Tài liệu Mental Health in a Multi-ethnic Society A Multi-disciplinary Handbook docx

Mental Health in a Multi-ethnic Society

As services in the community continue to replace institution-based

care there is an increasing need for professionals from medical, social

work, clinical psychology, nursing and other backgrounds to address

the diverse needs of a multi-ethnic society using a common frame of

reference. Those who provide mental health services must now face

up to challenges from service users and strive for a closer, more

effective working relationship with voluntary organisations. Mental

Health in a Multi-ethnic Society: A Multi-disciplinary Handbook

addresses all these issues. It offers an approach to the meaning of

mental health and suggests constructive and imaginative ways of

providing care for people with mental health problems.

Contributions from a multi-ethnic team of professionals are

organised in three parts: ‘Current setting’ describes the background

to contemporary mental health services, the legal framework and

the role of the voluntary sector, and examines the experience of black

people. ‘Confronting issues’ considers practical problems in delivering

services to a multi-ethnic society and offers some innovative

approaches. The final part, ‘Seeking change’, draws together the

various issues in order to indicate a way forward, with suggestions

for change on both a practical and theoretical level.

Intended primarily as a handbook for practitioners working in

the mental health field, it is also suitable for multi-disciplinary

trainings, basic trainings and in-service postgraduate trainings in a

variety of professions including social work, psychology, psychiatry

and nursing.

Suman Fernando is a Senior Lecturer in Mental Health at the Tizard

Centre, University of Kent at Canterbury, and Honorary Consultant

Psychiatrist at Enfield Community Care Trust, Middlesex.

Mental Health in a

Multi-ethnic Society

A Multi-disciplinary Handbook

Edited by Suman Fernando

London and New York

First published 1995

by Routledge

11 New Fetter Lane, London EC4P 4EE

This edition published in the Taylor & Francis e-Library, 2006.

To purchase your own copy of this or any of Taylor & Francis or

Routledge’s collection of thousands of eBooks please go to

www.eBookstore.tandf.co.uk.

Simultaneously published in the USA and Canada

by Routledge

29 West 35th Street, New York, NY 10001

© 1995 Suman Fernando, the edited collection; individual

contributions © 1995 the contributors

All rights reserved. No part of this book may be reprinted

or reproduced or utilised in any form or by any electronic,

mechanical, or other means, now known or hereafter

invented, including photocopying and recording, or in any

information storage or retrieval system, without permission

in writing from the publishers.

British Library Cataloguing in Publication Data

A catalogue record for this book is available from the British

Library

Library of Congress Cataloging in Publication Data

A catalog record for this book is available from the Library

of Congress

ISBN 0-203-13459-1 Master e-book ISBN

ISBN 0-203-18559-5 (Adobe eReader Format)

ISBN 0-415-10536-6 (hbk)

ISBN 0-415-10537-4 (pbk)

To all those who meet racism or cultural

intolerance in the field of mental health.

