainable.

service.improvements.for.BME.communities

Detailed.information.about.the.RECC.materials.and.the.additional.levels.of.RECC.available.

on.the.website:.http://wwwfernsassociatescouk.

Or.contact.us.on.0208-641-9358.

References

DH.(2003),.Delivering.Race.Equality:.A.Framework.for.Action,.DH,.October.2003



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Page0Page0KeydocumentsinRECCtraining

Key.documents.referred.to.in.RECC.training

Before.you.embark.on.the.RECC.learning.programme,.it.may.help.you.to.have.a.look.at.the.

following.national.policy.documents.You.may.have.come.across.them.before.but.just.refresh.

your.understanding.of.the.documents.and.bring.yourself.up.to.date.on.BME.mental.health.issues.by.visiting.the.Delivering.Race.Equality.(DRE).website.on:.wwwactiondreorguk

......................................................................................................................................

Document.1:.Delivering.race.equality.in.mental.health.care.-.An.Action.Plan.for.

reform.inside.and.outside.services;.and.the.Governments.response.to.the.indepen-

dent.inquiry.into.the.death.of.David.Bennett.11.January.2005

David.Bennett.was.a.38-year-old.African-Caribbean.patient.who.died.on.30.October.1998.in.

a.medium.secure.psychiatric.unit.after.being.restrained.by.staff.The.report.of.the..

independent.inquiry.into.the.death.of.David.Bennett.made.important.recommendations.about.

the.way.that.mental.health.care.is.delivered.to.service.users,.especially.those.from.BME..

communities.The.recommendations.also.address.wider.issues.such.as.the.safe.use.of..

physical.intervention.in.mental.health.settings.David.Bennett,.a.38-year-old.African-Carib-

bean.patient,.died.on.30.October.1998.in.a.medium.secure.psychiatric.unit.in.Norwich.after.

being.restrained.by.staff.for.around.25.minutes

The.report.of.the.independent.inquiry.into.his.death.was.published.on.12.February.2004.It.

can.be.seen.in.full.at:.http://wwwnscshanhsuk/publications/indexhtml

Delivering Race Equality.proposed.key.strategic,.whole.system.responses.to.Inside.

Outside.to.implement.the.reform.it.signalled.It.described.three.main.building.blocks,.closely.

related.to.the.objectives.of.Inside.Outside,.which.now.form.the.foundations.of.an.action.plan:

. the.development.of.appropriate,.sensitive.and.responsive.services;

. the.engagement.of.BME.communities.with.service.providers;.and

good quality, intelligently used information on the ethnic prole of local

populations.and.of.service.users

The.Governments.Five.Year.Plan.for.achieving.race.equality.and.tackling.discrimination.in.

mental.health.services.in.England.is.the.most.important.policy.statement.on.BME.mental.

health.

DRE.will.aim.to.achieve.twelve.key.characteristics.in.mental.health.services.by.2010.and.the.

following grid sets out these characteristics in the rst column with an explanation of howand.where.the.RECC.materials.covers.these.issues.in.the.training.materials:



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PagePageKeydocumentsinRECCtraining

DRE.Characteristics

1.Less.fear.of.mental.health.services.among.

BME.communities.and.service.users

Circles.of.Fear.exercise.in.Session.3

Awareness.of.negative.assumptions.and.

beliefs.in.Sessions.2.&.3

Improving.communications.in.Session.4

Anti-discriminatory.risk.work.in.Session.12

2.Increased.satisfaction.with.services Addressing.service.user.concerns.and.

needs.through.person-centred,.holistic.as-

sessment.and.planning.in.Sessions.10.&.11

Working.with.BME.families/carers.in.Session.

8

3.A.reduction.in.the.rate.of.admission.of.people.

from.BME.communities.to

psychiatric.in-patient.units.

Working.for.empowerment.of.service.users.

and.families.in.Sessions.7.&.8

Working.in.a.more.culturally.appropriate.way.

in.Session.5Prevention.as.a.Theme.of.Equality.in.Ses-

sion.6

4.A.reduction.in.the.disproportionate.rates.of.

compulsory.detention.of.BME.service.users.in.

in-patient.units;

Understanding.discriminatory.situations.bet-

ter.in.Session.9

Anti-discriminatory.risk.work.in..

Session.12

Identifying.needs.in.a.holistic.way.in.Session.

10

5.Fewer.violent.incidents.that.are.secondary.to.

inadequate.treatment.of.mental.illness

Improving.communication.in.service..

settings.in.Session.4

Circles.of.Fear.exercise.in.Session.3

6.A.reduction.in.the.use.of.seclusion.in.BME.

groups

Improving.communication.in.service.settings.

in.Session.4

Understanding.discriminatory.situations.bet-

ter.in.Session.9

7.The.prevention.of.deaths.in.mental.health.

services.following.physical.intervention.

Improving.communication.in.service.settings.

in.Session.4

8.More.BME.service.users.reaching.self-report-

ed.states.of.recovery



Addressing.service.user.concerns.and.

needs.through.person-centred,.holistic.as-sessment.and.planning.in.Sessions.10.&.11

9.A.reduction.in.the.ethnic.disparities.found.in.

prison.populations

Working.more.holistically.in.Sessions.10.&.

11

Looking.at.wider.Themes.of.Equality.in.

Session.6

10.A.more.balanced.range.of.effective.therapies,.

such.as.peer.support.services.and.psychothera-

peutic.and.counselling.treatments,.as.well.as

pharmacological.interventions.that.are.culturally.

appropriate.and.effective.

Looking.positively.at.cultural.difference.in.

Session.5

Addressing.service.user.concerns.and.

needs.through.person-centred,.holistic.as-

sessment.and.planning.in.Sessions.10.&.11

Working.with.BME.families/carers.in.Session.

8



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PagePageKeydocumentsinRECCtraining

11.A.more.active.role.for.BME.communities.and.

BME.service.users.in.the.training.of.profession-

als,.in.the.development.of.mental.health.policy.

and.in.the.planning.and.provision.of.services



Our.participatory.approach.to.implementa-

tion.of.RECC.with.BME.service.user.and.

carer.trainers

12.A.workforce.and.organisation.capable.of.de-

livering.appropriate.and.responsive.mental.health.

services.to.BME.communities

The.whole.RECC.Programme

Document.2:.Inside.Outside

Inside Outside.signalled.reform.of.mental.health.care.for.BME.communities

It was prepared by some of the leading experts in the eld and was supported by widespread

public consultation. It identied three key objectives:

. to.reduce.and.eliminate.ethnic.inequalities.in.mental.health.service.experience.

and.outcome;

. to.develop.the.cultural.capability.of.mental.health.services;.and

. to.engage.the.community.and.build.capacity.through.community.development.

workers

For.the.full.document.see:...wwwdhgovuk

Document.3:.Count.me.in.Census.2005

The Count me in census was carried out for the rst time in 2005 of in-patients in mental

health.hospitals.and.facilities.It.collected.details.of.ethnicity,.language.and.religion.as.well.as.

information.about.how.in-patients.came.to.be.in.hospital.and.details.about.their.carePublished.December.7th.2005:

Count Me In 2005

The rst Count Me In Census consisted of two parts:

. A.Census.of.all.in-patients.in.mental.health.facilities.in.the.NHS.and.in.the.

independent.sector.in.England.and.Wales.on.31.March.2005

. A.Survey.with.a.sample.of.service.users.in.a.sample.of.these.facilities,.undertaken.

by.means.of.face.to.face.interviews.using.a.structured.questionnaire.

Ethnic.origin.was.recorded.for.987%.of.in-patients.covered.by.the.census.Overall,.79%.of.in-patients.were.White.British.and.19%.were.from.black.and

minority.ethnic.groups

Nine.per.cent.of.those.from.black.and.minority.ethnic.groups.were.Black.Caribbean,.Black.

