FEATURE ARTICLE

E O EkeSaturday, October 20, 2012
eoeke@aol.com


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BLACK AND MAD?

An examination of mental Health in people of African Extraction, living in the United Kingdom. A paper presented on the 18 October 2012 at Southend-on-Sea Council, England in celebration of the Black History month by E O Eke


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r David Roy Bennett was a black patient in Norwich who was racially abused on the night of his death by fellow patients after a dispute over access to phone on the ward. He was born on 5 February 1960 in Jamaica and came to England in 1968 to join his parents who were already settled in Peterborough. His father was an Engineer with London Brick Company and he had eight siblings. He gained five GCSE at school and worked as a sign writer for about three years. He left the job voluntarily and did not appear to have worked after that. He was a talented footballer who was offered a trainee post with a football club just before the onset of his mental illness in 1980 aged 20. On the night he died, he was subsequently forcibly restrained by five nurses for almost half an hour. They only released him after they realised that he had stopped breathing. No attempt was made to resuscitate him. A subsequent public inquiry into his treatment, care and circumstance of his death concluded that mental health services within the UK are institutionally racist.

If you are black and living in the UK, you are more likely to develop mental illness than if you were living in any African or Caribbean country of your birth. People of African and Caribbean origins living in the UK suffer poorer health, have reduced life expectancy, have greater problem with access to health care than majority of the population. Rocky Bennett exemplifies this and everything wrong with mental health of people of African extraction living in diaspora. The inquiry into his death exposed the discriminatory nature of the diagnosis and some of the underlying personal and cultural practices and habits that mediate mental illness in Blacks. Black people are overrepresented among people sectioned under the Mental Health Act. Their culturally appropriate and acceptable behaviours and beliefs have been wrongly construed as symptoms of abnormality or aggression (a woman was detained under the Mental Health Act for believing that she was married to Jesus). Almost 10 per cent of mental health inpatients are black or mixed-race. But these ethnic groups make up 3% of the general population, according to the 2005 census.

  • Black people are three times more likely to be admitted to psychiatric hospitals in England and Wales than the rest of the population.

  • Black people are up to 44 per cent more likely to be detained under the Mental Health Act.

  • They are twice as likely to be referred to mental health services by the police and courts as the rest of the population. Black people are less likely to be referred by their GP than white people.

  • Within psychiatric services black men are about 50 per cent more likely than average to be put into seclusion in closed rooms.

  • Rates of control and restraint are 29 per cent higher among black Caribbean men than the average for all inpatients.

  • Black and mixed race men are more likely to be on a medium or high secure ward.

Black people are up to 18 times more likely to be diagnosed with psychotic illness than white people. They are four times more likely to find themselves locked up under the Mental Health Act. In a paper by Glynn Harrison, titled “Ethnic minorities and mental health Act”, he concluded that compulsory detention under part 2 of the mental Health Act are six times more likely to be of Black people than white. Eaton & Harrison (2000) suggested that rate of psychotic disorder in British –born individuals with African-Caribbean family background are significantly elevated.

On the 2nd of April 2007, Kwame McKenzie, a professor of psychiatry, in an article in the guardian titled “being Black in Britain is bad for your mental health”, argued that there is an epidemic of psychotic Illness in those of African and Caribbean origin and asked why nothing was being done to address it. Over the last 35 years or so, there have been more than 20 studies showing that people of African and Caribbean origin have increased risk of being treated for serious mental illness such as schizophrenia. In 2002, the yearly census of psychiatric inpatient in British hospitals showed that people who described themselves as Black Caribbean or Black Africans were over represented by about 4 fold. The vast majority of this group are young British born Black people and they are 18 times more likely to be in hospital than the British average. This finding is consistent with international reviews which concluded that migrants are more likely to develop mental illness. The sad fact is that this risk of developing mental illness in migrants is doubled if the migrant is black living in a white country and this risk is increased again in their children.

From these studies, it would seem that there is something about being black and living in a white country which can make a Black person who might not have developed mental illness if he was living in a black country to do so. However, the relationship may not be as simple as some of these studies suggest. Thornicroft et al. (1998) found that among 500 patients with psychosis, over 50% had been admitted under the mental health Act at least once in the course of the illness

Moreover, some of these studies have many limitations and many of them did not account for other variables associated with mental illnesses which are also prevalent in Black populations like poverty, unemployment, early and wide use of cannabis, difficult family circumstance characterised by divorce and broken homes, and racial discrimination. In fact, the comparison between the rate of mental illness in African and Caribbean countries do not compare like with like. African and Caribbean countries have very different standard of health care services and this has a direct relationship to the rate of diagnosis of the illnesses. However, in spite of these, it is a fact that the rate of mental illness in Britons of African and Caribbean origin is higher than the rate in Africans and Caribbean living in Black countries and any combinations of the variables mentioned above can conveniently account for this apparent anomaly.