Contents

List of illustrations x

Notes on contributors xi

Acknowledgements xiv

Introduction 1

Part I Current setting

1 Social realities and mental health 11

Suman Fernando

Psychiatric thinking in the context of culture and race 12

Recent history of service provision 18

Racism, multiculturalism and stereotypes 23

Models of mental health 30

Discrimination, diagnosis and ‘treatment’ 32

Summary 34

2 Professional interventions: therapy and care 36

Suman Fernando

Historical perspective 37

Treatment, self-help and need 44

Conclusions 49

3 Law and guidelines 50

William Bingley

The law and services 51

Protecting ‘vulnerable’ people 55

Compulsory admission and treatment 57

Conclusions 61

4 Sectioning: the black experience 62

Deryck Browne

viii Contents

Civil sections 63

Forensic sections 68

Discussion 71

5 Voluntary groups 73

Tanzeem Ahmed and Amanda Webb-Johnson

Background 74

Voluntary groups and mental health 75

Perceptions of users of services 76

Asian voluntary sector 78

Conclusions 83

Part II Confronting issues

6 Consulting and empowering Black mental health system

users 89

Mina Sassoon and Vivien Lindow

Introduction 90

Voices of the silenced: experiences of Black users 90

The validation of the user view 93

The emergence of a psychiatric system survivor movement 94

Relationship between Black service users and the mental

health service user movement 98

Black empowerment models 102

Black user projects 103

Conclusions 104

Some addresses 105

7 Training to promote race equality 107

Peter Ferns and Mita Madden

Defining race equality training 108

Context of race equality training 110

Race equality training programmes 112

Evaluation and follow up 115

Checklist for training courses 115

Implications of training for organisational development 117

Conclusions 119

8 Reaching out 120

Parimala Moodley

Counteracting racism 121

Outreach in the community 126

Contents ix

9 Interaction in women’s mental health and

neighbourhood development 139

Sue Holland

Four steps in social action psychotherapy 140

Emergent issues 142

Women’s Action for Mental Health (WAMH) 143

From ‘fringe’ to ‘mainstream’ 143

10 Culture and family therapy 148

Inga-Britt Krause and Ann C.Miller

Themes in cross-cultural therapy 150

A framework for ‘good enough’ cross-cultural

understanding 155

Cross-cultural practice: developing a community-based

service 156

Summary 170

Acknowledgements 170

Notes 171

11 Psychotherapy in the context of race and culture: an

inter-cultural therapeutic approach 172

Lennox Thomas

Race and culture in the consulting room 173

Case study 1 177

Case study 2 178

Experiences at Nafsiyat 179

Part III Seeking change

12 The way forward 193

Suman Fernando

A new meaning of mental health 196

A multi-systemic approach to assessment 199

Therapy: the interventions of professional workers 204

Understanding culture 205

Anti-racist measures 208

Needs assessment 209

Strategies for service provision 211

Conclusions 212

Further reading 215

References 217

Subject index 228

Name index 233

Illustrations

Figure 1.1 Culture of psychiatry 13

Figure 1.2 The psychiatric process 15

Figure 1.3 Ideals of mental health 18

Figure 1.4 Racial and cultural issues: British findings 34

Figure 2.1 Treatment/liberation East and West 44

Figure 7.1 Model for race equality training 107

Figure 7.2 The process and outcome of race equality

training 110

Figure 8.1 The patient and the institution 122

Figure 9.1 Theoretical positions in moving from personal

symptom to public action 141

Figure 10.1 A model for the development of a community

family counselling service 162

Figure 10.2 Different constructions of Salma’s behaviour 165

Figure 11.1 White therapist and Black child: initial position 188

Figure 11.2 White therapist and Black child: intermediate

position 189

Figure 11.3 White therapist and Black child: ultimate

position 190

Figure 12.1 Traditional psychiatric assessment 200

Figure 12.2 Relativist multi-systemic assessment 202

Contributors

Tanzeem Ahmed. Tanzeem is a psychologist with a background in

‘child guidance’ and research into cognitive development of children.

Currently, Tanzeem is the Director of Confederation of Indian

Organisations and she has managed three research projects in the

field of community mental health focusing on individual experiences

and voluntary organisations.

William Bingley. A lawyer by training, William was Legal Director

of the National Association for Mental Health (MIND) for six

years in the 1980s before becoming the Executive Secretary of

the working group that prepared the Mental Health Act Code of

Practice. In 1990, he was appointed the first Chief Executive of

the Mental Health Act Commission, a position which he still

holds.

Deryck Browne. Deryck is Policy Development Officer with the

National Association for the Care and Resettlement of Offenders

(NACRO). With a background of African-American studies and

forensic behavioural science, Deryck has researched the psychiatric

remand process as it affects black defendants and, more recently,

the impact of race on civil detention (‘sectioning’) under the Mental

Health Act 1983.

Suman Fernando. A consultant psychiatrist and former Mental

Health Act Commissioner, Suman is involved in consultancy, training

and research in the mental health field. He is Chair of the Board of

Directors of Nafsiyat (Inter-cultural Therapy Centre) and a member

of the Council of Management of MIND. Suman has written two

books, Race and Culture in Psychiatry (Routledge, 1988) and Mental

Health, Race and Culture (Macmillan/MIND, 1991).

xii Contributors

Peter Ferns. Peter is a qualified social worker with experience of

services for people with learning difficulties and of mental health

services. He has a wide experience of consultancy in both the

statutory and voluntary sectors, specialising in community care and

issues involving race. Peter has been involved in the training of

professionals in the mental health field for many years.

