Devolution means “you take the decision”, not me

I’ve been a bit slow to understand but now I realise what you mean, Sir Albert, by devolution. Birmingham is considered a bit big for an authority and could be split into smaller units. We’ve trying that for some years to work in districts, although the even more local ward committees have been criticised as “not being fit for purpose”.

Albert Bore has been around a long time now. Earlier he was seen as “bag carrier” for Sir Richard (Dick) Knowles. He was always democratic mostly when it was forced on him. So I wrote and told him how much I was pleased with his wish to devolve power to local areas based on constituencies and wards. The problem I told him was that we were given responsibility, but there were no resources to do anything. Yes we could take decisions, but the only decision to be made was to make cuts by closing or transferring assets, for example. Now my area of Handsworth Wood is virtually an asset-free area. What is left to govern?

A local family bought Hawthorn House, formerly housing a local library, community facilities and council offices. A children’s play area has been reinstated after the family objected to it, having acquired the house fully knowing it was planned to do this.

Laurel Road Sports Centre, rebuilt after a fire had gutted the former wooden structure, was put up for tender to transfer the assets to a new owner. The site had been much improved after the involvement of Sports England, but it never regained the feeling of local ownership it previously enjoyed. The popular protest failed after assets were passed to a local church group. In other words its long term future is far from guaranteed.

Camp Lane held a training centre, graced with a picture of Prince Charles in honour of a visit, and, yes, a plaque with the name of Sir Albert Bore from when it was opened, or re-opened after a period of closure. Considerable sums of Council (our) money was pumped in to improve social facilities. It could prove a major asset and funding source to a private owner for functions. Local power devolved. We weren’t asked or involved in deciding its future.

Local schools have become academies, another term for asset transfer. Again public money used to enhance our schools with considerable building schemes for sports centres etc. has been handed over for private gain.

Albert Bore has declared that it is the end of local government as we know it. It is essentially a loss of voice of people who formerly controlled local government. Evidently one or two councillors are voicing their concerns but it is muted by their temerity and dissuasion by those in Labour who still won’t rock the boat.

Contrast Birmingham in 1972 when Labour Party leaders like Moira Symons led in supporting miners’ industrial action with 30,000 Birmingham Trades Unionists marching on Saltley Gate. Their actions led to the end of a former corrupt Tory administration under Heath.

The Amazing Tory/LibDem High Wire Act

Truly amazing. The Tory LibDem Government are performing a spectacular high wire act, a look folks, no safety net! No this is not a remote country without resources, it is a well shod wealthy land where more and more are denied resources to feed, heat, house or clothe themselves by an overfed, self-satisfied elite. David Cameron, George Osborne, aided and abetted by Nick Clegg have, like so many in power, drawn up the ladder they climbed by taking away our essential services. They can well afford to do without the state assistance they revile labelling those affected scroungers and criminals. Their own tax dodging mates are heroes, now getting the occasional slap on the wrist to tell them not to be so naughty in future.

HSBC. What has it done wrong? Is it illegal? Well…er? Is it moral? Moral or not the Tory Party are cashing in big time.

The Labour Party are taking the opportunity to ask questions, but they too are a party of Capitalism, so how far can they go?

There was an old man called Michael…..

“There was an old man called Michael Finnagen, he grew whiskers on his chinnagen, the wind came up and blew them inagen. Poor old Michael Finnagen. Beginagen.”

Education (and other) policies seem an eternal “beginagen” routines when it is announced that “children must learn literacy and numeracy”. The obvious question is why there such large numbers who haven’t achieved after years of schooling when those like Michael Gove and Michael Wilshaw, self appointed know-it-alls, have been left in charge. Now Nicky Morgan, supposedly Gove’s successor, wants kids to know the 12 times table, it is reported. Why the 12 time table? Are we about to go back to pounds, shillings and pence?

How is it that education is equated with rote learning of specific items, apparently picked out of the air by those with no educational training. Of course this has nothing to do with education, it’s just another panic measure trotted out after another spate of bad publicity. Supposedly it is to tell the Sun and Daily Mail reader that what they are thought to regard as education is also a concern to, in this case, the Tories. (Since a number of the guys have been “educated” at Eton just what are they talking about? What exactly is it they think that the masses need?

