“I could have died in there”: Narratives of Mental illness and the discourse of Structural Violence Rubina Jasani and Sarah Pemberton University of Warwick

Case Study One 21 year old male, African, asylum seeker with psychosis. Rejected from university because of his undeclared status. Differing understanding of cause of illness Gaps in care

Data Collection Research is based in the Heart of Birmingham (HoB) Research seeks to investigate the reasons behind ethnic variations in the experiences of, and admission to, acute psychiatric treatment. Area chosen because of its high BME population

Main Ethnic Groups in HoB Total population of 250,755 of HoB – 10% Black British/Black Caribbean – 25% White British – 3% White Irish – 29% British Asian/Pakistani – 13% British Asian/Indian – 7% British Asian/Bangladeshi

Criteria for Interview Diagnosed as having had a psychotic episode by clinical team From all ethnic groups Aged between 18 and 65 Not considered as a real/present risk to researcher or themselves. Ability to consent

Ethnicity of Sample 21% Black British/Black Caribbean 38% White British 1% Mixed Other 32% British Asian/Pakistani 3% British Asian/Indian 3% British Asian/Bangladeshi

Structural Violence Based on work of Paul Farmer (1997, 2003) Farmer examines ways in which women are structurally disadvantaged with reference to the treatment of Aids. This can be applied to mental health and the multiple ways in which people are marginalised and the impact that this has on access to care.

Case Study Two 30 year old male, British Pakistani with psychosis. Negative experiences of inpatient unit Differing understanding of cause of illness Neglect by the system

Case Study Three 29 year old female, White British with psychosis. Raped, children removed by social services, homeless, heroin user Differing diagnoses Gaps in care

Conclusion Case studies attempt to show how structural inequalities of culture, class and gender play a role in disadvantaging service users and excluding them from main stream health and political systems Our research is not necessarily making a claim for culture specific services, but instead shows how culture is a dynamic concept that needs to be explored in the context of time and space, while remaining sensitive to differences of class and gender.

Contact Us Rubina Jasani Laura Griffith Sarah Pemberton