27 February 2004

Dear Mr Mantle

 

re: 'Delivering Race Equality: a Framework for Action'

 

The Royal College of Psychiatrists was grateful to receive a copy of this consultation document setting out the Government’s plans for improving mental health services for people from black and minority ethnic communities.

The document has been circulated very widely within the College – to our Special Committee on Ethnic Issues, Transcultural Psychiatry Special Interest Group, Special Committee of Patients and Carers, to the Executive and Finance Committee, and to the College’s Council, the membership of which includes representatives of all our specialist Faculties and Sections and geographical Divisions.

 

The College strongly welcomes the Framework for Action, which is consistent with the College’s *Race Equality Scheme – an area of work which is of high priority within the College. Our Race Equality Statement of Intent and Scheme were developed by the Special Committee on Ethnic Issues and endorsed by Council in 2002, and an Action Plan was devised last year to guide the implementation of the Scheme.

 

(*Details of the College’s Race Equality Scheme are available on the College’s website. nb We are currently in the process of expanding the College’s website to include more extensive information about our Race Equality strategy and Action Plan.)

 

The Royal College of Psychiatrists looks forward to working closely with NIMHE in relation to the implementation of the Department of Health’s Framework for Action. We would be very interested to receive details of the responses to the consultation if the Department is willing to share these with us.

 

Detailed comments on the Framework from the College’s Forensic Psychiatry Faculty are attached.

 

Yours sincerely

 

 

Comments from the Royal College of Psychiatrists’ Forensic Psychiatry Faculty

Consultation Points 2, 3and 4:

 

In regard to forensic psychiatry, there are a number of specific issues.

 

1. The problem with discrimination as described in this document is very much couched in terms of problems between the white UK majority and ethnic minorities. Within medium secure units, the problems are, however, considerably more complex. Within a relatively small unit, there may be patients drawn from a number of different ethnic minorities. There can be significant tension between different members of different ethnic minorities which are just as powerful and important as tensions between the white UK majority and a generic grouping of ethnic minorities. This is a complex and sensitive area but does need acknowledgement. Otherwise, the scenario becomes a crude white/black one. There can also be tensions between different ethnic groups within the staff group made more complex by that staff group having responsibility for a multi-ethnic patient group. The latter is reported as an increasing problem

 

2. In some medium secure units, white patients are in the minority and there needs to be an understanding of white experience as well as that of the minority ethnic groups.

 

3. Within forensic services where patients have been drawn from a number of different cultural and ethnic backgrounds, implementing this guidance may be impossible. It could lead to impotence on the part of the staff in that the mental health worker may feel that they cannot engage with a particular patient because they do not share their ethnic or cultural background. The end result can be a lack of engagement with patients and lack of availability of services to members of small ethnic minorities. Sometimes, the fact that the mental health worker has a different perspective can be positive and enabling.

 

Consultation Point 5

 

Forensic services need to engage with the wider community and particularly to work with the local voluntary sector. However, there are again complex problems with engaging with groups that may not necessarily have a great deal in common except for being a minority. East London, for example, has areas which encompass orthodox Jews, Muslims from Pakistan, Hindus from India and Bangladesh, Afro-Caribbean, African, Turkish and Albanian communities. The patient mix is drawn from these communities and there can be considerable problems for the unit in engaging with the community leaders and the families of patients.

Consultation Point 11

 

For forensic psychiatry, perhaps the most important issue is coercion. Most of our patients do not choose us. A lot of patients are compelled by legislation to come to us and treatments are often given against the person's will. Secure units involve confinement and the nature of the unit often means that techniques such as control and restraint are employed. The length of stay in forensic services is not always determined by clinical considerations but is influenced by the prevailing climate in society regarding risk and attitudes to mentally disordered offenders. There is concern in this Faculty about the likely increase in the number of black people detained in the proposed Mental Health Act legislation. One of the most positive ways of improving better services for black and ethnic minorities would be around developing innovative ways of reducing coercion.