Why does this matter?

The cost of mental illness to the individual, family and society is enormous. Most sufferers of mental illness suffer unemployment. People with mental illness have higher rate of suicide. They have lower life expectancy and their children are more likely to develop mental illness. They are often unable to speak coherently for themselves and must depend on others to do so for them. In addition, there is a lot of prejudice against mental illness and many cultures are still very ignorance about mental illness and have traditional beliefs and practices which perpetuate this unfortunate state of affairs. Some people still believe that mental illness is caused by evil spirit or will respond to prayer, fasting and spiritual intervention. Hence, they seek help in prayer houses and churches hoping that God would intervene in one of His mysterious ways or miracles. Children with behaviour problems or developmental disorders are believed to be possessed by the devil.

Mental illness destroys families and costs lives. Many innocent people have been attacked or even killed by people with mental illness. Christopher Clunis was born 1963 in London, both parents were from Jamaica. His father was a factory worker. He left school with 'O' levels. He started study of economics and sociology 'A' levels but dropped out to be a Jazz Guitarist. He played with the "Aqua Vita Show band". Mother had Cerebrovascular accident (CVA) in 1980 and parents returned to Jamaica. Mother died in 1985. In 1986, Christopher started to behave oddly. He dressed inappropriately, rambling, and threatened to hit his niece for no apparent reason. He was sent to join his father in Jamaica and was admitted to Bellevue Hospital, Kingston, Jamaica and diagnosed with Paranoid schizophrenia. He was discharged to the care of his father, but when his father became ill, he returned to England.

On Thursday, 17 December 1992, Jonathan Zito was travelling home by London Underground with his brother Christopher. Jonathan had met his family at Gatwick Airport and there had been insufficient room in his friend's car, so the rest of the family had gone on ahead. The brothers stood waiting for a change of train on the Piccadilly Line at Finsbury Park Station, chatting to each other in a crowd of waiting passengers. On the platform was a large, shabbily dressed, black man acting in a bizarre manner. The waiting passengers ignored Christopher Clunis until he came very close behind the Zito brothers on the edge of the platform. Without any warning, Clunis suddenly stabbed Jonathan Zito three times in the face, one of the wounds penetrating upwards over his eye and into his eyes. This is what people can do when they suffer from untreated mental illness. Christopher Clunis was jailed indefinitely.

Furthermore, mental illness is the most expensive part of the NHS budget. A Centre for Mental Health policy paper published in 2003 estimated that the economic and social costs of mental health problems in England in the financial year 2002/03 amounted to £77.4 billion (Sainsbury Centre for Mental Health, 2003). Using the same methodology, a straightforward updating of this figure suggests that the aggregate cost of mental health problems in England increased to £105.2 billion in 2009/10. About six million Britons suffer from depression and they contribute to a significant number of suicides in the country.

What do we know about mental illness?

Most Psychiatric outcomes have clearly multi-factorial aetiology with strong familial tendencies and presumed underlying genetic basis. However, environmental factors are evidently important, and researchers are becoming increasingly interested in the potential interactions between genetic and environmental factors (Martin et al 2003). We know that mental illnesses, especially psychotic illnesses, are associated with poverty, poor education, racism, poor obstetric care, living in cities, head injury, brain infections especially in childhood, head trauma, family break up and cannabis use. Some of these risk factors are over represented in immigrant Black population. It is therefore rational to argue that addressing these factors will impact on the rate of mental illness in the community. Africans living in Diaspora do not have access to the best education available in the west and are often condemned to earning a living by doing poorly paid menial jobs.

Role of Discrimination (racism or injustice) in mental illness.

There is a recognised association between deep sense of injustice, real or perceived, and mental illness. The role of racism in mental illness has been denied in the past. Even now there are people who are still opposed to it just as there are people who deny the holocaust. Surprisingly, the role of injustice in mental illness has been known since antiquity. In the book of Ecclesiastes chapter 7:7 King Solomon said” surely oppression maketh a wise man mad”.

On the 5th of September 2008, the guardian newspaper under a caption “black Caribbean children held back by institutional racism in school”, Reported that “Black Caribbean pupils are being subjected to institutional racism in English schools which can dramatically undermine their chances of academic success, according to a new study. “Researchers have uncovered evidence that teachers are routinely under-estimating the abilities of some black pupils, suggesting that assumptions about behavioural problems are overshadowing their academic talents.

