NSUN Values-based Commissioning - Culture, Race and Ethnicity in Commissioning for Mental Health To reflect on the origins of racism, prejudice and stigma. To understand the social determinants that make people from BME communities more vulnerable to poor mental health - racism, stigma, discrimination, interpersonal violence, conflict To understand the inequalities experienced due to structural discrimination and how it translates into coercion, control and restraint in practice To introduce the principles of ‘values based practice’ and ‘values based commissioning’ and devise the cultural competencies and actions commissioners can take to eradicate structural discrimination of BME people. To explore baseline involvement standards and how they can be put into practice (National Involvement Partnership’s 4pi standards – Principles, Purpose, Presence, Process, Impact and DTOOT’s). 08/10/2015Racism, mental health and services 1

Learning outcomes Participants will: be confident in their ability to describe and identify ethnic inequalities in the mental health system have a thorough working knowledge of ethnic inequalities with a thorough understanding of systemic and structural discrimination be able to prescribe commissioning action to address inequality and racism 08/10/2015Racism, mental health and services 2

The historical eye and race as a perception 08/10/2015Racism, mental health and services 3

Reflections on the origins Euro-centric Kant Wittgenstein Darwin Eugenics IQ Mental health Body reader Exploitation Legacy of Slavery AFRO-CENTRIC Fanon Mask Dubois Veil Welsing Symbol Rodney Europe underdeveloped Africa Self-determination Person centred 08/10/2015Racism, mental health and services 4

The Social determinants "If any one or more of them, at any time, are inclined to raise their heads to level with their master or overseer, humanity and their own good requires that they should be punished until they fall into that submissive state which was intended for them to occupy. They have only to be kept in that state, and treated like children to prevent and cure them from running away." Cartwright (1851p:) 08/10/2015Racism, mental health and services 5

Historical values Cultural schizophrenia Bowlby International Detachment Slavery Freud Black penis envy The madness of the European Whiteness as a Psychotic illness 08/10/2015Racism, mental health and services 6

THE EXPERIENCES Gemini V Schizophrenic Failed 11+ Assessed Educational subnormal Experienced abuse 08/10/2015Racism, mental health and services 7

Structural discrimination Six times more likely to be excluded from school. Three times more likely to be given a custodian sentence. Ten times more likely to have a mental illness More likely to be diagnosed with schizophrenia 08/10/2015Racism, mental health and services 8

Structural discrimination. Failure of the legislation 1983/2007 Mental Health Act 1990 Community Care Act 2014 Care Act 1998 Human Rights Legislation 2000 Race Relation Act 2010 Equality Act DSM 5 ICD 10 Modern Slavery Act ( /10/2015Racism, mental health and services 9

The missed (diagnosis) Meeting the white specification of madness Reading their words Writing their words Madness specification DMS Treatment specification Educationally subnormal Dyslexic Manic Depression Schizophrenic ECT. Medication. Locked up 08/10/2015Racism, mental health and services 10

Survival V Selling out Personal and Professional From maudsley to College, from O levels to A levels and qualifying as a Approved social worker. Trading the black body for European accolade, working along side the enemy of your own misdiagnosis. Managing the new slave trade of mental illness in your own community. Moving over to other side, decoding whiteness as mental disorder, GP/Consultants/ 08/10/2015Racism, mental health and services 11

Values. They diagnosed me a schizophrenic when I was really a Gemini The night shift of mental disorder. The day care and the voluntary sector. The plantation field of higher education, from MA – PHD – NOTHING. Writing and reflections, breaking down and breaking down. Teaching re-emergence of radical community based social work. 08/10/2015Racism, mental health and services 12

Researching the other side Body dysmorphic disorder Re-conceiving the Europe centric. The role of black theorist. Challenging research as social process of whiteness, Goffman. Changing the models. Challenging needs and service approach to race and racism. 08/10/2015Racism, mental health and services 13

Well-being WORLD HEALTH ORGANISATION Definition.BAME – No reference State of well-being in which every individual realises his or her own potential. Can cope with normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community. 03/07/2014PFA Mental Health Slides1412/5/2015PFA Mental Health Slides1412/5/2015 PFA Mental Health Slides. BACA Copyright /10/2015Racism, mental health and services 14

Baseline Practice Goffman (1961) Littlewood and Lipsedge (1981) Small (1994) Racialised barriers – Housing –Education – Social Welfare - Politics Richie Report (1994) Christopher Clunis Fernado (2010) Criminal Justice and Mental health. Fernando (2010) Survey in schizophrenia Lambeth, (2014) Black report Mental Health Foundation (2001) Mental Health Foundation (2008) 08/10/2015Racism, mental health and services 15

Implications Dancing to Our Tunes: Reassessing BME Mental Health Service User Involvement - by NSUN consultant Jayasree Kalathil published in 2012 and reprinted in 2013 Dancing to Our Tunes: Reassessing BME Mental Health Service User Involvement Ethnic Inequalities in Mental Health: Promoting Lasting Positive Change - a consultation with Black and Minority Ethnic Mental Health Service Users - by NSUN for the Lankelly Chase Foundation - published in 2014Ethnic Inequalities in Mental Health: Promoting Lasting Positive ChangeLankelly Chase Foundation JCP guidance: Commissioning Mental Health Services for BME Communities - published in 2014JCP guidance: Commissioning Mental Health Services for BME Communities 4PI: Mental Health Involvement Standards - 4PI: Principles, Purpose, Presence, Process, Impact: the standards defined by NSUN and the National Involvement Partnership (NIP) – PI: Mental Health Involvement StandardsNational Involvement Partnership Evidence and Ethnicity in Commissioning 2014Evidence and Ethnicity in Commissioning 08/10/2015Racism, mental health and services 16

Values in our practice 12/5/2015PFA Mental Health Slides1712/5/2015 PFA Mental Health Slides. BACA Copyright /10/2015Racism, mental health and services 17

Challenge for Commission Researching our past. Rewriting the past. Educating whiteness. New models, new assessments. The political challenges of looking at Mental health services and commissioning. 08/10/2015Racism, mental health and services 18