It doesn’t look like something to do with being able to think for themselves. (Is that what Eton et al are about?) The problem is that whenever someone else takes over education we seem to go back to the beginning or basics so nothing seemingly progresses. “Education” starts earlier and earlier in the UK – whereas elsewhere in the developed world children might start formal learning at 7. When, they ask, will children learn to play? In Britain play isn’t popularly seen to be learning. Stress laden classes must begin as soon as possible after leaving the womb. Counterproductive? Well the experiments with the private sector leading hasn’t been exactly promising with academies and free schools showing no advance over state run schools. In process accountability has been lost and this year even the league tables have fallen apart so no one has a clue how schools are performing, even in the narrow world the UK education is being made by the ignorant and privatisation-driven political elite.

Fracking serious

While Lancashire councillors dither about allowing fracking exploration to continue, residents of Oklahoma worry about earthquakes occurring daily in an area where the oil/shale gas companies have had their evil way.

The Lancashire Councillors it seems have no principled objection to fracking, they just fiddle round the edges objecting to noise and nuisance. The environmental harm and consequential health hazards apparent to their constituents don’t appear to be on their radar.

In the US today’s report of what is happening in Okaloma is a repeat of what happened in Ohio. Lancashire has already experienced them, but the fracking industry, while not denying their existence, likens them to a lorry rumbling past your house at the very worst. Who do you believe and trust when so much is at stake, with governments supporting the massively powerful corporations to the hilt?

North Dakota faced another problem, this time not an earthquake but a waste water spill. Interesting to know how this is contained but more importantly how leaks occur. All this is minimised and glossed over but not just by the corporations themselves, but by the politicians who get into bed with them. They should be representing us since we voted for them. The Corporations don’t and are totally unaccountable unless you’re a shareholder, that is. In that case you want bigger and better wars, food that makes you ill so you can sell medicines, and fracking until the world has an orgasm.

Don’t vote. Won’t vote? In Greece they will and are going to it seems

There’s a view, a concern that young people don’t vote or won’t vote. They will if there’s a good reason to. Conversely they won’t if there’s no reason not to. That’s why I’m looking at Greece today with a party described as “left wing” favourite to win because it has captured young people’s enthusiasm. “Austerity” the curse placed on the World, Europe and Greece in particular is being challenged. The Greeks have with Syriza a young candidate (as Greek leaders go) at 40 and there seems a point in going to the polls.

Last year hope was raised when Syriza performed well in the European elections. Anti-austerity demonstrations were fuelled in other European countries hit hard by the imposition placed on them because the ruling elite, recently seen in Davos, says it must be so. They have messed everything up with their Capitalist projects, and they want a cuddly friendly capitalism to sort things out. If that’s what the Greek ruling party thinks is possible, today may be the day when they’re told it’s not. Enough is enough.

Back in Germany the attitude to Greece articulated by a leading member of Angela Merkel’s party says why the Greek people need to exercise their independence.

Frankenstein’s monster created by global elite

The monster that is Capitalism is frightening the global elite involved in the consequences of their own making. Just like Frankenstein it is rampaging out of control. If you’re asset rich you just can’t help making more and more money while at the other end of the spectrum no cash means no food on the table, no heat and probably no roof over your head. The consequences of inequality can come back on you if you leave it spiralling out of control.

The lengths that the ruling elite will go to is illustrated with the passing of King Abdullah of Saudi Arabia. Scarcely distinguishable in its barbaric practices from arch enemy ISIS (funded like other excoriated groups including Al Quaeda from Saudi sources) flags on official building are at half mast while leaders and royals are dispatched to Riyadh to cry crocodile tears.

Meanwhile back in Davos issues of earth shaking importance are announced. Prince Andrew has made his first public statement on allegations of sexual impropriety. Talk of global warming, international aid is all put into sharp perspective. This is all about 1% of the world’s population defining what the rest of us are supposed to be concerned about. Reality recedes.

Interestingly Christine Lagarde has been making references to Marx including “Capitalism sowing the seeds of its own destruction”. The idea of “inclusive Capitalism”, as with “cuddly Capitalism” and other ideas which bring to mind the idea of throwing scraps to dogs, is invoked. Capitalism by its nature is the absolute antithesis of such descriptions. Clearly others in attendance at Davos are bored out of their minds when such ideas are raised.

In Europe the Marxist response looks most likely to emerge in Greece at tomorrow’s election. Scaremongering has been rife, but as the report by Paul Mason on the state of the parties there shows, anyone tainted with “Austerity” is likely to be summarily dismissed by many making Syriza the favourite. The left are starved of political oxygen, very clearly in the UK, where the crackpots of UKIP are chased around by the media while Socialism remains an unmentionable word.

