NSUN Values-based Commissioning - Culture, Race
and Ethnicity in Commissioning for Mental Health
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To reflect on the origins of racism, prejudice and stigma.
To understand the social determinants that make people from BME
communities more vulnerable to poor mental health - racism, stigma,
discrimination, interpersonal violence, conflict
To understand the inequalities experienced due to structural discrimination
and how it translates into coercion, control and restraint in practice
To introduce the principles of ‘values based practice’ and ‘values based
commissioning’ and devise the cultural competencies and actions
commissioners can take to eradicate structural discrimination of BME
people.
To explore baseline involvement standards and how they can be put into
practice
(National Involvement Partnership’s 4pi standards – Principles, Purpose,
Presence, Process, Impact and DTOOT’s).
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Learning outcomes
• Participants will:
• be confident in their ability to describe and identify ethnic
inequalities in the mental health system
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• have a thorough working knowledge of ethnic
inequalities with a thorough understanding of systemic
and structural discrimination
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• be able to prescribe commissioning action to address
inequality and racism
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The historical eye and race as a
perception
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Reflections on the origins
Euro-centric
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Kant
Wittgenstein
Darwin
Eugenics
IQ
Mental health Body
reader
• Exploitation
• Legacy of Slavery
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AFRO-CENTRIC
• Fanon Mask
• Dubois Veil
• Welsing Symbol
• Rodney
• Europe underdeveloped
Africa
• Self-determination
• Person centred
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The Social determinants
• "If any one or more of them, at
any time, are inclined to raise
their heads to level with their
master or overseer, humanity
and their own good requires
that they should be punished
until they fall into that
submissive state which was
intended for them to occupy.
They have only to be kept in
that state, and treated like
children to prevent and cure
them from running away."
Cartwright (1851p:)
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Historical values
Cultural schizophrenia
Bowlby
International
Detachment
Slavery
Freud
Black penis envy
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The madness of the
European
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Whiteness as a
Psychotic illness
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THE EXPERIENCES
Failed 11+
Gemini
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Schizophrenic
Experienced
abuse
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Assessed
Educational
subnormal
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Structural discrimination
• Six times more likely to
be excluded from school.
• Three times more likely to
be given a custodian
sentence.
• Ten times more likely to
have a mental illness
• More likely to be
diagnosed with
schizophrenia
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Structural discrimination.
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Failure of the legislation
1983/2007 Mental Health Act
1990 Community Care Act
2014 Care Act
1998 Human Rights
Legislation
2000 Race Relation Act
2010 Equality Act
DSM 5 ICD 10
Modern Slavery Act (2014
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The missed (diagnosis)
Meeting the white specification of madness
• Reading their words
• Writing their words
• Educationally
subnormal
• Dyslexic
• Madness specification • Manic Depression
• Schizophrenic
• DMS
• Treatment
specification
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• ECT. Medication.
Locked up
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Survival V Selling out
Personal and Professional
• From maudsley to College, from O levels to A
levels and qualifying as a Approved social
worker.
• Trading the black body for European accolade,
working along side the enemy of your own
misdiagnosis.
• Managing the new slave trade of mental illness
in your own community.
• Moving over to other side, decoding whiteness
as mental disorder, GP/Consultants/
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Values. They diagnosed me a schizophrenic when
I was really a Gemini
• The night shift of mental
disorder.
• The day care and the
voluntary sector.
• The plantation field of
higher education, from
MA – PHD – NOTHING.
• Writing and reflections,
breaking down and
breaking down.
• Teaching re-emergence
of radical community
based social work.
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Researching the other side
Body dysmorphic disorder
• Re-conceiving the Europe
centric.
• The role of black theorist.
• Challenging research as
social process of
whiteness, Goffman.
• Changing the models.
• Challenging needs and
service approach to race
and racism.
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Well-being
WORLD HEALTH ORGANISATION
BAME – No reference
Definition.
• State of well-being in
which every individual
realises his or her
own potential. Can
cope with normal
stresses of life, can
work productively and
fruitfully, and is able
to make a contribution
to her or his
community.
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03/07/2014
3/19/2016
mental
and
PFA Racism,
Mental Health
Slides.health
BACA Copyright
PFA Mental Health Slides
services
2014
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Baseline Practice
• Goffman (1961)
• Littlewood and Lipsedge (1981)
• Small (1994) Racialised barriers – Housing –Education –
Social Welfare - Politics
• Richie Report (1994) Christopher Clunis
• Fernado (2010) Criminal Justice and Mental health.
• Fernando (2010) Survey in schizophrenia
• Lambeth, (2014) Black report
• Mental Health Foundation (2001)
• Mental Health Foundation (2008)
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Implications
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Dancing to Our Tunes: Reassessing BME Mental Health Service
User Involvement - by NSUN consultant Jayasree Kalathil published
in 2012 and reprinted in 2013
Ethnic Inequalities in Mental Health: Promoting Lasting Positive
Change - a consultation with Black and Minority Ethnic Mental
Health Service Users - by NSUN for the Lankelly Chase Foundation
- published in 2014
JCP guidance: Commissioning Mental Health Services for BME
Communities - published in 2014
4PI: Mental Health Involvement Standards - 4PI: Principles,
Purpose, Presence, Process, Impact: the standards defined by
NSUN and the National Involvement Partnership (NIP) – 2012 2015
Evidence and Ethnicity in Commissioning 2014
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Values in our practice
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3/19/2016
mental
and
PFA Racism,
Mental Health
Slides.health
BACA Copyright
PFA Mental Health Slides
services
2014
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Challenge for Commission
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Researching our past.
Rewriting the past.
Educating whiteness.
New models, new
assessments.
• The political challenges of
looking at Mental health
services and
commissioning.
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