African,.Other.Black.or.White/Black.Mixed,.3%.were.Other

White,.3%.were.Asian,.2%.were.Irish,.and.3%.were.from.other.ethnic.groups.(including.

Chinese)

Almost.70%.of.in-patients.from.black.and.minority.ethnic.groups.were.in.just.23.of.the.212.

organisations.that.took.part.in.the.census.The.remaining.30%.were.spread.across.a.number.

of.organisations:.184.of.the.212.organisations

each.had.fewer.than.50.in-patients.from.black.and.minority.ethnic.groups



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PagePageSession:Refectingonculture

After.the.White.British.group,.the.largest.group.of.in-patients.were.Black.Caribbean.followed.

by.Other.White,.White.Irish,.Black.African.and.Other

Black.groups

The.census.collected.information.about.any.periods.of.seclusion.during.an.in-patients.time.in.hospital,.or.within.the.last.three.months.if.their.stay.was.longer.In.the.three.months.prior.

to.the.census,.3%.of.in-patients.had.experienced.one.or.more.periods.of.seclusion,.about.

0.3% had experienced ve or more periods, and 0.1% had experienced 10 or more periods

of.seclusion.Men.from.the.White.British.group.were.less.likely.to.be.placed.in.seclusion.than.

men.from.the.Black.Caribbean,.Black.African,.Other.Black.and.Indian.groups.No.statistically.

signicant ethnic differences were observed among women.

Overall,.8%.of.in-patients.had.experienced.one.or.more.incidents.of.control.and.restraint,.

1.5% had experienced ve or more incidents, and 0.7% had

experienced.10.or.more.incidents.The.rate.of.control.and.restraint.among.men.from.the.

Black.Caribbean.group.was.29%.higher.than.the.average.rate.for.all.in-patients.No.statisti-cally signicant ethnic differences were observed

among.women.

In-patients.on.medium.or.high.secure.wards

Eleven.per.cent.of.in-patients.were.on.a.medium.or.high.secure.ward.The.likelihood.of.men.

from.the.White.British.group.to.be.on.a.medium.or.high

secure.ward.was.lower.than.average,.when.compared.with.all.other.types.of.wards.Men.

from.the.Black.Caribbean,.Other.Black.and.White/Black.Caribbean.groups.were.more.likely.

to.be.on.a.medium.or.high.secure.ward

Three.per.cent.of.in-patients.were.on.a.high.secure.ward.Among.several.black.and.minor-

ity.ethnic.groups,.and.particulary.among.women,.there.were.low.numbers.of.in-patients.on.

a.high.secure.ward.However,.men.from.the.Other.White.group.were.more.likely.to.be.on.a.

high secure ward than a low or medium secure ward. No statistically signicant ethnic differ-

ences.were.observed.among.women.

For.the.full.report.see:.http://wwwmhacorguk/census/2005Resultsphp

.

Document.4:.Community.Development.Workers.for.

Black.and.Minority.Ethnic.Communities



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Community.Development.Workers.(CDWs).will.work.with.and.support.communities.includ-

ing.the.Black.and.Minority.Ethnic.(BME).voluntary.sector,.help.build.capacity.within.them,.

and.ensure.the.views.of.the.minority.communities.are.taken.into.account.by.the.statutory.

sector.during.planning.and.delivery.of.services.Community.development.is.an.integral.part.

of.our.attempts.to.improve.MH.services.so.that.they.can.meet.the.needs.of.minority.ethnic.groups.effectively.Our.assumption.is.that.reform.inside.the.mental.health.system.must.take.

place.in.tandem.with.investment.and.developments.outside.the.service.in.order.for.this.to.

be.meaningful.and.successful.The.national.programme.to.improve.services.and.care.for.

people.who.use.MH.services.from.the.BME.communities.is.clear.on.the.importance.of.this.

role.for.CDWs.This.commitment.is.backed.by.our.resolve.to.fund.80.community.engage-

ment.projects.as.part.of.the.preparation.to.recruit.500.CDWs.nationally

CDWs

Capacity

Builder

Service

Developer

Access

Facilitator

Change

Agent

FOUR KEY ROLES OF CDWS

Develop joint working

between statutory &

communit services.

Address language

barriers and

others barriers to

services.

Directing

people to

community

resources.

Helping people find

effective pathways

across services.

Identify community

concerns and gaps

in services.

Developing socially inclusive

BME communities.

Seek out capabilities of

communities to develop

innovative practice.

Advising on

training &

education of staff.

Engaging in establishment of

community leadership.

Assist in development of

community organisations.

Increase channels of

communication between

community & statutory services.

Highlight the importance of

culture in service systems

and practice.

(Community.Development.Workers.for.Black.and.Minority.Ethnic.Communities:.Final.Hand-

book.November.2006)

For.the.full.document.see:...wwwdhgovuk



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PRE-COURSE READING

SESSION.1-.REFLECTING.ON.CULTURE

Learning.Outcomes

Participants.will.be.able.to.

. have.a.clearer.understanding.of.the.variety.and.complexity.of.the.concept.of.

culture

. describe.a.useful.model.of.culture.

explain how cultural assumptions can inuence the values and behaviours of

practitioners

Key Words for Session 1

AcculturationThe modication of the culture of a group or individual as a result of contact with a differ-

ent.culture.People.will.still.retain.a.large.part.of.their.original.cultural.heritage.

Assimilation

A process whereby people are put under pressure to t into the dominant culture in a so-

ciety.thereby.being.forced.to.relinquish.or.deny.aspects.of.their.original.cultural.heritage

Black

A.political.term.of.solidarity.between.people.who.are.vulnerable.to.White.racism.as.a.

result.of.their.skin.colour.and.physical.appearance

Ethnic Group

A.group.of.people.who.share.traditions,.heritage.and.history.over.a.long.period.of.time.

and come to identify closely with one another. It is often tied to a specic geographic loca-

tion.and.usually.involves.shared.language.and.religions

Norms

A.norm.is.an.expectation.of.how.people.will.behave.and.takes.the.form.of.a.rule.that.is.

socially rather than formally enforced. It reects certain values in a society that the major-

ity.of.people.in.the.society.feel.should.be.adhered.to

Race

Categorisation of people dened by colour of skin and physical appearance, which has

developed from a falsely scientic way of thinking about human beings as arising from dif-

ferent.species.It.has.now.become.a.social.concept.with.negligible.importance.attached.

to its biological and/or scientic connotations but is inuential in community relationships,

the.way.we.organise.our.institutions.and.power.structures.within.society

Racism.

A.belief.system.or.ideology.that.propose.a.hierarchy.amongst.human.races.or.(more.

recently).ethnic.groups.It.is.based.on.an.assumption.that.there.are.inherent.biological.

differences.between.different.racial.or.ethnic.groups.of.people.that.determine.the.char-acter.and.ability.of.individuals.in.those.groups.It.always.infers.the.inferiority.or.superiority.



