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1 Session 3 Session 3 Agenda Stereotypes Stereotypes Circles of Fear Circles of Fear Communicating with service users in a clinical setting. Communicating with service users in a clinical setting. UK immigration UK immigration Population Statistics Population Statistics Count me in Census 2009 Count me in Census 2009 Themes of Equality Themes of Equality Personal empowerment Personal empowerment The RELATE model© The RELATE model©
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2 Task : Divide yourself into small groups, discuss and writing down your thoughts for these 2 questions. 1. What are the common stereotypes of Black people, White people and Asian people? 1. What are the common stereotypes of Black people, White people and Asian people? 2. List other marginalised groups who were subjected to systematic forms of discrimination / abuse 2. List other marginalised groups who were subjected to systematic forms of discrimination / abuse 3. What are the common stereotypes of marginalised people e.g. gay men, lesbians, young people, gypsies 4. What do the stereotypes tell you about the underlying beliefs in relation to each marginalised groups
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3 “Especially the African Caribbean males on the ward, they do feel the vibes. They feel that people are shrinking away from them if they are trying to express themselves. What they see as expressing themselves, others perceive as sort of anger and almost threatened violence.”(quoted in McLean et al. 2003) 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) 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)
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4 BME women remain marginalised within current policy debates. They are often viewed exclusively, in stereotyped ethnic images – for instance, as ‘loud and difficult to manage’ in the case of African-Caribbean women, or in the case of Asian women, as having problems that are rooted exclusively in ‘cultural conflict or practice’ within the family. This results in their needs as women being ignored and overlooked. (Keating, Robertson & Kotecha, 2003)
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5 Examples of some common stereotypes Gypsy and Travellers are dirty Gypsy and Travellers are dirty Short people are aggressive Short people are aggressive Blonde women are not clever Blonde women are not clever Chinese people are secretive Chinese people are secretive Black people are irrational & aggressive Black people are irrational & aggressive Irish, stupid and drunk Irish, stupid and drunk Homeless people are lazy Homeless people are lazy Children do not know what is good for them Children do not know what is good for them Mental Health service users do not know what is good for them Mental Health service users do not know what is good for them Men can’t multi-task Men can’t multi-task All Jews have dark hair, large noses and love money All Jews have dark hair, large noses and love money Gay men responsible for spreading Aids Gay men responsible for spreading Aids BME people look after their own, therefore do not need services BME people look after their own, therefore do not need services Young people who wear hoodies are dangerous Young people who wear hoodies are dangerous Lesbian women have hairy legs Lesbian women have hairy legs Black people who are in management; made it because of their colour Black people who are in management; made it because of their colour
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6 Count me in Census Annual, 1day count of inpatients, introduced March 2005 Joint initiative with the:- Annual, 1day count of inpatients, introduced March 2005 Joint initiative with the:- the Care Quality Commission (formerly Healthcare Commission) the Care Quality Commission (formerly Healthcare Commission) the Mental Health Act Commission (MHAC) the Mental Health Act Commission (MHAC) the Care Services Improvement Partnership the Care Services Improvement Partnership National Institute for Mental Health in England (NIMHE). National Institute for Mental Health in England (NIMHE). The census aims to:- 1. Obtain accurate mental health & learning difficulties inpatient figures in England and Wales. 1. Obtain accurate mental health & learning difficulties inpatient figures in England and Wales. 2. Improve recording and monitoring of data on the ethnic group of patients. 2. Improve recording and monitoring of data on the ethnic group of patients. 3. Provide information to achieve the Government’s five-year plan Delivering Race Equality in Mental Health Care (DRE) - aims improvement mental health services for black and minority ethnic communities. 3. Provide information to achieve the Government’s five-year plan Delivering Race Equality in Mental Health Care (DRE) - aims improvement mental health services for black and minority ethnic communities.
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7 Count me in Census 2009 (published January 2010) Minority ethnic groups inpatients admissions – Minority ethnic groups inpatients admissions – 2005 20%, 2008 22% (Increase in Other White group) 2005 20%, 2008 22% (Increase in Other White group) Admission rates for Black groups were over 3 times higher Admission rates for Black groups were over 3 times higher Over 9 times higher in the Other Black group. (No change from previous Census’s) Over 9 times higher in the Other Black group. (No change from previous Census’s)
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8 Count me in Census 2009 Referral GPs and community mental health team referrals - lower among some Black and White/Black groups, criminal justice system referrals - higher. GPs and community mental health team referrals - lower among some Black and White/Black groups, criminal justice system referrals - higher.Detention Detention rates - higher Black Caribbean, Black African, Other Black & White/Black Caribbean Mixed groups. Detention rates - higher Black Caribbean, Black African, Other Black & White/Black Caribbean Mixed groups. Higher detention rates under section 37/41 (imposed by courts, except Black African). Higher detention rates under section 37/41 (imposed by courts, except Black African). Detention rates – also higher in the Other White and Pakistani groups. Detention rates – also higher in the Other White and Pakistani groups.
