A light in the dark room

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

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

“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

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