16/117


Introduction.to.cultureThe concept of culture is much more complex and difcult to dene than we think, the word

culture.is.often.used.in.everyday.language.to.mean.very.different.things.While.the.word.culture.is.used.frequently.in.our.everyday.language,.we.are.often.not.fully.aware.of.what.

we mean by culture, especially not our own culture. Culture is like the water in which a sh

swims, the sh is not aware of the water and the needs it serves until it is out of it. In the

same.way,.we.may.not.be.fully.aware.of.our.own.culture.until.we.are.out.of.it,.for.example.

when.we.go.into.a.cultural.environment.that.is.very.different.from.our.own.In.this.session.

we.will.explore.the.concept.of.culture.in.more.depth.and.encourage.you.to.be.more.aware.

of.your.culture.If.you.are.meeting.and.dealing.with.people.who.are.from.different.cultural.

backgrounds from you then you need to know where you are coming from rst before you

can.really.understand.another.persons.point.of.view.We.will.introduce.you.to.a.useful.way.of.

thinking.about.culture.and.how.power.and.oppression.in.society.can.affect.culture.We.will.try.

to.show.how.oppression.and.discrimination.occurs.when.culture.in.society.starts.to.operate.in.a.negative.and.socially.destructive.way

You.may.have.come.up.with.some.of.the.following.meanings.of.the.word.culture.in.our.every-

day.language:

. Socially.transmitted.beliefs,.values,.arts.and.products.of.a.particular.ethnic.group.

of.people.Such.as.Jewish.or.Irish.culture

. Customs,.fashions.and.traditions.passed.on.from.one.generation.to.the.next

. All.the.knowledge.and.values.shared.by.a.society

. Inappropriately.used.to.mean.the.same.as.race.or.ethnicity

Considered as the expression of a particular period, class, community, or specic

population.Such.as.in.Edwardian.culture;.Islamic.culture;.the.culture.of.poverty

Considered with respect to a particular category of human activity, as in a eld,

subject,.or.mode.of.expression.For.example,.religious.culture.in.the.Middle.Ages;.

musical.culture;.oral.culture. The.predominating.beliefs,.values.and.behaviours.that.characterise.the.

of.some.races.over.others.with.ones.own.race.being.seen.as.superior.Racism.can.take.

different.forms.at.individual,.institutional.and.societal.levels

Values

A.principle,.standard,.or.quality.considered.worthwhile.or.desirable.In.essence.values.

are.what.people.view.as.being.important.in.their.lives.and.expresses.a.concept.of.worth.

There.are.many.basic.human.values.that.are.present.in.every.culture.and.shared.by.

people whatever their background. Values shape and inuence behaviour through the

creation.of.general.guiding.principles.about.what.is.wrong.or.right.for.people.in.their.lives

Personal Reection

How.many.uses.of.the.word.culture.can.you.think.of?

Write.them.down.on.a.blank.sheet.of.paper.and.then.read.on



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functioning.of.a.group.or.organization.that.form.a.common.ethos.Such.as.

corporate.culture.or.public.service.culture

. Intellectual.and.artistic.activity

A high degree of taste and renement formed by aesthetic and intellectual

training. Being.seen.as.civilised.as.opposed.to.primitive

. The.cultivation.of.soil

. The.breeding.of.animals.or.growing.of.plants.as.in.agriculture

. Sometimes.used.in.a.way.that.actually.means.a.sub-culture.Such.as.in.the.use.of.

term.gang.culture

. The.growing.of.micro-organisms,.tissue.cells,.or.other.living.matter.in.a.specially.

prepared.nutrient.medium.Such.as.a.culture.of.bacteria

Ethnic.Make-up.of.the.UK

The 2001 Census has given us the most accurate gures to date about the numbers and keycharacteristics.of.Black.and.Minority.Ethnic.groups.in.the.UK.It.is.useful.to.understand.this.

background.information.on.a.national.basis.to.make.sense.of.the.research.around.discrimi-

nation.in.mental.health.services.

The UK population: by ethnic group, April 2001 (Census gures)

Total population.. Minority ethnic population

.White .54,153,898 .921 .n/a

.Mixed ..677,117 .12 .146

.Asian or Asian

.British

.Indian ..1053,411 .18 .227

.Pakistani .747,285 .13 .161

.Bangladeshi .283,063 .05 .61

.Other.Asian .247,664 .04 .53

Black or Black

British

.Black.Caribbean .565,976 .10 .122

.Black.African .485,277 .08 .105



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.Black.Other ..97,585 .02 .21

.Chinese .247,403 .04 .53

.Other .230,615 .04 .50

.All minority ethnic

population .4,635,296 .79 .100

.All population .58,789,194 .100 .n/a

To look up population data specic to your area go to the following website:

wwwstatisticsgovuk

The.South.Asian.community.is.the.largest.ethnic.minority.group.living.in.Britain,.represent-

ing.just.over.4%.of.the.population.(2001.Census).It.consists.of.four.main.groups.of.people.

.Indian.(18%),.Pakistani.(13%),.Bangladeshi

(05%).and.other.Asian.(04%).South.Asian.culture.is.very.diverse,.encompassing.many.

languages.and.dialects,.religions,.beliefs,.people.of.different.classes,.histories.and.countries

According.to.the.2001.Census,.the.number.of.people.of.Black.Caribbean.descent.living.in.

the.UK.is.around.10%.of.the.population.and.people.of.Black.African.descent.is.08%.Those.

dening themselves as Black Other make up

02%.of.the.population.In.the.main,.the.African-Caribbean.community.lives.within.the.inner.

cities,.and.over.half.are.British.born.They.tend.to.experience.poorer.health,.have.reduced.

life.expectancy.and.have.greater.problems.accessing.health.services.than.the.majority.white.

population.For.mental.health,.major.concerns.include.disparities.and.inequalities.in.terms.of.

rates.of.mental.ill.health,.service.experience.and.service.outcome.

(DH,.2007).

Irish-born.people.now.make.up.approximately.15.per.cent.of.Britains.population.When.

people of Irish parentage are included, the gure rises to 2.5 million, that is, 4.6 per cent of

the.population.making.Irish-born.people.in.Britain,.the.largest.migrant.minority.in.Western.

Europe

(Hickman.and.Walter,.1996).

The Chinese community is a diverse group both socially and culturally. It includes both rstgeneration.migrants.who.speak.little.or.no.English,.and.second.generation.who.are.often.

Points of interest

A.campaign.on.the.internet.claimed.-.wrongly.-.that.Jedi,.the.belief.system.

at the heart of the Star Wars lms, would receive ofcial government recogni-

tion.as.a.religion.if.enough.people.quoted.it.on.their.Census.forms.Just.over.390,000.of.the.52,000,000.people.in.England.and.Wales.wrote.in.Jedi.on.their.

census.form



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PagePageSesson:Refectingonbelies

well.educated.and.in.employment.Around.28%.of.the.Chinese.community.have.been.born.in.

the.UK,.the.lowest.proportion.of.all.the.principal.ethnic.minority.groups.in.the.UK,.with.almost.

half.of.the.remainder.born.in.Hong.Kong.A.variety.of.languages.are.spoken.in.addition.to.

Cantonese, and there are a range of religious practices and varying degrees of identication

with.the.dominant.culture.(Yee.&.Au.1997).

The.Vietnamese.refugee.population.in.the.UK.is.currently.estimated.to.be.27,000,.with.

16,000.living.in.the.Greater.London.area.The.majority.(70%).of.Vietnamese.people.in.the.

UK.comes.from.North.Vietnam.60%.of.the.population.here.are.ethnic.Chinese,.most.of.

whom.are.from.families.who.lived.in.Vietnam.for.many.generations.and.mostly.speak.Viet-

namese.as.well.as.Cantonese...

(mentality,.2004).

The.2001.Census.collected.information.about.ethnicity.and.religious.identity

White.Christians.remain.the.largest.single.group.by.far.In.England.and.Wales,.36.million.people.(nearly.7.out.of.10).described.their.ethnicity.as.White.and.their.religion.as.Christian

Majorities of Black people and those from Mixed ethnic backgrounds also identied as Chris -

tian.(71.and.52.per.cent.respectively).In.total.there.were.810.thousand.Black.Christians.and.

347.thousand.Christians.from.Mixed.ethnic.backgrounds

Among.other.faiths.the.largest.groups.were.Pakistani.Muslims.(658.thousand).and.Indian.