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9 Census 2008 Seclusion 4% of inpatients had an episode of seclusion- higher for Other Black group (No change) 4% of inpatients had an episode of seclusion- higher for Other Black group (No change)Restraint higher among the Other White and White/Black Caribbean Mixed groups. higher among the Other White and White/Black Caribbean Mixed groups.
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10 Census 2009 Length of stay 29% of patients had been in hospital for one year or more, and 20% for over two years. 29% of patients had been in hospital for one year or more, and 20% for over two years. Black Caribbean and White/Black Caribbean Mixed groups – Longest stays Black Caribbean and White/Black Caribbean Mixed groups – Longest stays Chinese, South Asian and White British groups - Shortest stay. Chinese, South Asian and White British groups - Shortest stay. Black Caribbean, White/Black Caribbean Mixed and Other Black groups- more likely to be on a medium or high secure ward. Black Caribbean, White/Black Caribbean Mixed and Other Black groups- more likely to be on a medium or high secure ward.
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11 No contact Non Compliance Crisis Escalates HARM TO SELF HARM TO OTHERS The diagram above highlights the challenges which may be faced by ‘black men’ accessing the mental health services A Perspective - Circles Of Fear
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12 “There is a risk that, in places like X, people may never develop the awareness and skills to deal with Black people because there are so few of them” Assumptions such as this may seem rather innocuous and commonplace but they can have very serious consequences. This quote was made by a consultant psychiatrist at the Norvic Clinic in Norfolk where David ‘Rocky’ Bennett, a young African Caribbean man, who died while being restrained. The psychiatrist had made the statement in response to questions from the Panel of Inquiry about ‘racial issues’ at the Clinic (‘Independent Inquiry into the Death of David Bennett - December, 2003).
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14 The Themes of equality Theme 1 ~ Valuing Cultural Diversity Theme 2 ~ Preventative Approaches Theme 3 ~ Autonomy & Advocacy Theme 4 ~ Holistic Approach Theme 5 ~ Participation & Information Theme 6 ~ Safeguarding Rights
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15 The Themes of Institutional Discrimination Assimilation Assimilation Under Reaction or Over Reaction Under Reaction or Over Reaction Disempowering & Stereotyping Disempowering & Stereotyping Service Led (rather than service user led) Approaches Service Led (rather than service user led) Approaches Poor Access to services Poor Access to services Erosion of Rights Erosion of Rights
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16 Reflect on the Poem and description in Handout 7. Break into small groups and discuss these questions. 1.What is your reaction to the poem? 2.What could help people to cope or deal with a situation of powerlessness? 3.Where does this fit into the RELATE model©?
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17 The ‘spiral of oppression’ ( by Premila Trivedi, 2001)
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18 A model of personal empowerment
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19 The RELATE Model © © Caroline Hounsell, 2008
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20 British asylum laws :- Asylum Seekers are those people who are awaiting a decision. The Home Office National Asylum Support Service (NASS) generally offer accommodation in a town outside the area of South-East England & London while their case is considered. Asylum Seekers are those people who are awaiting a decision. The Home Office National Asylum Support Service (NASS) generally offer accommodation in a town outside the area of South-East England & London while their case is considered. Refugees with Exceptional Leave to Remain (ELR) do not qualify as ‘having a well-founded fear of persecution’) but are recognised as being in great danger if they return home. Usually offered ‘temporary protection’ & the right to live here for up to 4 years. Refugees with Exceptional Leave to Remain (ELR) do not qualify as ‘having a well-founded fear of persecution’) but are recognised as being in great danger if they return home. Usually offered ‘temporary protection’ & the right to live here for up to 4 years. Refugees with Indefinite Leave to Remain (ILR) meet the UN terms, and have no time limit on their right to live in Britain. Majority of their rights are the same as a British passport-holder, and many settle here permanently. Refugees with Indefinite Leave to Remain (ILR) meet the UN terms, and have no time limit on their right to live in Britain. Majority of their rights are the same as a British passport-holder, and many settle here permanently. Refugees and those with ELR have the full entitlement to NHS treatment available to all legal residents in Britain, and do not have to pay fees. Asylum seekers whose cases have not yet been determined (including those with appeals pending) are also entitled. Those whose applications have failed where appeal processes have been exhausted and are entitled only to free emergency treatment. Refugees and those with ELR have the full entitlement to NHS treatment available to all legal residents in Britain, and do not have to pay fees. Asylum seekers whose cases have not yet been determined (including those with appeals pending) are also entitled. Those whose applications have failed where appeal processes have been exhausted and are entitled only to free emergency treatment.