Latin American countries have developed economic and political alliances which have offered alternatives to the powerful nations in the north of the continent who continue to threat and destabilise where they can. Pressure has mounted against Venezuela following the death of Chavez, so the question is asked who will support them from going the way of Allende’s Chile? Once again it is necessary to go to alternative sources of information to get a picture.

Free speech or responsibility

The shooting of people in Paris brought about a swift reaction of revulsion, horror and disbelief. The immediate response was to want to act in a display of solidarity with all who shared such feelings that this must end. Having seen the line up of those who gathered in Paris to do just that feelings of revulsion, horror and disbelief returned as my mind cleared so that I could see just what I was supporting.

Benyamin Netanyahu has been prominent in Paris, then Jerusalem – or was it the other way round? So confusing are image upon image of the self-righteous making political capital out of this event. He claimed he had to be there because the Palestinian leader would be present. While other leaders from Western Europe have shown concern that this will fuel Islamaphoebia, their role in promoting endless wars in Islamic countries while funding Israel in some way or the other is overlooked. A massive coup for a man who hates free speech as much as anyone when it comes to his own State, and who has made it look as if he has regained his status as untouchable for whatever he says or does, particularly with regard to Palestinian people.

France was responsible for providing the highly secret nuclear reactor, maskerading as a textile factory until Mordechai Vanunu clarified its purpose back in 1986 in an article published by the Sunday Times in the UK. He remains under close supervision in Israel after serving years in prison, much in solitary confinement, for his expose providing a service to mankind. More recently Germany gifted 5 nuclear submarines to Israel capable of holding and firing nuclear missiles. There are reports that NATO have brought this frightful weaponry into commission. Israel therefore has the capacity to threaten anyone anywhere with the blessing of all those participating in the Paris street theatre.For some reason Cameron appears to have missed out on this particular photo opportunity, although it was clear that the General Election in May 2015 might have had an effect on his attendance at a demonstration. No one remembers him taking part in one before.

All are jostling to speak out in the name of “free speech” for the right of Charlie Hebdo to publish pictures offensive to Islamic feeling not restricted to “extremist” views. It has done so once more as a further act of defiance in the name of press freedom. The big problem is that the “free” press does not publish large areas of truth for our benefit, rather it kowtows to powerful corporate interest which included the media, health, food, military interests etc. etc. Mordechai Vanunu told the truth in 1986. Those demonstrating in Paris are content to let him and other courageous whistle blowers rot in obscurity. Publishing pictures offensive to large sections of the population does nothing to serve the furtherance of “free speech” where it most matters to the wider population freeing them of corporate greed and exploitation. It does serve the interests of the corporate need to divide and rule.

“We’re not Charlie” Views of young Muslims in France. While Charlie Hebdo went ahead and published a new edition with a picture of Mohammad Muslims were placed in a position where many wanted to show revulsion at the violence but at the same time their dismay at disrespect for their feelings.

What MPs get paid for. Self interest it seems!

Scan

My good friend John Fryer sent me this and I’ve shared it widely. It seems as if those I’ve sent it to are doing the same! It’s unbelievable that the House of Commons is virtually empty when considering the issues for debate: war in Afghanistan, child sex abuse, knife crime prevention, drug laws, impact of welfare reforms on the sick and disabled, a living wage, recognition of Palestine (the nest attended of this group), tenancy reform and schooling for Syrian refugees. Yet when it comes to debating MPs’ pay and expenses there is overflow.

What then do we elect representatives to Parliament for? The question of leadership jumps into my mind. If it is effective then would you expect this to happen.

Perhaps Parliament practices and procedures are already set out so when the new member enters the place for the first time expectations of an outmoded tradition which has lasted hundreds of years takes them over. Dave Nellist spoke of his experience when he was offered directorships of companies for himself and family and friends maybe. We see the revolving door in operation, the lobbyists that one David Cameron, vowed to tackle. No Dave, you don’t change the system and those upholding it: they change you!!!

As far as involving Britain in wars MPs have come to understand they don’t have a role to play. It became abundantly clear after war in Iraq was put into motion that what anybody thought other than the “leadership” meant diddly squat.

Hansard gives detailed reports of debates. This one on child sex abuse took place on 27th November, 2014.