Hindus.(467.thousand).followed.by.Indian.Sikhs.(301.thousand),.Bangladeshi.Muslims.(260.

thousand).and.White.Jews.(252.thousand)

The.Indian.group.was.religiously.diverse.45.per.cent.of.Indians.were.Hindu,.29.per.cent.

Sikh.and.a.further.13.per.cent.Muslim.By.contrast.the.Pakistani.and.Bangladeshi.groups.

were.more.homogenous,.Muslims.accounting.for.92.per.cent.of.each.ethnic.group

Some.faith.communities.were.concentrated.in.particular.ethnic.groups.For.example,.91.per.

cent.of.Sikhs.were.Indian.and.97.per.cent.of.Jews.described.their.ethnicity.as.White.Oth-

ers faiths were more widely dispersed; signicant proportions of Buddhists were found in the

White,.Chinese,.Other.Asian.and.Other.Ethnic.groups

Overall,.15.per.cent.of.the.English.and.Welsh.population.reported.having.no.religion.al-

though.variation.by.ethnicity.was.marked.Just.over.half.of.all.Chinese.people,.and.one.quarter.of.people.from.Mixed.ethnic.backgrounds,.stated.they.had.no.religion.Asian,.Black.

African and Irish people were least likely to have no religious afliation. Fewer than 1 in 200

Pakistanis.and.Bangladeshis.reported.having.no.religion

14.per.cent.of.people.in.the.Other.Black.group.chose.not.to.answer.the.religion.question,.

almost.twice.the.average.for.England.and.Wales.as.a.whole.Similar.proportions.of.people.in.

the.Black.Caribbean.and.Mixed.ethnic.groups.also.gave.no.answer

(Source: Census, April 2001, Ofce for National Statistics)



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Page0Page0Sesson:Refectingonbelies

References

DH.(2007),.Positive.steps..Supporting.race.equality.in.mental.healthcare

DH.Feb.2007

Eriksen,.Thomas.Hylland.(1995).Small.Places,.Large.Issues.-.an.Introduction.to.Social.and.

Cultural.Anthropology.London,.Pluto.Press

Hickman,.M,J,.and.Walter,.B,.(1996).Discrimination.and.the.Irish.Community.in.Britain,.Lon-

don.Commission.for.Racial.Equality

mentality.(2004),.Celebrating.our.Cultures:.Guidelines.for.Mental.Health.Promotion.with.

Black.and.Minority.Ethnic.Communities.for.NIMHE

Yee.L.and.Au.S.(Eds).(1997).Chinese.Mental.Health.Issues.in.Britain.London:.Mental.Health.

Foundation



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SESSIONS.2a.&.2b.-.REFLECTING.ON.BELIEFS

Learning.Outcomes

Participants.will.be.able.to:.

understand how culture inuences the process of diagnosis in mental health work

. recognise.the.impact.of.social,.political.and.personal.factors.on.practice.with.

service.users.in.the.mental.health.system

. explain.how.culture,.power,.privilege.and.oppression.are.inter-related.within.

society


DiagnosisThe.process.of.determining.the.nature.and.cause.of.illness,.condition.or.injury.through.

evaluation.of.patient.history,.examination,.and.review.of.clinical.observations.and.evi-

dence.Diagnosis.is.both.the.process.(from.the.verb.diagnose).and.the.thing.we.come.

up.with.(the.noun.a.diagnosis.meaning.diagnostic.categories).

Bias

A.preference.to.one.particular.point.of.view.or.ideological.perspective.that.prevents.ob-

jective.consideration.of.an.issue.or.situation

Racial Discrimination

(Direct)This.occurs.when.you.are.able.to.show.that.you.have.been.treated.less.favour-ably.on.racial.grounds.than.others.in.similar.circumstances.To.prove.this,.it.will.help.if.

you.can.give.an.example.of.someone.from.a.different.racial.group.who,.in.similar.circum-

stances,.has.been,.or.would.have.been,.treated.more.favourably.than.you.Racist.abuse.

and.harassment.are.forms.of.direct.discrimination.

(CRE.website:.wwwcregovuk)

(Indirect).When.an.apparently.non-discriminatory.requirement.or.condition.which.is.ap-

plied.to.everyone.actually.impacts.differentially.on.particular.groups.of.people.on.the.

basis.of.race,.ethnicity,.national.origin,.nationality.or.colour.People.from.these.groups.

may not be able to full the criterion because of disadvantage or the criterion is unjusti-

able.on.racial.grounds

Personality Disorder

This.is.a.controversial.diagnosis.because.it.is.felt.by.many.people.to.be.rather.too.vague.

and a catch-all for people who do not seem to t any other category of mental illness. It

essentially refers to problems of social functioning for some people and difculties with

sustaining.relationships.with.others.and.perhaps.picking.up.on.social.cues.It.usually.

involves.what.is.seen.as.socially.unacceptable.behaviours.which.are,.of.course,.culturally.

dened. People may be described as inexible or have rigidly held views. As one can see

these are all aspects of everyones behaviour and hence this diagnosis is difcult to bedenitive about. In Rethinks experience, a diagnosis of personality disorder is some-



22/117


times.given.inappropriately.to.people.who:.

are non-compliant or difcult to engage in treatment

. . .do.not.respond.to.most.treatments

are difcult to manage in settings like a hospital ward

are difcult to diagnose

Prejudice

Attitudes.or.beliefs.that.are.negative.towards.certain.groups.of.people.and.which.are.not.

founded.on.rational.thinking.or.factual.information

Privilege

A special advantage or immunity or benet not enjoyed by all inferring that some people

have.to.bear.the.burden.of.not.having.such.an.advantage

Schizophrenia

This.another.contentious.diagnosis.given.to.people.who.experience.disruptions.in.their.

thoughts,.beliefs.and.experiences.People.may.hear,.see.or.smell.things.that.are.not.real.

(hallucinations).thus.giving.a.sense.of.people.being.out.of.touch.with.reality.People.may.

believe.that.they.are.being.controlled.by.outside.forces.or.that.people.are.plotting.against.

them.or.have.some.unusual.beliefs.(delusions).Again,.a.lot.of.these.symptoms.can.be.

seen.as.culturally.determined.a.well

Slavery

Slavery.is.a.socio-economic.system.where.people.are.deprived.of.their.personal.freedom.

and.compelled.to.work.and.labour.for.others.without.payment.The.term.also.refers.to.the.condition.of.people.as.the.property.of.others.held.against.their.will,.often.from.birth,.and.

not.allowed.to.leave.or.refuse.work.Chattel.slavery.is.the.absolute.legal.ownership.of.a.

person.including.the.right.to.buy.and.sell.them

Stereotyping

Commonly.held.assumptions.and.beliefs.about.particular.racial.and.ethnic.groups.of.

people where everyone from that group is assumed to have specic personal character-

istics.because.they.belong.to.that.group.In.effect.people.are.denied.their.unique.indi-

viduality.through.stereotyping

Values

A.principle,.standard,.or.quality.considered.worthwhile.or.desirable.In.essence.values.

are.what.people.view.as.being.important.in.their.lives.and.expresses.a.concept.of.worth.