The findings, based on a survey which tracked 15,000 pupils through their education, add weight to the theory that low achievement among some black students is made worse because teachers don't expect them to succeed. A third of the most capable black Caribbean pupils are not entered to take the hardest papers in tests at 14. Black Caribbean and mixed white-and-black Caribbean children are excluded at rates three times greater than that for white children. In 2007, 44.9% of black Caribbean pupils, and 47.3% of pupils of mixed white and black Caribbean heritage, achieved 5 or more A*-C grades, compared to 57.3% nationally. The gap between black Caribbean achievement and the national average at GCSE has narrowed by eight percentage points in four years.

Dr Steve Strand from Warwick University, the author of the study, said: "After accounting for all measured factors, the under-representation is specific to this one ethnic group and indicates that, all other things being equal, for every three white British pupils entered for the higher tiers, only two black Caribbean pupils are entered." He concludes that "institutional racism" and low expectations by teachers explain the missing black Caribbean students from top-tier exams. By 'institutional racism' I mean organisational arrangements that may have disproportionately negative impacts on some ethnic groups," he said. In 2005 there were twice as many black men in prison in the UK than in universities and Black people are among the poorest communities in western countries.

This study is consistent with my own experience of living,. working and bringing up children in the UK. All the factors which mediate mental illness in Black people can be amendable to intervention with or without the support of the government. A people who are intelligent and alive to their responsibility to their future and children would target these variables to improve the quality of their mental health and advance the emancipation of their people.

Such a people would seek to unite to produce appropriate response to the problem. The question remains, why is it that black people do not seem to take initiative in solving the problems that affect them? Why do they always look to the white man to develop solution to their problems? In spite of the prevalence and endemicity of malaria in Africa, black nations have not invested or done enough to find a solution to it. . Black nations do not seem to focus enough on knowledge or invest enough in science, technology and good leadership which are the main variables that mediate development and advancement. Many Black nations are badly governed with endemic corruption. These are problems that have to do with a people’s moral development and values they cherish. Black people can invest more on their families and relationships, work less extra shifts and devote more time to the education, and upbringing of their children. This little change in attitude would translate into a large benefit in outcomes for the people.

We can look at our values and realise that sending one’s child to a good school and paying for it, is better than building a big house in Africa or driving a BMW. We need to see good education and up bringing as the best investment we can make for our children. Our priorities, worldviews and values will have to change if we will impact on the appalling statistics about the mental health of black people. Therefore, unless we lead in addressing the many complex factors that mediate high rate of mental illness in our population, the status quo. Will change very little in the foreseeable future.

Doctors, know that there are many causes of fever just as there are many reasons for depression or psychosis. Like fever, I believe that the secret for the treatment of mental illness in black people is to uncover the probable causes or precipitants and addressing them to the satisfaction of the individual. just like a fever due to infection would not respond to antipyretics like paracetamol, so is depression or psychosis in Black patients due to injustice in form of racism perceived or real, poverty, difficult and chaotic family circumstance, or cannabinoid use would not respond to antidepressant or antipsychotic without address real cause of the problem. The choice is in our hands.

References

Audini, B. & Lelliott, P. (2001) Age, gender and ethnicity of those detained under Part II of the Mental Health Act 1983. British Journal of Psychiatry, 180, 222-226.

Davies, S., Thornicroft, G., Leese, M., et al (1996) Ethnic differences in risk of compulsory psychiatric admission among representative cases of psychosis in London. BMJ, 312, 537

Eaton, W. W. & Harrison, G. (2000) Ethnic disadvantage and schizophrenia. Acta Psychiatrica Scandinavica, 102 (suppl. 407), 1-6.

Harrison, G., 2002, ‘Ethnic minorities and the Mental Health Act’, The British Journal of Psychiatry (2002) 180: 198-19

Martin P Et al Practical Psychiatric Epidemiology Oxford University press 2003.

Sashidharan, S. P. (2001) Institutional racism in British psychiatry. Psychiatric Bulletin, 25, 244-247.

Selten, J. P. & Sibjen, N. S. (1994) First admission rates for schizophrenia in immigrants to the Netherlands. Social Psychiatry and Psychiatric Epidemiology, 29, 71-77.

Thornicroft, G., Strathdee, G., Phelan, M., et al (1998) Rationale and design. PRISM Psychosis Study I. British Journal of Psychiatry, 173, 363-370.

Wall, S., Churchill, R., Hotopf, M., et al (1999) A Systematic Review of Research Relating to the Mental Health Act (1983). London: Department of Health.

E O Eke is qualified in medicine. At various times he has been a General medical practitioner, Medical missionary, Medical Director and senior medical officer of health in Nigeria. He specializes in child, Adolescent and adult psychiatry and lives in England with his family. His interest is in health, religion philosophy and politics. He cares for body and mind.

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