Sixty second interview with Errol Francis
Errol Francis is the joint programme manager at Breaking the Circles of Fear, Sainsbury Centre for Mental Health.
AT:- The government’s response to the inquiry into the death of David Bennett, published last week, has been criticised by campaigners as failing to recognise the inquiry’s recommendation for recognition at a ministerial level that mental health services are institutionally racist. Do you think that this recognition is needed?
EF:- The original definition of ‘institutional racism’ was provided in 1968 by Stokely Carmichael who said: “When white terrorists bomb a black church and kill five black children, that is an act of individual racism… But when in the same city, Birmingham, Alabama, five hundred black babies die each year because of the lack of proper food, shelter and medical facilities…that is a function of institutional racism”.
It is unlikely that any government will ever accept this definition for obvious political reasons.
However, what is really important is that the present government has acknowledged that there is something seriously wrong with UK mental health services and that radical reform is required.
The response also fails to recognise the inquiry’s recommendation for no patient to be restrained in the prone position for longer than three minutes. What are your feelings on this?
The government has side-stepped one of the most important recommendations of the inquiry by hiding behind the review by the National Institute for Clinical Excellence. There is no practical reason why the government could not have provided leadership on this issue by making it clear that the present lack of guidance is unacceptable. Extensive evidence was presented to the inquiry to confirm the dangers of prone restraint. Therefore it is unacceptable that the government has not taken a position on an issue that is of paramount important to patient safety.
Do you think the measures outlined by the government in its response to achieve a “more culturally capable” workforce in NHS mental health services are enough?
It is not clear what the government means by a ‘culturally capable workforce’. We hope that this is not a reference to cultural awareness training, which has demonstrably failed to tackle issues of racism and discrimination in professional practice.
According to our research (Breaking the Circles of Fear, 2002) practitioners are all too aware of the cultural difference of their patients – manifested as fear. What is required is for managers to pay attention to discriminatory practice in key areas such as risk assessment, diagnosis and treatment options.
The inquiry recommended the appointment of a national director for mental health and ethnicity. Is the appointment of Professor Kamlesh Patel to lead the Department of Health’s programme of action and to chair its BME mental health programme board enough?
We welcome the appointment of both Professor Patel as National Director of the DH BME Programme and also Surinder Sharma as National Director for Equality and Human Rights in the NHS. However these posts should not detract attention on the need for mainstream leadership at the political level and also within the NHS, nationally and locally, to achieve the sort of change promised by the government in its recently published ‘Delivering Race Equality in Mental Health Care’.
‘Delivering Race Equality in Mental Health Care,’ – the government’s action plan on improving mental health services for ethnic minorities by 2010 published to coincide with the response – does not contain clear targets. How do you feel about this omission?
The absence of targets is the most serious failing of ‘Delivering Race Equality in Mental Health Care’. This policy document sets out a number of ambitious aspirations such as reducing admissions under the Mental Health Act, diagnosis of schizophrenia and untoward deaths in mental health care settings. It is difficult to see how the local NHS Trusts can assess their performance in these areas without clear and measurable targets. The absence of targets calls into question both the feasibility and the sincerity of the government’s five-year action plan.
Is 2010 a realistic target date for achieving this?
It is highly unlikely that any government can achieve such enormous changes within such a short time-scale, especially where the complex multi-agency nature of the problem has not been grasped – as in this case. To achieve the Five Year Plan would require a concerted effort by a number of departments and agencies in the health, social services, criminal justice and educational fields – and with a political and financial commitment far in excess of what we have seen so far.