There.are.many.basic.human.values.that.are.present.in.every.culture.and.shared.by.

people whatever their background. Values shape and inuence behaviour through the

creation.of.general.guiding.principles.about.what.is.wrong.or.right.for.people.in.their.lives



23/117


Culture.&.mental.health.diagnosisCulture is important in mental health work because our cultural background inuences the

way.in.which.we.think.and.respond.to.others..We.make.assumptions.based.on.our.cultural.

values.and.beliefs,.and.have.a.human.tendency.through.our.evolutionary.development.to.

make.rapid.judgements,.that.often.involves.pre-judging.people.and.situations.in.order.to.

simplify.complex.problems.and.help.us.to.make.quick.decisions..But.there.are.dangers.in.

this.process.If.we.are.not.aware.of.our.pre-judgements.(prejudices),.they.may.become.a.

powerful.source.of.bias.and,.intentionally.or.unintentionally,.lead.us.to.engage.in.behaviours.

which.discriminate.against.certain.groups.of.people..We.need.to.identify.and.face.up.to.our.

prejudices.honestly.and.courageously.if.we.are.to.avoid.discriminatory.behaviour

In.mental.health.services,.the.judgements.we.make.have.serious.consequences.on.the.lives.

of.others.Especially.as.there.are.no.widely.agreed.biochemical.or.physical.tests.on.which.to.

base.diagnosis.of.mental.health.problems,.despite.a.great.deal.of.research.Therefore.diag-

nosis.is.a.process.where.practitioners.match.a.persons.behaviours.and.feelings.to.a.previ-

ously.researched.list.of.clinical.criteria.based.on.observations.that.represent.symptoms.

using.a.theoretical.model.of.mental.illness.resulting.in.a.diagnosis..But.is.this.valid?..Can.

we scientically match human behaviour to some predetermined list?

The.following.statement.was.made.in.2003.about.diagnosis.by.an.ex-president.of.the.Royal.

College.of.Psychiatrists,.Dr.Robert.Kendell:.

Thoughtful clinicians have long been aware that diagnostic categories are simply con-

cepts, justied only by whether they provide a useful framework for organising and ex-

plaining the complexity of clinical experience in order to derive inferences about outcome

and to guide decisions about treatment. Unfortunately, once a diagnostic concept such as

schizophrenia or Gulf War syndrome has come into general use, it tends to become rei-

ed. That is, people too easily assume that it is an entity of some kind that can be invoked

to explain the patients symptoms and whose validity need not be questioned.

(Kendell.&.Jablensky,.2003)

BME service user quote

We.should.see.ourselves.as.a.river.with.constant.movement.and.change.not.

a diagnosis which solidies us, like a block of ice, so that they can label us

and.put.us.away

Points of interest

In.1973.the.American.DSM.(Diagnostic.and.Statistical.Manual.of.Mental.Disor-

ders) de-classied being lesbian or gay as being a mental illness. The World

Health Organisation did not engage in this declassication until 1992; it still has

egodystonic.homosexuality.as.a.form.of.mental.disorder.to.this.day

In.a.study.comparing.black.and.white.patients,.black.patients.were..

perceived.as.being.more.dangerous,.despite.exhibiting.lower.levels.of..

aggressive.behaviour..(Bhui,.2001)



24/117


Our.personal.values.and.the.values.of.society.will.always.play.a.part.in.determining.the.

judgements.that.are.made.during.the.diagnostic.process.in.mental.health.The.diagram.be-

low.is.adapted.from.Suman.Fernando.(2002).and.summarises.the.wider.process.of.diagno-

sis

The.issues.surrounding.personal.values.of.practitioners.are.focused.around.the.individual.

factors box in the diagram. Practitioners will be strongly inuenced by their sense of what

feels.natural.to.them.or.what.feels.like.common.sense.when.faced.with.making.judgements.

about.social.situations.Underlying.these.natural.preferences.are.the.practitioners.own.

cultural.assumptions.gained.from.a.variety.of.sources,.including.their.ethnic.background.and.

the.cultural.norms.of.their.society.in.which.she.or.he.operates.Racial.stereotypes.are.liable.

to inuence a societys cultural norms and so perceptions of Black people tend to be nega-

tive

In.the.social.factors.box.the.political.agenda.will.also.have.a.big.impact.on.the.diagnostic.

process. For example, if there is a public panic about a specic group of people such as

those.with.a.diagnostic.label.of.personality.disorder.there.will.be.pressure.on.authorities.to.do.something.about.that.group.and.the.perceived.threat.they.present.to.the.public.This.

group.effectively.constitutes.an.out-group.in.society.which.is.discussed.later.in.this.session.

The.impact.on.diagnosis.may.then.be.to.have.a.greater.focus.on.dangerousness.and.the.

issue.of.treatability.and.the.persons.best.interests.may.then.be.side-lined.Traditional.views.

of mental distress will also inuence the purpose, process and outcomes of diagnosis as it is

essentially.a.value-based.process

Common sense is the collection of prejudices acquired by age eighteen.

(Albert Einstein)

Nineteenth century study of facial expression and the emotions attached great impor-

tance to blushing as a particularly human characteristicBlushing and conscience were



25/117


thought to be related; the debate that ensued about the capacity of Negroes to blush was

not so much a physiological one, as one of moral development (Skultans, 1979).

(Fernando, 1988)

Stanley Hall, founder of the American Journal of Psychology described the inhabitantsof colonies and dependencies of the world , that are in relation of greater or less subjec-

tion to a few civilised nations as members of adolescent races; he saw African, Asians

and North American Aborigines as immature children who live a life of feeling, emotion

and impulse, where the individual is always merged in the tribe, and only the chief, and

often not even he, can give pledges or make bargains.

(Fernando, 1988)

MacDougall(1921), (who wrote the standard textbook on social psychology) formulated

the concept of national minds, or group minds, which were dependent on racial homoge-

neity; he described Nordics showing a propensity for scientic work, Mediterraneans for

architecture and oratory and Negroes an instinct for submission.(Fernando, 1988)

Now what is more contagious than to live side by side with a rather primitive people?

Go to Africa and see what happensThe inferior man exercises a tremendous pull upon

civilised beings who are forced to live with him, because he fascinates the inferior layers

of our psyche, which has lived through untold ages of similar conditions.

(Carl Jung, 1930 quoted in Fernando, 1988)

A contributor to the Psychological Review in 1895 compared the speed of sensory

perception in a group of 12 Whites, 11 Indians and 11 Blacks. When the White subjects

proved to have the slowest reactions, this was taken as proof that they were the supe-

rior group. Their reactions were slower because they belonged to a more deliberate and

reective race than did the members of the other two groups.

(Thomas & Sillen, 1972 quoted in Fernando, 1988)

Culture,.Power.&.OppressionWe.have.seen.in.Session.1.how.complex.culture.is.and.how.it.can.be.viewed.as.a.series.

of.layers.People.in.a.particular.culture.are.born.with.or.acquire.differences.which.may.be.

visible..for.example.gender,.physical.disability,.or.less.immediately.visible..for.example.

sexuality,.approach.to.relationships,.spiritual.beliefs,.cultural.preferences.in.food.and.class.

afliations. These differences may be particularly signicant for individuals depending on

whether.their.society.responds.to.them.in.positive.or.negative.ways.Within.any.society,.

Personal Reection

Where.does.the.stereotype.of.Black.people.being.big.and.dangerous.come.from?.Write.

down.your.thoughts.and.discuss.with.a.colleague


Mental.illness.is.seen.as.a.cop.out.in.our.society.and.alienation.is.seen.as.

a.just.punishment



26/117


structured power relations between different groups of people strongly inuence the norms

of.the.society.and.determine.which.differences.are.positively.or.negatively.valued...