Improving access to appropriate mental health services for BME communities

Unit for a syllabus: Improving access to appropriate mental health services for BME communities

Year 3 Report of “If only we were told…” Project

Sikh Community & Youth Service (UK)
Information Advice & Gu
idance Centre
Serving All Communities
(Charity No. 518946)
75 Holyhead Road, Handsworth
Birmingham, B21 0LG, UK
Tel : 0044 (0)121-523-0147
Website : www.scysuk.info

Section 1

Year 3 of Project update 2013-2014

1.
1.1 Decision to provide a Unit resulted from discussions with staff of University Departments and Colleges offering courses in Mental Health say that syllabuses already exist for their purposes. Birmingham City University exemplify City and Guilds Level 3 Certificate in Community Mental Health (for people aged 18-65 years) (ref 3056-31). Earlier on in this Project a member of staff from the Metropolitan College, Birmingham, had indicated that they would find a Unit addressed to the issue of use to them.

1.2 Although there are existing syllabi addressing Community Mental Health knowledge and understanding of issues such as “cultural competence” are assumed. Evidence cited below shows that there is little coherence in the concept although ideas are emerging. On the other hand it is evident that inequalities persist in mental health provision. “No Health Without Mental Health” was the flagship of the coalition government’s approach when they claimed that mental health would be given parity of esteem with physical health. A recent report states that while mental health problems are set to exceed those of physical health adding that their effects are more debilitating and cost the economy huge sums many are getting no treatment.

“only a quarter of all those with mental illness are in treatment, compared with the vast majority of those with physical conditions. It is a real scandal that we have 6,000,000 people with depression or crippling anxiety conditions and 700,000 children withproblem behaviours, anxiety or depression. Yet three quarters of each group get no treatment. One main reason is clear: NHS commissioners have failed to commission properly the mental health services that NICE recommend. The purpose of this paper is to mend this injustice, by pressing for quite new priorities in commissioning. This might seem the worst possible moment to do this, but that is wrong……This is mainly because the costs of psychological therapy are low and recovery rates are high. A half of all patients with anxiety conditions will recover, mostly permanently, after ten sessions of treatment on average. And a half of those with depression will recover, with a much diminished risk of relapse. Doctors normally measure the effectiveness of a treatment by the number of people who have to be treated in order to achieve one successful outcome. For depression and anxiety the Number Needed to Treat is under 3. In the government’s Improving Access to Psychological Therapies programme, outcomes are measured more carefully than in most of the NHS, and success rates are much higher than with very many physical conditions.”

How Mental Illness loses out in the NHS, LSE pp1,2 2012.

1.3 The provision of IAPT needs to be coupled with the assurance that it will be available for all across language and culture so that practitioners are able to be culturally competent. An IAPT document spells out the principles but no guidance is given on how this is to be addressed practically.

1.4 This year there have been some key conferences addressing BME mental health.

1.4 (i) The Joint Commissioning Panel for Mental Health services for people from bme communities report was launched at the Botanical Gardens, Edgbaston, Birmingham. Launch attended.

1.4 (ii) Birmingham City Council put together a working party and produced a document: Mental Health: Working in Partnership with Criminal Justice Agencies. (Download). This provides a protocol where agencies work together to ensure that vulnerable people are taken to a place of safety rather than end up in a police cell. In the African Caribbean community individuals disproportionally end up receiving coercive treatment for mental health problems. Meetings attended and input made.

1.4 (iii) Birmingham and Solihull Mental Health Trust launched a project “300 Voices” aimed once again at African Caribbean men. This looks like a replay of actions taken following the David Bennett Report 10 years ago. Could it be that this is reinforcing stereotypical views by focussing on inedividuals rather than the agencies where there is lack of understanding leading to misdiagnoses. It may be that it is institutions and practitioners that need to change their practices. Meetings attended and input made.

1.5 My personal experience of applying cultural competence to cases is very disappointing given the high claims made. Staff appear to be tasked with severe budget reductions and have little time or inclination to get involved in furthering measures to combat inequality. Cultural competence appears to be a remote concept to many staff with much indifference and denial of need. This reflects the situation described in the Francis Report on Staffordshire Hospital and the Winterbourne View account of care practice.

Section 2

Rationale for the Unit

2.1 This additional separate Unit encompasses principles and actions governing other Units of a mental health syllabus. In this case reference is made to the City and Guilds (C & G) Certificate in Community Mental Health (for people aged 18 to 65 years) levels 2/3. The soundness of what is in the syllabus is not questioned, rather it is intended to add a dimension addressed at dealing with diversity which may well be implied but evidence shows cannot be taken as read.

