Circle of Fear

I’ve been campaigning on the Mental Health Act for many years and one thing which never seems to change is the experience of Black people with mental health problems…

Let me take you back 20 years to the publication of Breaking the Circles of Fear by what was then known as the Sainsbury Centre for Mental Health. This sensible report set out ideas on how to break the “Circle of Fear” which describes how Black people – especially Black men – are alarmingly over-represented in the statistics of those subject to compulsion under the Mental Health Act and yet they are under-represented among those seeking help from community mental health services.

The reasons for this are complex but basically it goes something like this: the reluctance of Black people to seek help is because of historical (and sometimes still current) discrimination by mental health services; the result is that their illness grows worse because no treatment or help is in place; and so for many the first contact with services is when compulsion is used – and unsurprisingly this reinforces the fear; and so the Circle of Fear continues.

Sadly history seems to have stood still because the Circle of Fear is still firmly in place. How could this be when everybody got the message years ago and, to be fair, there is a good deal of support for fixing it? How can we break out of this other circle – of good intentions followed by failure and back to the drawing board?

Well, I don’t have the answer but I believe I know who does…

In my evidence on the new draft Mental Health Bill I suggested that the people to ask are those directly affected – Black people who have been detained under the Act. In Wales this is not a huge number of people (reflecting the population of Wales but still disproportionate as explained above). It would be straightforward to speak to all of those affected who are willing to talk – a few dozen have been detained in the last few years. I don’t mean send them a form to fill in – I mean ask if they and their families would be willing to sit down and talk about their experience.

Listening respectfully to these true experts could enlighten us all about those with the most serious problems and lead the way towards improving the wider experience of Black people in mental health services in Wales. We all know that this issue is about more than the Mental Health Act but these patients and families have seen it all and it’s time to hear their story and their ideas for breaking the circle.

Based on that dialogue we might finally:

• Develop a new service model for Black people which reflects their community in terms of staffing, management, and culture.
• Transform the experience of Black patients with recovery-based support in place of routine compulsion.

But, please, speak to the true experts first!

Jo Roberts is a mental health campaigner who was on the receiving end of the Mental Health Act for over 30 years. In the past she has received compulsory treatment; some of that treatment was deeply unpleasant and even terrifying. Jo is campaigning for a progressive Mental Health Act fit for the 21st Century – an Act that gives patients and carers in Wales and beyond a fairer deal.