When.differences.are.positively.valued.in.a.society.where.discrimination.exists,.the.group.of.

people.with.that.particular.difference.share.a.privileged.position.and.becomes.an.in-group.in.society.that.has.advantage.and.status,.is.shown.respect.and.has.easy.access.to.life.op-

portunities.such.as.employment,.education,.housing.and.health.It.has.to.be.remembered.

that.being.aware.that.you.are.in.a.privileged.position.may.feel.very.comfortable.as.it.is.inher-

ently.based.on.the.disadvantage.and.unfair.treatment.of.others

When.differences.are.regarded.in.a.negative.way.in.a.discriminatory.society,.the.group.of.

people.with.a.particular.negative.difference.are.put.in.a.disadvantaged.position.and.become.

an.out-group.in.society.subject.to.prejudice,.discrimination,.stereotyping,.disempowerment.

and.institutional.discrimination.resulting.in.disadvantage.and.poor.access.to.life.opportuni-

ties.This.can.lead.to.deeply.in-grained.prejudices.over.time.becoming.even.further.embed-

ded.into.the.society.and.its.power.structures.Institutions.and.organisations,.including.public.services,.then.acquire.an.in-built.bias.against.certain.groups.in.the.way.that.they.operate.and.

people.from.these.groups.will.experience.inequalities.in.terms.of.access,.outcomes.and.fair.

treatment.within.institutions..

This.is.the.true.nature.of.institutional.discrimination..it.is.hidden.and.indirect.in.the.sense.

that.discrimination.is.built.into.its.policies.and.procedures.as.well.as.its.operation.through.

systems.and.procedures.Consequently,.it.is.hard.to.detect.and.harder.to.challenge.par-

ticularly.for.those.people.on.the.receiving.end.of.unfair.treatment.We.will.talk.more.about.

institutional.discrimination.in.Session.6.

In.summary,.within.a.society.where.discrimination.occurs.some.groups.of.people.are.privi-

leged.while.other.groups.may.experience.widespread.institutional.discrimination,.the.former.

beneting at the expense of the latter. The diagram below summarises the whole process.



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PageKeydocumentsinRECCtraining PageSesson:Assumptionsinpractice

Racial.superiority.is.a.mere.pigment.of.the.imagination..(Author.Unknown)

In.the.late.1980s.an.investigative.delegation.of.American.psychiatrists.to.Russia.found.com-

pelling.evidence.that.medication.was.used.widely.for.punitive.purposes.High.doses.of.anti-

psychotic.drugs.were.routinely.administered.by.injection.in.a.10-.to.15-day.regimen.to.punish.violators.of.hospital.rules.and.to.treat.delusions.of.reformism.and.anti-.Soviet.thoughts....

(Bonnie,.2002)

Personal Reection

What.feelings.might.you.have.if.you.were.part.of.an.in-group?

What.feelings.might.you.have.if.you.were.part.of.an.out-group?

References

Bhui,.K.(2001).Over.representation.of.black.people.in.secure.psychiatric

facilities,.British.Journal.of.Psychiatry,.178.(6).575

Bonnie.RJ,.(2002).Political.Abuse.of.Psychiatry.in.the.Soviet.Union.and.in.China:

Complexities.and.Controversies,.J.Am.Acad.Psychiatry.Law.30:13644,.2002

Fernando,.Suman.(2002).Mental.Health,.Race.and.Culture.Second.Edition.Palgrave.(Mac-

millan),.Basingstoke.(UK)

Fernando,.S.(1988).Race.and.Culture.in.Psychiatry,.Croom.Helm,.London

Goleman,.D.(1995).Emotional.intelligence,.New.York:.Bantam.Books

Hall.S.(1904),.Adolescence:.its.psychology.and.its.relations.to.physiology,.anthropology,.

sociology,.sex.crime,.religion,.education,.Vol.II,.D.Appleton,.New.York

Jung.C.(1930),.Your.Negroid.and.Indian.behaviour.Forum,.83,.4,.193-9

Kendell,.R.and.Jablensky,.A.(2003).Distinguishing.between.the.validity.and.utility.of.psychi-

atric.diagnoses,.American.Journal.of.Psychiatry,.160,.4-12

MacDougall(1921),..Is.America.safe.for.democracy?,.Scribner,.New.York

Patel,.Nimisha.et.al.(eds).(2000).Clinical.Psychology,.Race.and.Culture..A.Training.

Manual.BPS.Books.(British.Psychological.Society),.Leicester.(UK)

BME service user quoteHealing.in.a.soulless.capitalist.society.is.about.making.you.economically.

productive.again



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Rosenhan,.David.L..(1973),.On.Being.Sane.in.Insane.Places,.Science,.Vol.179.

(Jan.1973),.250-258

Skultans.V.(1979),.English.madness:.Ideas.on.insanity.1580-1890,.Routledge.and.Kegan.

Paul,.London

Thomas.A.&.Sillen.S.(1972),.Racism.and.Psychiatry,.Brune/Mazel,.New.York

Further.reading

Bhui,.K.(2002).Racism.and.Mental.Health.Prejudice.and.Suffering.Jessica.Kingsley,.Lon-

don.&.Philadelphia.

Fulford.KWM.(1999),From.Culturally.sensitive.to.culturally.competent.by.p.21-42.in.Mental.

Health.Service.Provision.in.a.Multi-Cultural.Society,.K.Bhui,.D.Olajide.(Saunders).1999

Fanon,.Frantz.(1952).Peau.Noire,.Masques.Blancs.Editions.de.Seuil,.Paris.translated.by.C.

L.Markmann,.Black.Skin,.White.Masks.Grove.Press,.New.York.1967

Hwang,.P.O.(2000).Other-Esteem.Meaningful.Life.in.a.Multicultural.Society.Accelerated.

Development.(Taylor.&.Francis.Group),.Hove



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PRE-COURSE.READING.

SESSION.3..ASSUMPTIONS.IN.PRACTICE

Learning.Outcomes

Participants.will.be.able.to

. understand.the.importance.and.power.of.personal.assumptions.for.a.practitioners.

quality.of.practice

. describe.the.impact.of.common.stereotypes.of.BME.people.on.communication.

between.service.users.and.practitioners

. identify.ways.of.positively.engaging.with.BME.people.in.mental.distress


LabellingLabelling is concerned with how the self-identity and behaviour of an individual is inu-

enced.(or.created).by.how.that.individual.is.categorised.and.described.by.others.in.their.

society.Originating.in.sociology.and.criminology,.the.theory.focuses.on.the.tendency.of.

majorities.to.negatively.label.minorities.or.those.seen.as.deviant.from.norms,.and.is.as-

sociated with the concept of a self-fullling prophecy and stereotyping.

Mental Distress

It.is.felt.by.some.people.that.the.term.mental.illness.is.a.limiting.term.and.does.not.fully.

describe.a.persons.experience.of.mental.health.problems.and.serious.disruptions.of.a.

persons.ability.to.cope.with.everyday.life.The.use.of.the.term.illness.is.felt.to.be.too.

narrow.and.medicalised.a.description.of.what.is.a.more.complex.human.experience.

Furthermore,.there.are.many.non-medical.forms.of.help.and.assistance.people.in.mental.

distress.may.prefer.

Neuroses

Neurotic.covers.those.symptoms.which.can.be.regarded.as.severe.forms.of.ordinary.

emotional.experiences.such.as.non-clinical.depression,.anxiety.or.panic.Conditions.

formerly.referred.to.as.neuroses.are.now.more.frequently.called.common.mental.health.

problems

OppressionThe.abusive.use.of.power.and/or.authority.to.coerce,.control,.exclude.or.disadvantage.

groups.or.individuals.in.society.resulting.in.social.inequalities.and.injustice

Psychoses

These.involve.psychotic.symptoms,.which.interfere.with.a.persons.perception.of.real-

ity,.and.may.include.hallucinations.such.as.seeing,.hearing,.smelling.or.feeling.things.

that.no-one.else.can.Some.mental.health.problems.feature.both.neurotic.and.psychotic.

symptoms

Stigma

Erving Goffman (1963) dened stigma as an attribute that is deeply discrediting thatreduces.the.bearer.from.a.whole.and.usual.person.to.a.tainted,.discounted.one



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Page0KeydocumentsinRECCtraining Page0Sesson:Assumptionsinpractice

Beliefs.&.assumptions.in.mental.health.servicesWe are often not fully aware of the cultural inuences on our views of people who experience

mental.distress.and.we.do.not.appreciate.how.powerful.they.are.in.shaping.the.way.we.ap-

proach.mental.health.service.users.So.just.how.powerful.are.these.often.unspoken.beliefs.

and.assumptions.in.mental.health?