2.2 The Philosophy underpinning the C & G syllabus states:
(6.3 Philosophy) “The content of the Certificate is underpinned by the philosophy that to provide effective mental health services, practitioners at all levels need to understand the service user’s perspective. They should respect diversity and deliver appropriate individualised responses to meet the needs of service users. Effective practice is centred on the user and recognises and values the experience and insight of the service user in respect of his or her own mental health. Workers should enable and empower service users to enhance the overall quality of their lives, and should promote partnerships that service users find helpful.”

2.3 Background. The David “Rocky” Bennett Report (2004) made findings and recommendations which were taken up by the Delivering Race Equality (DRE) agenda and the Count Me In annual statistics for much of the next decade. Inequality and injustice was to be given added weight and media coverage with the publication of the McPherson Report on Stephen Lawrence.

2.4 The effects of “Race” and “Racism” and on individuals are still hotly debated .Diverse views range from the denial that they have an effect to the belief that experiences are integral to the lives of individuals. As shown in the reports on Bennett and Lawrence they may have a profound effect on the individual’s mental health. Denial of such experiences by professionals lead to misdiagnoses. The incidence of schizophrenia diagnosed for African Caribbean men for example is 6 times higher in the UK than anywhere else, including Caribbean islands. David Bennett’s experience is just one example where the Report itself questions whether the “schizophrenia” was a medical condition he suffered from, or a either a misdiagnosis of a condition brought on by the use of Cannabis. It is clear that Bennett had to deal with racial abuse in the description of events leading to his death. He had deal with a level of provocation that could seriously affect anyone.

2.5 During the next 10 years there have been many repetitions of David Bennett’s experience when African Caribbean men have died in custody. Disturbingly there is little sign that his report had made an impact on those dealing with such cases. Regrettably deaths in custody and violence to individuals have continued since the Bennett Report. Deaths of Mikey Powell and Kingsley Burrell, both African Caribbean men, in Birmingham following police intervention have been followed by prolonged periods where families have been left in the dark about what happened, all reminiscent of Bennett’s death. There have been many other examples across the country. While Mikey was known to have a history of mental health problems before the highly inappropriate police involvement Kingsley Burrell did not until he was taken into custody at the Mary Seacole Centre in Winson Green and sectioned under the mental health act.

2.6 A characteristic of the decade following Bennett that the focus remains on the African Caribbean community. This has lead to the ignoring of trends in mental health in other communities, some of which may share similar experiences to the African Caribbean.The work of such authorities as Sashidharan, Bhui and Swaran Singh has shown that their are considerable anxieties in South Asian communities. The earlier SCYS “Talk to Us Project” showed that many others shared these anxieties and faced problems in accessing appropriate mental health services.

2.7 Misdiagnosis. The term “schizophrenia” is associated particularly with African Caribbean men. The question is raised in the Bennett report whether he was misdiagnosed as a result of stereotypical views held by clinicians. A report from the US asks questions. This is an experience shared by many in BME communities.