Sue Holland. Sue has pioneered ‘social action psychotherapy’ services

in working-class multi-racial London neighbourhoods for 20 years.

Currently, she is a consultant clinical psychologist with South

Buckinghamshire NHS Trust, working specifically with Black and

Asian minorities. Recently, Sue was given the newly established

Award for Challenging Inequality of Opportunity by the British

Psychological Society (BPS).

Inga-Britt Krause. Britt is a family therapist at the Marlborough

Family Service in London, and a tutor on the Diploma Course in

Inter-cultural Therapy at University College. With Ann Miller, she is

involved in the Asian Families Community Project based at the

Marlborough. Britt is an anthropologist who has worked in a Hindu

community in the Himalayas and with Punjabis settled in Britain.

Vivien Lindow. Vivien is an independent consultant, researcher and

writer in the field of user involvement in mental health services. She

is an active member of the psychiatric system survivor movement,

including ‘Survivors Speak Out’, and is involved in the training of

professionals working in the mental health field. Vivien is an elected

member of the Council of Management of MIND.

Mita Madden. Following extensive experience in social work,

Mita has been involved in training in the mental health field for

many years, with a special interest in anti-racist/discriminatory

practice and in user/carer empowerment issues. Currently, she is

Training Officer, Social Services Department, London Borough

of Harrow.

Ann C.Miller. Ann, a family therapist, is Principal Clinical

Psychologist at the Marlborough Family Service. With Britt Krause,

she is involved in the Asian Families Community Project based at

the Marlborough. She is director of the joint Malborough/University

College London Diploma in Family Therapy which has developed

teaching in relation to racism and culture. Ann also teaches at the

Institute of Family Therapy in London.

Contributors xiii

Parimala Moodley. In the 1980s Parimala set up a unique service in

Camberwell—the Maudsley Outreach Service Team (MOST), for

outreach work with (mainly) black clients with mental health

problems living in the community. She is now a consultant

psychiatrist in South London and also Chair of the Transcultural

Psychiatry Society (UK) and the Transcultural Interest Group within

the Royal College of Psychiatrists.

Mina Sassoon. Mina has extensive experience of working with user

groups and ethnic minority communities while working in the

voluntary sector, including local MIND Associations and Good

Practices in Mental Health (GPMH). Currently, she is Training

Officer in Mental Health and Ethnicity for North West London NHS

Trust.

Lennox Thomas. Lennox is the Clinical Director of Nafsiyat

(Intercultural Therapy Centre) and joint Course Director of the

Diploma in Intercultural Therapy at University College, London.

With a background in psychiatric social work and probation before

training in psychoanalytic psychotherapy, Lennox works as an

individual and family therapist with an interest in the psychological

development of the Black child.

Amanda Webb-Johnson. As a primary school teacher, Amanda had

an interest in multicultural and anti-racist education and spent a

year in India researching the education of children. Later, while

working at the Confederation of Indian Organisations, Amanda

carried out the research for the reports A Cry for Change

(Confederation of Indian Organisations, 1991) and Building on

Strengths (Confederation of Indian Organisations, 1993). Amanda

is a trained counsellor and also works at Voluntary Services

Overseas.

Acknowledgements

Although the views expressed in each chapter are those of the

author(s) concerned, they have been influenced by many colleagues

and friends in various organisations and settings, in particular the

Transcultural Psychiatry Society (UK); Survivors Speak Out; Nafsiyat

(Intercultural Therapy Centre); MIND; the Marlborough Family

Service; Good Practices in Mental Health; Clinical Psychology, Race

and Culture Special Interest Group of the British Psychological

Society and the confederation of Indian Organisations. In addition,

the editor acknowledges the encouragement and help of numerous

people in the field of mental health.

The extract from the video ‘From anger to action’ is published

with the permission of Mental Health Media. The extract from ‘Still

I rise’ in And Still I Rise by Maya Angelou copyright © 1978 by

Maya Angelou is reprinted by kind permission of the publishers,

Virago Press and Random House, New York. The extract from

‘Untitled’ in Survivors’ Poetry: From dark to light is reprinted by

kind permission of Premila Trivedi.