On Being Sane in Insane Places

In 1973 sociologist David Rosenhan designed a study to examine the difculty that people

have.shedding.the.mentally.ill.label.He.was.particularly.interested.in.how.staffs.in.men-tal.institutions.process.information.about.patients.Rosenhan.and.his.associates.had.

themselves.committed.to.different.mental.hospitals.by.complaining.that.they.were.hearing.

voices.(a.symptom.commonly.believed.to.be.characteristic.of.schizophrenia).The.staff.

did not know the pseudopatients were actually part of a eld experiment. The important

events.of.the.pseudopatients.life.histories.were.presented.as.they.had.actually.occurred.

Furthermore,.prior.to.the.study,.Rosenhan.instructed.them.to.act.completely.normal.upon.

admission.into.the.hospital.That.is,.they.were.not.to.act.crazy.in.any.way.Despite.the.

fact.that.they.did.nothing.out.of.the.ordinary,.the.pseudopatients.remained.hospitalized.for.

an.average.of.19.days,.from.a.low.of.9.days.to.a.high.of.52.Their.sanity.was.never.detect-

ed.except,.ironically.enough,.by.the.actual.patients.in.the.hospitals.All.of.Rosenhans.asso-

ciates.retained.the.deviant.label.even.after.being.discharged.Their.schizophrenia.was.said.to.be.in.remission,.implying.that.it.was.dormant.and.could.possibly.resurface.Rosenhan.

instructed.his.observers.to.gather.quantitative.data.on.a.variety.of.routine.behaviours.and.

events.that.occurred.during.their.hospitalization.

Thus,.Rosenhan.was.able.to.buttress.many.of.his.generalisations.about.interpersonal.reac-

tions.to.patients.with.quantitative.evidence.Many.psychiatrists.did.not.believe.that.Rosen-

hans conclusions were justied by his evidence. His article became the subject of almost

unprecedented.controversy.following.its.publication.in.the.prestigious.journal.Science.

Rosenhans critics attacked his ndings on the false diagnoses of 12 pseudo-patients and

defended.the.ability.of.the.psychiatric.profession.to.distinguish.various.forms.of.psychoses.

from.non-psychotic.behaviour.At.least.one.critic.implied.that.the.pseudo-patients.may.

not,.in.fact,.have.been.acting.or.been.as.normal.as.Rosenhan.indicated.in.his.article.At.

the other extreme, several psychiatrists attempted to account for his ndings on admis -

sions.and.discharges.by.arguing.that.the.pseudo-patients.had.by.chance.encountered.12.

hospitals.with.unusually.incompetent.diagnostic.procedures.(Rosenhan,.1973)

Communication.&.stereotypingThe.degree.of.the.problem.of.stereotyping.that.faces.mental.health.services.is.characterised.

by.a.recent.study.about.the.experience.of.African-Caribbean.people.by.the.Sainsbury.Centre.for.Mental.Health.(SCMH)


Professionals.want.to.understand.your.illness.not.you.as.a.person



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What.the.SCMH.has.termed.circles.of.fear.have.been.created.so.that:

. many.people,.particularly.in.the.Black.African.and.Caribbean.communities,.do.not.

believe.that.mainstream.mental.health.services.can.offer.positive.help,.so.they.

delay.seeking.help;. they.therefore.are.not.engaging.with.services.at.an.early.point.in.the.cycle.when.

they.could.receive.less.coercive.and.more.appropriate.services,.coming.instead.to.

services.in.crisis.when.they.face.a.range.of.risks.including.over.and.misdiagnosis,.

police.intervention.and.use.of.the.Mental.Health.Act;

these aversive care pathways further inuence both the nature and outcome

of.treatment.and.the.willingness.of.communities.to.engage.with.mainstream.

services.(Delivering.Race.Equality:A.Framework.for.Action,.DH,.October.2003,.

page.8)

The.following.diagram.has.been.created.by.one.of.the.BME.service.users.involved.in.the.

SCMH.research.project

The.four.key.drivers.in.the.idea.of.Breaking.the.Circles.of.Fear.diagram..are.the.stereotypi-

cal.views.a.practitioner.may.hold.about.Black.people;.complete.or.partial.ignorance.to.the.

BME.service.users.culture,.fuelled.in.part.also.by.the.stigma.attached.to.mental.distress,.as.

well.as.racism.within.mental.health..services.These.drivers.then.fuel.inappropriate.respons-

es.from.service.providers.as.a.result.of.inaccurate.assessments.of.the.service.users.need.

and.level.of.risk.in.the.situation.The.combination.of.poor.assessment.and.the.four.key.driv-

ers.invariably.result.in.the.escalation.of.a.crisis,.because.not.only.is.the.service.user.likely.

to.have.little.or.no.contact.with.the.inappropriate.service.on.offer.but,.even.where.contact.is.

made,.the.service.user.is.unlikely.to.comply.with.an.inappropriate.intervention.plan.that.often.

ensues.This.ultimately.provokes.a.more.coercive.response.driven.by.prejudices.that.are.ap-

parently.reinforced.by.real.events.



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On.the.one.side,.staff.have.a.perception.of.a.dangerous.service.user.while.BME.service.us-

ers.perceive.the.service.to.be.dangerous.to.them.and.never.the.twain.shall.meet!.Breaking.

the.Circles.of.Fear.(Keating.et.al,.2003).raises.issues.about.breaking.the.pattern.of.these.

key.drivers.and.challenging.the.practice.that..follows.in.mental.health.services.through.listen-

ing.to.both.sides,.BME.service.users.and.practitioners(by.Dominic.Makuvachuma.Walker..BME.survivor.trainer,.based.on.work.done.by.the.

Sainsbury.Centre.for.Mental.Health,.2002)

References.

Abel.K,.Buscewicz.M,.Davison.S,.Johnson.S,.Staples.E.eds.(1996).Planning.Community.

Mental.Health.Services.for.Women.London:.Routledge

Coid,.J.W,.Kahtan,.N,.Gault,.S,.et.al.(2000).Ethnic.differences.in.admissions.to.secure.

forensic.psychiatry.services.British.Journal.of.Psychiatry,.177,.241247.Quoted.in.Advances.

in.Psychiatric.Treatment.(2002).8:.26-33.Mental.illness.in.Black.and.Asian.ethnic.minorities:.

pathways.to.care.and.outcomes,.Kamaldeep.Bhui.and.Dinesh.Bhugra

Crawley,.H.2003.Moving.Forward:.The.Provision.of.Accommodation.for.Travellers.and.Gyp-

sies,.Institute.of.Public.Policy.Research

Department.for.Education.and.Skills.(DfES).(2004),.National.Curriculum.Assessment.and.

GCSE/GNVQ attainment by pupil characteristics, in England, 2002 (nal) and 2003 (provi -sional)

Fernando,.Suman.(2002).Mental.Health,.Race.and.Culture.Second.Edition.Palgrave.(Mac-

millan),.Basingstoke.(UK)

Goffman.E,.(1963).Stigma:.Notes.on.the.Management.of.Spoiled.Identity.(Englewood.

Cliffs,.New.Jersey:.Prentice-Hall).