“Racialized experiences have long been linked with the mental health and illness of Black people (See Fanon, 1952; Grier & Cobbs, 1968; Pierce, 1970). At the same time, integration of non-White minorities into majority White populations (a common feature of multiracial societies) arguably results in an increase in racialized experiences, and exposure to White racism. Of particular interest is the case of the UK, a country where the integration and assimilation of the Black population is particularly intense. This paper considers the role of the UK racial situation in the very high rates of schizophrenia found in the UK African Caribbean population.
Schizophrenia is the most chronically disabling of all the major mental disorders and typically affects only one percent of any given population. However, there is a six- to eighteen-fold elevated rate of diagnosed schizophrenia in the UK African-Caribbean population compared to Whites (Hickling, 2005). Moreover, the Black incidence rate of schizophrenia is higher in the UK than anywhere else in the world (Cochrane & Sashidharan, 1996).
The issue of extremely high rates of schizophrenia in African-Caribbeans in the UK has been a topic of interest to British scholars since the 1960s. However, much of the British research has been criticized with regard to its preoccupation with biological explanations for this issue (See Sashidharan, 2001). Indeed, it is only recently that sociological factors have been given recognition with regard to the dynamics of ethnic schizophrenia in the UK (See Boydellet al., 2001, Mallett, Leff, Bhugra, Pang & Zhao, 2002; Whitley, Prince, McKenzie & Stewart, 2006). In 2001, Boydell et al. demonstrated that the incidence of schizophrenia in non-White ethnic minorities in London was higher when they constituted a smaller proportion of the local population, indicating that social factors were having an influence on the elevated rate of diagnosed schizophrenia. Additionally, in 2002, Mallett et al. found that the rates of schizophrenia among African-Caribbeans in London were significantly higher than those in Trinidad and Barbados, again suggesting that social factors played a key role in the Black incidence rate of schizophrenia. In a similar vein, Whitley et al. (2006) demonstrated that mental illness was greater among minorities in areas where they comprised a smaller proportion of the population.
While the above research studies indicate a willingness to consider how society may play a role in ethnic schizophrenia, there is a lack of discussion on how “racialized experiences” could be influencing the elevated rates of diagnosed schizophrenia. For example, while Mallet et al’s (2002) study draws attention to the importance of social factors in the high rates of schizophrenia in African-Caribbeans in the UK, there is little reference to African-Caribbeans as “racial minorities”, and the role that racism might play in the Black incidence rate of schizophrenia. While their research highlights the significance of “social disadvantage” as a cause of severe mental illness, Mallet et al. (2002) focus on issues such as unemployment, and on individuals who had been separated from one or both parents during childhood.
It is argued here that more attention needs to be given to the experience of African-Caribbeans as racial minorities with regard to this topic. As Jamaican scholar and psychiatrist, Frederick Hickling (2005) points out, the evidence regarding the Black incidence rate of schizophrenia is shifting in favor of factors of social alienation and racism experienced by Black people in the UK, and to misdiagnosis by White British psychiatrists. Hammack (2003) notes that an individual’s minority status represents an intrinsic stressor, and Bhugra & Ayonrinde (2001) draw attention to the idea that racism is likely to act as a chronic stressor, and that chronic racism may well precipitate psychiatric disorders. Moreover, it has been suggested that psychiatry as a discipline is inextricably linked with racism (See Littlewood & Lipsedge, 1982; Fernando, 1988; Sashidaran, 2001; Timimi, 2005); as such racial bias in psychiatric diagnosis might also be an important factor in the Black incidence rate of schizophrenia. For these reasons, racialized experiences (racial minority status stress, racism-induced stress, and racial bias in diagnosis) need to be seriously considered in the analysis of the elevated rate of diagnosed schizophrenia in the UK African-Caribbean population.”
Racializing Mental Illness: Understanding African-Caribbean Schizophrenia in the UK by Clare Xanthos, M.Sc., Ph.D., Senior Researcher National Center for Primary Care, Morehouse School of Medicine, Atlanta, Georgia. Abstract.

Consideration must be given to institutionally racist views and practices in psychiatry. The following article discusses this:

“Although the debate about race and psychiatry is as old as psychiatry itself, it is only in the past three decades that the psychiatric institutions and practices in this country have come under critical scrutiny for their racial bias. During this period, much has been written about the experience of Black and other ethnic minority groups within psychiatry and the tacit acknowledgement that there is a problem about race within British psychiatry appears to be shared by psychiatrists in general. There have also been many attempts in recent years to make mental health services more culturally aware and sensitive. How we provide better services for Black and other ethnic minority groups has become a service priority in many areas.
Despite the commitment by both professionals and managers to provide ethnically sensitive and culturally appropriate services the overall experience of psychiatric services by Black and South Asian people in this country remains largely negative and aversive. The disparity between ethnic minority groups and White people in service usage, service satisfaction and outcome persists with little to suggest that the situation is likely to change. In fact, there is no single aspect of contemporary psychiatric care within which Black or South Asian people are not disadvantaged.
One conclusion that we can draw from all this is that the various changes and innovations around ‘ethnically sensitive services’ have largely failed to address problems with race and psychiatry. Perhaps the practical emphasis placed on improving services for particular ethnic groups has distracted us from the more fundamental but also the more difficult task of addressing racism within psychiatry. In other words, until we begin to address racism within psychiatry, in its knowledge base, its historical and cultural roots and within its practices and procedures, we are unlikely to achieve significant progress in improving services for minority ethnic groups.”
Institutional racism in British psychiatry †S. P. Sashidharan, Professor of Community Psychiatry and Medical Director

2.8 Experiences of Asian and other BME communities. The virtually exclusive focus on mental illness on African Caribbean communities ignoring the experiences of other groups has led to increasing assertion that much need is
not being met. The “Talk to Us” Project met with representatives of many other communities each of whom spoke of problems being faced by them. Somalian and Bosnian communities included many who had experienced the trauma of wars and forced displacement. Others, including South Asians, said that what was being said about the African Caribbean community was recognisable to them, including access to appropriate mental health services. This was discussed in the second year report of the current Project “If only we were told…” (a comment made by Dr Joanna Bennett, sister of David, echoed by many since). See section 4.

