Faith, Community and Mental Health
Ahead of tonight’s lecture from Dr. Rasjid Skinner, Malik Gul reflects on the first lecture of the series…
What we know is that social factors have a huge impact on our health. In fact, ‘healthcare’ only plays about a 10% role in our health and well being. The greatest influences on us are our environment and behaviours and the lifestyle choices that we make. Yet, the ‘healthcare industry’, and its bio-medical model of health, remains the dominant lens through which health and well being is seen in the UK and much of the western world.
Professor Fernando has been a long standing advocate for transcultural psychiatry – which is concerned with the cultural context of mental disorders and the challenges of addressing ethnic diversity in psychiatric services. You would think, in a diverse and multicultural city like London, where within the next decade its BME communities will be its majority population, transcultural psychiatry would be major discourse within the professions. That it is not, and over the last 20 years its education and knowledge further extinguished from modern day mental health practice, speaks very loudly to what Professor Fernando has dubbed ‘ the whiteness of psychiatry’.
You can listen again and see his presentation on another part of our web site (http://wcen.co.uk/faith-community-mental-health-lectures/). One of his most powerful insights was the juxtaposition of historical events such as slavery and colonisation with the growth of psychiatry. Whilst the former specialised in the dehumanising and ‘othering’ of anyone who was not white and European, this informed the growth of a profession that labelled, incarcerated and also regularly degraded anyone who didn’t fit in with its constructs of what it is to be ‘normal’.
There exists hundreds of evidenced based authorities on transcultural mental health and its treatments; that they are not known and taught within the UK psychiatry profession, is a damming indictment of its failures, and a contributing factor to the inexorable rise in mental health conditions across the country and their disproportionate impact on people from BME communities.
A few days after I attended a talk on ‘Open Dialogue’, dubbed a ‘new approach to mental healthcare’ that ‘involves a consistent family/social network approach to care, in which the primary treatment is carried out through meetings involving the patient together with his or her family members and extended social network’
A number of community leaders at the event were not so taken with this approach, and talked about how many of them are already doing this type of systemic work, and others questioning why this is ‘new’! The room was dominated by ‘healthcare professionals’ and it was quite telling how most of them did not work in this way, and the questions that they were asking was how difficult it would be for them and their services to adapt and change to these methods. Some colleagues from our Communities Network for Family Care were present and noted how these conversations around care and support for vulnerable people were being framed through an ‘institutional lens’ and that, in fact, by the time anyone had got into ‘services’ , it was already too late.
I was reminded of a conversation which I had with a senior consultant in mental health a few years ago, when talking about ‘black mental health’, and referred to a few leaders in this field like Dr Joy Degruy and Dr Nai-im Akbar. He had not heard of them, nor anyone else outside the western bio medical tradition. And this person was leading a service where over 44% of its clients were from BME communities!
Tinkering with the edges of institutional models of health and well being is not going to tackle the multiple challenges that are at the doorstep of our public agencies. I was at a recent debate at the LSE called ‘We can look forward to a healthier future’ where Professor Richard Smith, a panel member in the discussions noted that 36 million prescriptions for anti depressants where written out last year, of which half had no benefit at all. Another panellist, the Chair of Council for the Royal College of General Practitioners (RCGP) Dr Helen Stopes-Lampard responded by saying ‘people come into us and we have do something’. That something seems to be trying to fix complex social challenges through medicaising the problems!
It seems to get clearer every day; the top-down , profession driven, institutional-centric models of public service are only going to continue to band-aid the rising tide of complex heath and social welfare challenges that we face. These systems do not possess the leadership or the capacity to provide the range of joined-up and integrated solutions that are needed across a genuine whole – system (and not just across the partial ‘whole system’ which they inhabit) These wider intelligences lie in the hands of the many, in the diverse and multicultural communities and social networks that we all belong too. It will only be by unlocking the capabilities that are held within these, will we be able to enable the better, smarter systems we need for today and tomorrow.”