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Posing for photographs is not something that comes naturally to Errol Francis, despite being a photographer himself. He's shy and doesn't relish the media spotlight.

"I do it because I really want to make a difference and it works, but I'd much rather be behind the scenes," he confesses.

Away from his part-time role as joint manager of the Sainsbury Centre for Mental Health's work on African and Caribbean mental health, Francis works as an artist, photographing architecture and landscape. To the untrained eye the two fields may seem a world apart, but Francis disagrees.


"There are many parallels with mental health work. We're dealing with identity and cultural meaning and I don't think mental health workers are very good at dealing with that. The art world is a bit better at dealing with those issues," he says.

It may come as little surprise, then, that art, not mental health, was his first interest. After leaving school Jamaican-born Francis studied architecture, but his college lost its grant status and he had to make alternative career plans.

By his own reckoning he was "already someone who was very concerned with social issues".

"I was conscious of how debilitating psychological stereotypes are and you don't have to be talking about mental illness. It's such a key part of understanding race and culture," he says.

"I was trying to understand the role that medical knowledge has played in black people's lives and I was interested in it from a different point of view. As a gay man I was interested in how medical knowledge pathologises one. Mental health was a kind of extension of that concern with sexuality and identity," he adds.

So, in the early 1980s, Francis started working in a community group for African Caribbeans with mental health problems, and stayed for 10 years. After studying criminology and social policy, he managed services for mental health charity Mind before moving to Birmingham in 1996. There he set up the Frantz Fanon Centre, an NHS service for African Caribbeans with mental health needs "who are not getting what they should from the rest of the statutory service". He left his job as director last year, but still holds a part-time role as artist in residence.

Given his years of experience it is understandable that Francis has developed clear, if damning, thoughts on the "negative stereotyping" that afflicts ethnic minorities in mental health services. He says assumptions that people are dangerous and more ill than they are has led to overuse of legislation and secure settings.

"Once people are in hospital there's a preference for more coercive types of treatment such as medication and ECT rather than psychotherapy and counselling. And they are more likely to die in hospital as a result of control and restraint and less likely to recover from the experience of being in hospital," he says.

Simply, his view is that being in hospital is a worse experience than the illness itself. He says patients worry they may die as a result of their contact with mental health services - that the people involved in the services will kill them. They also fear being the subject of experiments, and Francis says he can understand why it is not just the patients, but also their parents, who think this.

"They see their loved one dribbling and suffering from gross side-effects and see other patients who don't appear to be so drugged up and they conclude that the only reason for this is some kind of experiment. When you look at these fears of the patient and the parent I'm afraid they have been substantiated."

Only time will tell whether the events last month surrounding former boxer Frank Bruno will have any long-term effects on society's perception of mental illness. Public outrage forced The Sun to change its first-edition headline of "Bonkers Bruno locked up", but Francis sees this as an isolated case and holds no illusion that attitudes will have changed for good. And he does not consider the overall impression as positive.

"In the end the enduring image is of a wealthy black guy who has lost it. That's a negative image. It's an image that really affects the internal world of all black people. You see this and think it doesn't matter who you are - if you're black that means you're at this sort of risk," he says.


Francis points out that Bruno's wealth was unable to prevent him following an ordinary black man's route into mental health services, particularly given the reported use of the Mental Health Act 1983. "It does seem to be that if you're black, the type of pathway you take into hospital and the sort of treatment you get there is going to be markedly different. With the rest of the population they contact services earlier. They're more likely to contact their GP and have it dealt with at GP level."

But these days, few mental health professionals will have escaped some sort of cultural awareness training. Surely this has made a difference? Not so, Francis explains: "The proof of the pudding should be in the admission rates and levels of diagnosis and they are getting worse, so it can't be having an effect."

All it has done is drive racism underground, he says. "In-your-face racism" has gone but its substitute is little better. "What we will hear doctors say now more readily in public is things like 'there is something in the development of black men that predisposes them to serious mental illness'. They are not saying anything crude and racist that's obvious, but they are still saying there's something different about black people."

He believes specific training is only worth doing where a workplace issue, such as the way schizophrenia is diagnosed, is analysed and then monitored for change. "Yet we're still doing cultural awareness training that teaches people what rastas eat or what public holidays Asians have - stupid cultural tourism."

How to manage violence in mental health settings has been debated in recent months during the inquiry into the case of David Bennett, an African Caribbean patient who died after being restrained in a psychiatric clinic.

A report is expected this side of Christmas, and Francis is clear what his top recommendation would be. He proposes a system for violent incidents that is comparable to that in the airline industry for near misses. This, he says, would help staff to understand what leads up to a violent incident and the part they, as well as the patient, play. In his view "every violent incident is a near miss, a near tragedy", but he believes violence could be prevented through behavioural strategies, blatantly preferable to the physical strategies currently relied on.

Despite the cynics, Francis believes that the government is taking action on improving mental health provision for ethnic minorities but emphasises that, unless the plans are taken further, they risk being tokenistic. He believes a systems change is required and would support setting performance standards from the centre.

"There's no justification for the number of admissions under the Mental Health Act and no justification for the coercive treatment people get and the levels of deaths in hospital. We know it's about pathways and systems. We've been studying it for 40 years."

But Francis himself may not be studying it for much longer. Currently a fine art MA student, he makes no secret of his future artistic plans. "I feel more accepted as an artist whereas in the mental health world I'm so conscious of the fact that I'm only working in a field to do with black people. I feel that I'm limited from doing any other kind of work because people think my only expertise is working with other black people. One of the reasons I've gone back to doing art is because I feel that it's my choice if I do a picture that is to do with race."

If his thoughts about doing an art-related PhD materialise, Francis plans to leave his mental health work behind. It's impossible to disagree with him when he says that this may be easier said than done.