2.9 The history of “cultural competence” in relation to health care is coupled with a patient-centred approach in a brief history of this in relation to health care in the US. While these aspects are also familiar in the UK it is more difficult to trace a coherent approach.

2.10 A model showing an iceberg, with matters commonly regarded as being the essence of “Cultural Competence” reveals the complex nature of the subject, with the hidden aspects affecting an individual’s understanding of life being subject to self-concept, position in family, values etc. These aspects cannot be captured within formulae since they will be particular to the individual concerned, although within a framework of the specific culture, within its traditions and histories. This has at first to be recognised if not immediately understood. Understanding can only be gained by interacting with the individual, their family and community. While here may be factors presenting problems, there are also traditional support networks existing in communities which could provide considerable help.

2.11 Kamaldeep Bhui and others examined courses promoting cultural competence in 2007 and only found few courses in North America that met their criteria. They were looking for courses which had been evaluated to show that outcomes were effective in improving competence. Bhui cites the report into the death of David “Rocky” Bennett (download) as a call for training in cultural competence for health workers, but outcomes for BME communities remain the same as before. While there appear to be many scattered attempts at making improvements funding crises have led to statutory care agencies failing to act while many voluntary organisations (some 40 documented in the earlier SCYS “Talk to Us” Project report in the West Midlands) have lost the capacity to help if not closed. This is spite of the current Government’s “No Health without Mental Health” document which recognises the persistence of serious inequality in appropriate service provision affecting BME communities.

2.12 While “Cultural Competence” is widely spoken of but in reality there is little coherence in course provision with little evidence of their effectiveness, although there are individuals in the UK who are trying to change this. At present it is necessary to look to North America for a more sustained approaches, although “Cultural Competence” courses are coming into favour in the world of business. When it comes to the imperative of profit rather than health there appears to be a greater enthusiasm to grasp principles. Is there something to learn from this?

2.13 Talking Therapies
Many people from BME communities have said that they have been unable to access key developments on mental health, including talking therapies such as Cognitive Behavioural Therapy. Governments have shown interest since early findings were that such therapies could be as effective as medication in appropriate cases. It was announced that Newham would be the place where developments would be trialled on giving access to BME communities. This was 2006-7. Newham’s current website gives information on their Talking Therapies services but it is not immediately apparent how accessible it continues to be in addressing equality. The one aspect which stand out as important in the ability to make self-referrals, a declared barrier in the past.
As with other treatments it is necessary for practitioners to be fully aware of cultural understandings relating not only to individuals but to families and community because of a key difference between nuclear and extended family practices and understanding. In the west it is usual for individuals to decide on action they take without necessarily referring to anyone else, whereas in Asian cultures, for example, actions are taken within the context of family and may impinge on relationships with a number of people, all of whom have beliefs and expectations. It is often assumed that those expectations may be negative and unhelpful, but it is wise to consider whether traditional support may be just what is needed by the individual concerned. In this respect agencies, families and communities need to work together.

A report on BME counselling in Devon is worth consulting as it appears to promote a considered approach.

2.14 What is on offer here is a unit considering factors which will act as a guide to ensuring that groups identified as receiving less favourable, or no treatment, can be directed to appropriate services that meet their needs and help their families and communities develop support networks in partnership with statutory bodies. Earlier reports “If only we were told” (Year 1) and “Cultural Competence” (Year 2) made links to many reports and articles relevant for students following this Unit. The two reports can be seen at the Project website with the warning that some of the links need updating where reports have been removed.

2.15 The Unit is modelled on City and Guilds Level 2/3 Certificate in Community Mental Health Care (for people aged 18-65 years).
Level 2:
Level 3:
The Unit however may be regarded as stand alone or be used with other courses for training, particularly with regard to Cultural Competence.