Goleman,.D.(1995).Emotional.intelligence,.New.York:.Bantam.Books

Kendell,.R.and.Jablensky,.A.(2003).Distinguishing.between.the.validity.and.utility.of.psychi-

atric.diagnoses,.American.Journal.of.Psychiatry,.160,.4-12

Points of interest

Black.African.suspects.are.more.likely.than.white.suspects.to.be.arrested,.

tried.by.courts.and.six.times.more.likely.to.be.in.prison.and.be.given.longer.

sentences.(The.Parekh.Report,.2002)

A.study.of.drug.misuse.based.on.the.1996.British.Crime.Survey.reported.that.

46%.of.white.young.people.said.they.had.taken.controlled.drugs,.compared.to.31%.of.Caribbeans,.22%.of.Indians.and.16%.of.Pakistani.and.Bangladeshi.

young.people.taken.together..............

(Ramsay.&.Spiller,.1997)


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McKenzie.K.(2002).A.community-embedded.psychiatry.Openmind.(114).14-15.March/April.

quoted.in.Nazroo.JY.(1997).The.Health.of.Britains.Ethnic.Minorities:.Findings.from.the.

Fourth.National.Survey.London:.Policy.Studies.Institute.

Meltzer,.H.et.al.1995,.PPCS.Surveys.of.Psychiatric.Morbidity.in.Great.Britain,.HMSO

Nazroo,.J,.King.M,.2002,.Psychosis.-.symptoms.and.estimated.rates,.in.Sproston,.K,.Naz-

roo,.J,.(ed).Ethnic.Minority.Psychiatric.Illness.Rates.in.the.Community.(Empiric),.National.

Centre.for.Social.Research,.TSO

Patel,.Nimisha.et.al.(eds).(2000).Clinical.Psychology,.Race.and.Culture..A.Training.

Manual.BPS.Books.(British.Psychological.Society),.Leicester.(UK)

Perkins.R.ed.(1996).Women.in.Context:.Good.practice.in.mental.health.services.for.wom-

en.London:.Good.Practices.in.Mental.Health

Ramsay,.M.and.J.Spiller.(1997),.Drug.Misuse.Declared.in.1996:.Latest

results from the British Crime Survey, Home Ofce Research Study 180

Rosenhan,.David.L..(1973),.On.Being.Sane.in.Insane.Places,.Science,.Vol.179.

(Jan.1973),.250-258

Sainsbury.Centre.for.Mental.Health.(2002),.Breaking.the.Circles.of.Fear.published.by.the.

Sainsbury.Centre.for.mental.Health

Sashidharan.SP.(2003),.Inside.Outside..Improving.Mental.HEalth.Services.for.Black.and.

Minority.Ethnic.Communities.in.England,.DH.March.2003

The Parekh Report, 2002, The Future of Multi-ethnic Britain, London: Prole Books.

Further.reading

From.Culturally.sensitive.to.culturally.competent..KWM.Fulford.p.21-42.In.MH.Service.Pro-

vision.in.a.Multi-Cutlural.Society,.K.Bhui,.D.Olajide.(Saunders).1999


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PageKeydocumentsinRECCtraining PageSesson:Refectingoncommunication


SESSION.4..REFLECTING.ON.COMMUNICATION

(This.Session.has.been.co-authored.by.Premila.Trivedi.&.Peter.Ferns)

Learning.Outcomes

Participants.will.be.able.to

. understand.the.differences.between.the.use.of.power.and.authority

. describe.the.importance.of.communication.within.mental.health.services.and.

gain.an.appreciation.of.how.poor.communication.can.contribute.to.unnecessary.

misunderstandings and conicts

. describe.the.types.of.power.and.authority.that.operate.through.communication.in.

services


Authority

The.right.to.make.decisions.or.exert.control.over.or.make.demands.of.others.by.virtue.

of.position.and.role.within.an.organisation.or.institution.Authority.operates.within.agreed.

limits.set.by.employing.organisations,.policies.and.legal.frameworks

Forensic

Forensic.services.are.the.provision.of.mental.health.services.for.people.with.mental.

disorders.who.are.offenders.or.at.risk.of.offending.Services.are.provided.in.secure.and.community.NHS.and.criminal.justice.settings

Harassment.

Racial.harassment.is.verbal.or.physical.aggression.towards.individuals.or.groups.be-

cause.of.their.colour,.race,.nationality.or.ethnic.or.national.origin.and.includes.attacks.on.

property.as.well.as.people

Sexual.harassment.can.be.unwanted.conduct.because.of.your.sex.which.violates.your.

dignity,.intimidates,.degrades.or.creates.an.offensive.environment.It.is.also.unwanted.

physical,.verbal.or.non-verbal.conduct.of.a.sexual.nature,.this.includes.indecent.remark.or.

intrusive.questions.of.a.sexual.nature

Interpreter

Interpreters.convert.spoken.statements.from.one.language.to.another.in.a.range.of.

settings.Interpreting.involves.listening.to,.understanding.and.memorising.content,.then.

reproducing.statements,.questions.and.speeches.in.a.different.language.This.is.usually.

from.another.language.into.the.mother.tongue.on.a.one.or.two-way.basis

Non-Verbal Communication

Is.a.process.of.sending.and.receiving.messages.without.using.words.through.gestures,.

body.language,.tone.of.voice,.posture,.facial.expressions,.eye.contact.as.well.as.other.

factors.such.as.clothing,.hairstyle.etc


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PageKeydocumentsinRECCtraining PageSesson:Refectingoncommunication


If you talk to a man in a language he understands, that goes to his head.If you talk to him in his language, that goes to his heart. (Nelson Mandela)

Introduction.to.communicationCommunication.is.a.fundamental.part.of.human.relationships.and.so.is.central.to.good.

mental.health.services.Because.we.all.communicate.in.our.everyday.lives.the.skills.required.

seem.deceptively.simple.and.familiar.but,.in.mental.health.settings.and.with.people.from.

diverse.cultural.backgrounds.who.may.be.in.distress,.communication.has.to.be.carefully.

considered.by.everyone.involved.Our.feelings.can.often.complicate.our.communications.

and.we.should.always.be.aware.that.our.skills.are.affected.by.emotions.such.as.fear,.suspi-

cion,.stress,.happiness,.sorrow.etc.In.this.Session.we.are.basically.talking.about.effective.

communication.skills.as.these.are.the.very.skills.that.are.called.upon.more.heavily.when.

communication.occurs.between.people.from.different.cultural.backgrounds.It.is.important.to.

remember that a lot of unnecessary conicts occur through misunderstanding and poor com-

munication.and.this.is.more.likely.across.different.cultural.groups.

in.Persian,.the.word.compromise.apparently.lacks.the.positive.meaning.it.has.in.Eng-

lish.of.a.midway.solution.both.sides.can.live.with,.but.has.only.a.negative.meaning.as.in.

our.integrity.was.compromised.Similarly.the.word.mediator.in.Persian.suggests.med-

dler,.someone.who.is.barging.in.uninvited.In.early.1980.UN.Secretary.General.Wald-

heim ew to Iran to seek the release of American hostages. His efforts were seriously set

back.when.Iranian.national.radio.and.television.broadcast.in.Persian.a.remark.her.report-

edly.made.on.his.arrival.in.Tehran:..I.have.come.as.a.mediator.to.work.out.a.compro-

mise.Within.an.hour.of.the.broadcast.his.car.was.being.stoned.by.angry.Iranians

(Fisher.et.al,.1991)

Power

The capability or potential through force, manipulation or instruction to inuence the

behaviours.of.others.and.get.things.done.in.a.particular.way.Power.may.be.manifested.in.

the.mental.health.system.through.diagnoses,.assessments.and.guidance.Unlike.au-

thority,.power.operates.outside.of.any.legal.or.policy.limits.or.authorities.that.have.been.

agreed.in.a.formal.way..

Translator

Translators.convert.written.material.from.one.or.more.languages.(source.languages).in

recc participants reader

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