Institutional racism in mental health services : the consequences of compromised conceptualisation

Inequalities in mental health service use and outcome in the British NHS have been attributed to institutional racism. Institutional racism is widely understood in terms of the definition published in the Macpherson report, despite critique of its inability to differentiate the role of individual and institution in discrimination, and weakness in distinguishing racism from other forms of discrimination. The inquiry into David Bennett's death declared the NHS to be institutionally racist, and, although still contested, this has been widely accepted. Poor conceptualisation and the endemic failure to demonstrate how institutional racism leads to iniquitous outcomes can be seen in recommendations to tackle it through individual education. Policy based on a compromised conceptualisation of institutional racism is unlikely to reduce racialised inequalities and, in the face of progress for ethnic minorities else-where, may lead to the conclusion that discrimination is no longer a problem. In the light of recent shifts in what is implied by institutional racism, suggestions for research towards a re-conceptualisation are made

As Little Regard in Life as in Death: A Critical Analysis of Subjugation and Accountability Following Deaths in Psychiatric Detention

This article draws on insights from doctoral research into deaths in psychiatric detention in England and Wales. As the article demonstrates, the response to patients in death has often been reflective of the response to them in life, both historically and contemporarily. Furthermore, the families and friends of patients and those who raised concerns have also been treated in a similar manner to patients themselves. Some of the key areas explored in the article are the exercise of power over patients and their advocates by the medical profession and other official bodies, including the oppression, categorization, and dismissal that they have faced. The contestations and challenges of this power will also be explored and how dominant voices have been challenged through the emergence of alternative truths. Post-death procedures will also be critically examined, primarily the inquest and investigation processes, with a focus on issues surrounding the secrecy and lack of accountability apparent

The importance of relationships in mental health care: A qualitative study of service users' experiences of psychiatric hospital admission in the UK

<p>Abstract</p> <p>Background</p> <p>While a number of studies have looked at life on service users' experiences of life on psychiatric wards, no research exists that have approached these experiences from the user perspective since the introduction of community care.</p> <p>Methods</p> <p>This user-led study uses a participatory approach to develop an understanding of the processes and themes which define the user experience of hospitalisation. Nineteen service users who had all had inpatient stays in psychiatric hospitals in London were interviewed in the community.</p> <p>Results</p> <p>Relationships formed the core of service users' experiences. Three further codes, treatment, freedom and environment defined the role of hospital and its physical aspects. Themes of communication, safety, trust, coercion, and cultural competency contributed to the concept of relationships.</p> <p>Conclusion</p> <p>Relationships with an individual which comprised effective communication, cultural sensitivity, and the absence of coercion resulted in that person being attributed with a sense of trust. This resulted in the patient experiencing the hospital as a place of safety in terms of risk from other patients and staff. Barriers to positive relationships included ineffective and negative communication, a lack of trust, a lack of safety in terms of staff as ineffective in preventing violence, and as perpetrators themselves, and the use of coercion by staff. This unique perspective both acts as a source of triangulation with previous studies and highlights the importance of the therapeutic relationship in providing a safe and therapeutic milieu for the treatment of people with acute mental health problems.</p