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21 Immigration Restrictive immigration rules mean immigrants have been refugees or asylum seekers. Restrictive immigration rules mean immigrants have been refugees or asylum seekers. Facing all the problems that settled community BME people face but there are additional challenges for mental health services in providing for their needs. Facing all the problems that settled community BME people face but there are additional challenges for mental health services in providing for their needs. (quote based on Fernando, 2003) Many tortured before arrival & many have gone through difficult & traumatic experiences in the course of getting here. Many tortured before arrival & many have gone through difficult & traumatic experiences in the course of getting here. Refugees and asylum seekers feel intensely insecure in their political and social position within the UK. Refugees and asylum seekers feel intensely insecure in their political and social position within the UK. They face intense hostility & overt racism worse than black immigrants in the 1960s and 1970s. They face intense hostility & overt racism worse than black immigrants in the 1960s and 1970s.
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22 Asylum Seekers & Refugees 17 % of asylum seekers - limiting physical illness 17 % of asylum seekers - limiting physical illness 2/3 have experienced significant anxiety and depression (BMA 2002; Carey Wood et al 1995). 2/3 have experienced significant anxiety and depression (BMA 2002; Carey Wood et al 1995). Detaining asylum seekers in removal centres compounds the psychological damage Detaining asylum seekers in removal centres compounds the psychological damage Prospect of dispersal exacerbates mental health problems & reduces opportunities for developing community networks. (Watters 2002), Prospect of dispersal exacerbates mental health problems & reduces opportunities for developing community networks. (Watters 2002), Dispersal was to areas with low concentrations of refugees, leading to high visibility and an increase in racial abuse. (Watters C, 2002) Dispersal was to areas with low concentrations of refugees, leading to high visibility and an increase in racial abuse. (Watters C, 2002)
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23 Statistics The South Asian community largest ethnic minority group living in Britain, 4% of the population (2001 Census). The South Asian community largest ethnic minority group living in Britain, 4% of the population (2001 Census). Indian (1.8%),Indian (1.8%), Pakistani (1.3%),Pakistani (1.3%), Bangladeshi(0.5%) andBangladeshi(0.5%) and other Asian (0.4%).other Asian (0.4%). (DH, 2007) 1.0% of the population is Black Caribbean descent living in the UK (2001 Census) 1.0% of the population is Black Caribbean descent living in the UK (2001 Census) 0.8% - People of Black African descent is 0.8% - People of Black African descent is 0.2% - People of Black Other. 0.2% - People of Black Other. The African-Caribbean community mainly lives within the inner cities, The African-Caribbean community mainly lives within the inner cities, Over 50% are British born. Over 50% are British born. BME groups can experience poorer health, have reduced life expectancy & have greater problems accessing health. BME groups can experience poorer health, have reduced life expectancy & have greater problems accessing health. For mental health, major concerns include disparities & inequalities in terms of rates of mental ill health, service experience & service outcome. For mental health, major concerns include disparities & inequalities in terms of rates of mental ill health, service experience & service outcome.
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24 Divide yourselves into 3 groups – A, B & C. Group A – Handout 8 Group B – Handout 9 Group c – Handout 10 Read your handout section and prepare to present what you have found back to the whole group in a short presentation. You can deliver this presentation as creatively as you like.
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25 Organise yourselves into two groups. Write a short radio script of about 5mins around the basic scenario below using all the stages of the RELATE model ©. After you have written and practiced your short play you will ‘perform’ this 5mins RELATE radio play to the rest of the group. Situation: A forensic unit: Ahmed (a BME patient) complains to Jon (a staff nurse) that another White patient, Billy, has been repeatedly addressing him using racist names. Organise yourselves into two groups. Write a short radio script of about 5mins around the basic scenario below using all the stages of the RELATE model ©. After you have written and practiced your short play you will ‘perform’ this 5mins RELATE radio play to the rest of the group. Situation: A forensic unit: Ahmed (a BME patient) complains to Jon (a staff nurse) that another White patient, Billy, has been repeatedly addressing him using racist names. RELATE Model © Recognise the discrimination Recognise the discrimination Express your concern Express your concern Listen to the response Listen to the response Accurately educate with facts and feelings Accurately educate with facts and feelings Talk to relevant authorities Talk to relevant authorities Enable self sport Enable self sport
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26 Session 3 Session 3 Agenda Stereotypes Stereotypes Circles of Fear Circles of Fear Communicating with service users in a clinical setting. Communicating with service users in a clinical setting. UK immigration UK immigration Population Statistics Population Statistics Count me in Census 2008 Count me in Census 2008 Themes of Equality Themes of Equality Personal empowerment Personal empowerment The RELATE model© The RELATE model©
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