Matilda MacAttram is one of the leading figures addressing the issue of mental health within the African-Caribbean community. She is the founder and director of Black Mental Health UK (BMH UK.) Launched in August 2006, BMH UK campaigns to raise awareness about the inequality of mental health treatment provided to black communities. In her own words, MacAttram explains the nature of some of those inequalities and why people should get informed.
Belinda: What was the state of mental health for the African and afro-Caribbean community in the UK, before you started Black mental health in 2006?
Matilda: Well, the issue of the treatment of African Caribbean people who use the mental health services is a 30-year-old issue. The disparity in experience and outcome has been recorded and there have been policies and academics writing about it for 30 years. In 2006, the government introduced legislations to change the law and one of the reasons that Black Mental health came into existence is because even though there were many stake holders advocating for their interest groups like the Royal college of psychiatry and Royal college of nursing, there were carers groups and the big five charities in the mental health sector like SANE, Rethink, Mind and many players on the table, in fact, 75 organisations but there was not one single agency that was advocating and speaking out in this arena for African-Caribbean service users. Our concern was, when you go into in-patient wards or even in high secured settings, that’s all you will see. Yet, when it comes to the roundtable on policies and legislation, this same group are not just under-represented, we found that they were absent and that is why Black Mental health UK came to being.
Belinda: You website says your aim is to improve the black service user‘s experience and reduce the over representation of black people at the coercive end of psychiatric care. What are the statistics saying in regards to the over representation and how does that in turn affect the entire black British Population?
Matilda: The statistics at the moment, come from the agency called the Care Quality Commission and it produces census year on year, called the ‘Count Me In’ census and the latest data shows that people from the African-are 44 percent more likely to be sectioned than their white counterparts and to be sectioned is to be detained under the mental health act against your will. The stats shows that this group are 50 percent are more likely to be referred to the mental health services via the criminal justice system or via the police, which means, that when people from this community are presented to these services, it is not voluntarily. In fact, it is through force, an association of compulsion and an association of being criminalised. Once in the system, 29 percent are more likely to be restrained, placed in seclusion, and more likely to be misdiagnosed and over-medicated. The entire index shows that this group are more likely to have an adverse experience and poorer outcome and it is important to note that there is no evidence to show that this group has a higher prevalence of mental illness than any other ethnic group.
Belinda: What age groups of people, both men and women suffer the most due to this over-representation?
Matilda: The stats according to the ‘Count Me In’ census, shows that in the black community, the average age of an in-patient is between the age of 18 and 35. Hence, the most productive years, the years when you should be finishing your education, the years when you should be starting your career, the years when you should be getting married and having a family, the years in which you should be investing to ensure/assure for your future. Those are the years that black people are spending in medium and high psychiatric settings.
Belinda: What are some of the extreme cases you have witnessed or experienced/heard of since you embarked on your campaign in your fight for equal treatment for people from the black community?
Matilda: Well, one of the reasons Black Mental Health UK, exists is because the people who are responsible for founding it, came across a report called, the David Bennett Enquiry. The David Bennett Enquiry is a seminal document; this enquiry was an inquiry into the tragic death of an African Caribbean while in a medium secured psychiatric setting. He was 39 years old and he was in a secured ward and was allowed to go home. On the night of his death, a friday, he should have gone home but due to staff shortages, he was kept there. He was on the phone to a relative and dispute broke out, in which he was actually abused. In order to diffuse the situation, David Bennett was told that he would be moved to another ward and not the other patient and he lashed out. In the confusion, a team of five nurses for almost half an hour, and they only released him once they realised that he had stopped breathing. No attempt was made to resuscitate him. That was on the friday and on the monday, they informed the family that ‘oh, David, he had breathing difficulties,’ which technically was not untrue and then, they said, oh, we rushed him to hospital and then he died. One family member said my brother didn’t die of breathing difficulties; there was nothing wrong with him. It was three years later and at an inquest that they found out how he died. The reason the David Bennett inquiry is so important is because it typifies, it is not the exception but it typifies the African-Caribbean experience of mental health services. The pathology report shows he had three and half times the British National formula limit of medication in his blood stream.
Belinda: How is this imbalance affecting people from the black British community from the economic, personal and social aspects of life?
Matilda: Black Mental Health UK are of the opinion that the over-representation and adverse of outcomes of those who use the services is of critical importance, it is one of the most critical issues affecting Black Britain since we reached these shores. It is not only the experience but the numbers of people, the detention rates of black people under the mental health act, is at an historic high. It has never been higher in the history of our community. We see this as a critical issue that impacts on, not only the individual families but the whole of our community and it has impacted on our community in ways that cannot be quantified because of the stigma. What we are finding from the work we are doing is that the stigma keeps people silent. The stigma marginalises those who are affected. So, what happens is that not only service users but the family suffers in silence and the socio-economic impact of the failure of mental health services on black Britain, no research has been done on it but we think it is very grey. But we think the only way this can be addressed is for people to know that this is not an isolated thing but a corporate thing. And one of the things that we believe at Black Mental Health UK is that because it is a corporate issue, what we really need is a corporate response.
Belinda: What do you think are some of the reasons which contribute to these kinds of adverse treatments?
Matilda: Because there is no evidence to show that there is a higher prevalence of mental health illness within this group and I think the fact that there is so much evidence to show that this group gets poor outcome, if there was any evidence, they would have found it after 30 years. The conclusion of the David Bennett enquiry and its best to go on what the government report says – the conclusion of that report was that, institutional racism within the mental health services is what lead to David’s Bennett death, his suffering and his death and the institutional racism within the services determines how a person is perceived and treated by the system. And there is a perception and it came out from another report that was published a decade earlier, called the Big, Black and Dangerous Report. Now we are of the opinion, if these people are so dangerous, why is it, that they are the ones coming out dead?
Belinda: When you take the work you do into account and how the marginalisation affects the African Caribbean community, what would you say is the current state of the black British Community?
Matilda: The state of Black Britain is a hard question to answer because it is almost a nation within a nation. There are so many commendable things that have to ne applauded and celebrated about us being on these shores. There are so many achievements that have been made, like David Lammy, Michael Eboda for the third year running is producing the Power List and it shows all the black professionals, who are not only doing well but are doing exceptionally well regardless of race. For example, the head of prudential is a black guy, the people who are running the FTSE 100 or Baroness Scotland, who is doing well and 100 Black Men London, who are doing great things and transforming children’s lives. These are black professionals doing really well based on their own merit and they are sending their children to private schools and black businesses are thriving with the likes of Alex Amosu. I think given the uneven playing field, it is a huge achievement. But then, we have people who for no other reason, there may be the circumstance of their birth or their socio-economic background or just having an accident with the law, end up in a system that effectively means they can never fulfil destiny or their potential. They are caught up in a system, the mental health system that debilitates rather than help them to get well or you hear stories about the criminal justice system where an African-Caribbean male is 19 times more likely to be put in prison than his white counterpart even though this group have lower offending rate or you learn about the criminal DNA database which effectively criminalises every black family in Britain. So it’s a complex picture with no one word to describe it, where you see the aspects of success and stories of success and you also see a lot of areas where a lot of work needs to be done. I must say that the one place that has consistently tried to help and serve this community well, even when they have not been equipped to do so, is the black church. The black church serves this community well and because the leaders are not always totally informed about the latest social trends and issues, they are not equipped on every front but I don’t know of any other institution that has really helped this community. One thing I have noticed is that when the church is doing something positive, I have not seen it or heard it mentioned in the mainstream media.
Note: Matilda MacAttram was interviewed in April 2010 before the general election in May. To read full article, flow this link: UK Elections
