In place of fear

Ten years after 'Rocky' Bennett's death, progress is now being made to tackle discrimination against people from black and minority ethnic communities, the undaunted mental health champion tells Mary O'Hara

• Mary O'Hara
• The Guardian,
• Wednesday November 5 2008
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• Article history

Melba Wilson: "There's no point in doing this work if it's just goig to be another project that disappears after five years." Photograph: Frank Baron

For someone responsible for reforming one of the most entrenched problems in the mental health system, discrimination against people from black and minority ethnic communities (BME), Melba Wilson is undaunted. "I'm an optimist, but I'm also a pragmatist. I don't have rose-tinted glasses. I know exactly what needs to be done to make things happen."

What needs to happen is clear, Wilson says. The mental health system needs to cease being something of which people from BME communities are "afraid" or from which they can expect inferior care to that of their counterparts in the white community. "Historically, it has been about fear of the services ... not feeling that they are understood or that their needs are being met," she says.

As the national head of Delivering Race Equality in Mental Health (DRE), a five-year government-funded action plan to overhaul services for BME users, Wilson sees her role as helping to bring about lasting change. "There's no point in doing this work if it's just going to be another project that disappears after five years. What the DRE is setting out to do is nothing less than organisational change and attitudinal change as well."

Race equality campaigners disappointed by the slow progress of similar initiatives will be reassured by the work of the DRE, which has been up and running for 18 months, and has as its leader someone who has worked in senior roles across the statutory and voluntary sector. And it looks as if it's working.

Campaigners' frustrations, though, are not lost on Wilson. Next week, she will give the Henry Hawkins lecture - an annual talk organised by mental health charity Together - which aims to stimulate debate on controversial issues within the sector. Part of her reason for giving it is to commemorate the death of David "Rocky" Bennett.

Ten years ago, Bennett died while being held face-down by staff in a Norwich mental health unit. The case became a tragic symbol for the broader mistreatment of BME mental health service users, and an inquiry into his death concluded that there was institutional racism across the mental health system. It resulted in 22 recommendations for service improvements, yet research carried out as recently as last year found that BME patients can still expect a litany of problems. The 2007 Healthcare Commission study, Count Me In, concluded that despite Bennett's death and the subsequent outcry, BME service users are still more likely to be misdiagnosed, overmedicated, placed in seclusion and, as with Bennett, forcibly restrained. This is despite similar overall rates of mental illness to the wider population.

Wilson says that the timing in relation to the 10th anniversary is important, but she stresses that she believes "real progress" is finally being made. "We are making progress embedding the programme in the thinking and planning of commissioners and providers in health and social care."

Going mainstream

She points to work being done by individual trusts, voluntary groups and service user networks. "Islington and Camden looked at the pathways to care for African-Caribbean men, which is a significant area for us, and the board signed off a new service," she says. "It takes us away from the whole area that it's just a project that's going to be forgotten. It's within mainstream thinking and provision."

Wilson talks a lot about "embedding" the changes promoted by the DRE not just in inpatient settings, but in the wider culture of the health service and also in the community. As well as working directly with trusts and commissioners to improve provision, Wilson says work needs to be done directly with "the many different" BME communities to which mainstream services and their "one-size-fits-all" structure can seem alien.

She says the approach will help tailor services - in particular early intervention - which, if reformed, would help reduce the prevalence of "crisis" situations such as Bennett's, where BME users come into contact with services only when they are in a great deal of distress.

With this in mind, the DRE is recruiting 500 community development workers across the country; around 400 are already in place. The workers gather "intelligence" about the individual BME communities and deliver it to the commissioners and service providers at statutory and voluntary bodies, Wilson says. DRE is also collecting trust-specific data on things such as prescribing practices to get a more accurate picture of how practice differs across the country. "That's going to give us a solid evidence base," Wilson says. "Once we have a baseline, we have a lever for going to mental health trusts around the country and saying, 'Look, this is what the picture is. How can we work with you to change that picture?'"

Wilson says she is encouraged by the "will to change" she encounters, from ministers and civil servants to NHS bosses, and the police, who are often the route through which African-Caribbean young men are sectioned. She worked closely with the Metropolitan police while she was BME mental health service improvement lead at the Greater London Council, and says some of her "most inspiring conversations" about reform have been with Met officers.

There are, nevertheless, lightning-rod issues that are not going to go away any time soon. Many mental health reformers are worried about community treatment orders, which came into effect on Monday as part of the Mental Health Act 2007 and which are intended to foster more community-based and early intervention care for people with complex conditions, because they take away the right of a patient to refuse treatment. One race equality group, concerned that BME service users will be disproportionately affected, labelled them as little more than "psychiatric asbos". Wilson accepts that they are "one of the more contentious issues of the bill", but says the DRE is "looking at how well that is working in relation to BME communities".

Professional pedigree

If her job is a tough one, Wilson believes her professional pedigree and her personal experiences more than equip her to meet the challenge. Personal experience of mental illness in the family ignited her interest but regarding race specifically, Wilson says growing up in Texas ensures that she "knows that aspect" of things. "I'm old enough to remember 'coloured-only' fountains and going to the Greyhound bus station and having to use the side entrance. I didn't learn to swim until I was in my 40s because [the local pool] was white-only."

Bearing in mind the delayed response to the Bennett inquiry recommendations, it is perhaps understandable that Wilson is reluctant to put a timescale on when a watershed in mental health services for BME communities will arrive. But her optimism for the short term at least remains intact.

"Real change is incremental. It's day-to-day unglamorous stuff. Suddenly you look around and things have changed a few steps. It won't become a silo. I can see the signs are there. You talk about the watershed. I can see it happening."

Curriculum vitae

Age: 61.

Lives: London.

Education: MSc, social policy and planning, London School of Economics; BA, mass communications, California State University.

Career: 2007-present: National and London director, Delivering Race Equality in Mental Health Programme/ National Institute of Mental Health, England; 2006-2008 acting chief executive, London Development Centre; 2002-2007: chair, Wandsworth primary care trust; 2003-2005, BME mental health service improvement lead, Greater London Authority; 1998-2002: policy director, Mind; 1995-2005: non-executive director, South-west London and St George's Mental Health NHS trust; 1983-1994: health and social affairs freelance journalist.

Books: Co-author of Forensic Psychiatry, Race and Culture; Crossing the Boundary: Black women survive incest; Healthy and Wise: the essential health handbook for black women.