Section 3

Unit: improving access to appropriate mental health services for BME communities.
Level 2/3

Outcome 1 To consider how diversity in language, culture, ethnicity and experience vary individual and community’s concepts and understanding of mental illness.
The candidate will be able to
1. understand how the experiences of BME communities affect their lives and particularly how this can be a factor in mental illness
2. understand recommendations of key reports on those who have had poor experiences of living in Britain because of their “race” and ethnic origins eg David Bennett and Stephen Lawrence
3. consider their own beliefs and values regarding “race”. ethnicity and religion, recognising stereotypical views and ideas resulting from our colonial history
4. listen to the experiences of individuals from diverse background non-judgmentally.
Outcome 2 For providers to recognise the need for understanding the aspects of cultural competence essential for providing an appropriate service
The candidate will be able to
1. know with actions which followed for 10 years following the David Bennett Report in 2004
2. assess factors for failures to fundamentally alter the situation of intractable inequalities continuing after 10 years addressing the issues raised
3. understand the views and feelings of other members of BME communities and their ability to access appropriate and effective mental health services
4. understand what aspects of “cultural competence” need to be recognised and understood i.e. in the “iceberg model” is hidden factors which are crucial for consideration rather than superficial knowledge about different cultures

recognise why many from BME communities don’t come forward for help, or are unable to access appropriate services
Outcome 3 To assess how developing talking therapies such as CBT can be accessed by and delivered to people across languages and cultures.
The candidate will be able to
1. consider how effective talking therapies can be offered to those with different languages, cultures, religions etc.
2. take account of involving family members and communities in helping deliver support to individuals in need
3. examine cultural assumptions underlying such burgeoning remedies as Cognitive Behaviour Therapy (CBT) and be prepared to modify their approach
General outcome: The candidate will be able to apply principles appropriately throughout the syllabus. (City an Guilds Community Mental Health Certificate level 2/3)

A special thank and a big shout out for all the marvelous Christians of Gaza…

A MUST READ!!
10686909_1504973536425049_163441479559987167_n

A special thank and a big shout out for all the marvelous Christians of Gaza…

We all know about the previous summer aggression on Gaza and how many Treacherous countries stood beside it, utterly and completely supporting it, financially and emotionally.. We all know also about the traumatic harrowing scenes that all saw through the media during the sudden circumstances of that brutality. And we all know as well about the very first crisis that happened with the people of the boarders, especially in the east ( Al-Shojaeya, Al-Zaitoon, Khoza`a and the boarders of Rafah) Most of those people evacuated their properties as quick as they could before facing the death. They went, with their innocence, to the schools of the UN which they sheltered in to protect their families from the madness of the enemies. And many of the refugees, especially in Al– Shojaeya and Al- Zaitoon, left their homes and suburbs and went to the churches of the Christians. Perhaps some of you would wonder and say that the writer of this piece is mad or silly in saying something all know, but the truth is that I must mention how great the people of Gaza are and let the world know who we are.

A week ago, I made a short conversation with one of the refugees, who lives in my area, about his days during the war.

-“How were you feeling when you left your home with your family?”I began the conversation,
-“Well, First of all we all have to pray to our God to bless our great precious martyrs and to pour from his glorified Mercy on them. Then we pray to God to put a quick healing on our brave injuries and to make their families patient, Ameen. When I heard the tragic bombs and when my eyes saw the flying mutilated bodies in the skies, I decided with my family to leave my dangerous home to escape from the real death. Actually, we left it and went to a UN school, but it really was not a good place to stay in especially when you have young daughters like me. The school really was so crowded as a hell. As a result, I decided to leave that school…”

-“Ohhh, so tragic, well, when did you go eventually?
-“After leaving the school, I searched and searched for another place to stay, but I failed and my feet got exhausted. Eventually and after hours, I found a church called the church of the Patriarch Provius. I did not care about it and even I was not thinking of entering it as I knew that that place just would be for praying and preaching not for staying and sheltering. My wife asked me to enter it, but I was so hesitant. I thought that the warden would refuse and reject us due to the religious goals of that church. Well, I entered it anyway after a while and then really got shocked of what I saw. There were refugees inside that church with their entire families. So I found someone not to feel alone. The owners of that church welcomed us so hardly as though we were their special guests”

-“Mashallah, and what happened then?”
-“Then they gave us a special place to stay in and six mattresses and three bottles of water. We used to get three meals per day. The basic services were really acceptable and no one of the refugees complaint about anything. The owners of that church really dealt with us as special companions even if we are Muslims. Finally I got assured about my young daughters”

-“Where the vicars and the Christians praying inside that church and where did you use to pray?”
-“Believe or not, no one from the vicars or the prayers came every Monday. They refused to pray in order to let us rest well and feel free with our stricken families. They are really generous! We as Muslims were praying inside that church and used their water to have ablution. I was really feeling that that church was like my home and even better!!”

Those are the people of Gaza. We are humans and we love each other Muslims or Christians. We are two souls dwelling to each other to hoist the fluttering flag of our Palestine.

Mohammad S Arafat (Mr. Pen)