The year is 2010, and Steve Gilbert is behaving erratically outside a police station. A friend is trying to calm him down when two officers ask if they can have a word inside the station, away from prying eyes. The friend explains the situation: Gilbert has a history of mental ill-health and, in the past few days, his behaviour has become disturbing. He has been going around the pawnshops in Birmingham city centre, selling all the camera equipment he uses as part of his fledgling photography business. He has also moved out of his friend’s house and is currently sleeping in the basement of the restaurant he tried to launch, without success, a few years earlier.
The officers tell Gilbert that he is being detained for an assessment under Section 136 of the Mental Health Act. “I had my assessment in a police station,” recalls Gilbert today. “I was held in a cell, and this woman came to the door and said, ‘Mr Gilbert, we’ve concluded the assessment and we’re detaining you under the Mental Health Act.’ I thought it was a joke. I was looking around for cameras. I thought I was being punked. I just couldn’t get my head around the fact that, only that morning, I was a free man – and now I was being told I was going to be taken to hospital.
“It was the oddest experience. It’s proper confirmation that you’re crazy, and nothing will be the same again, because you’ll always be that person who was so mentally unwell that you had to be locked up. That has a significant impact on your life, in terms of stuff like your ability to get insurance, but also the way that people view you as being dangerous.”
The year is 1989, and David Harewood – an actor, then in his mid-twenties – is asleep at his home in Islington. He wakes up when he hears his friends throwing stones at his window. Harewood has been missing for the past 24 hours and they’re concerned. His recent behaviour has been erratic: he has vivid dreams during the few hours he is able to sleep and, during the day, he hears voices. He is experiencing a manic episode but doesn’t yet have the knowledge or vocabulary to verbalise this.
Harewood’s friends decide that it would be best to take him to see his parents but, on the way, he passes out in the car. His friends turn the vehicle around and head to the nearby Whittington Hospital; he comes to before they get there. “Apparently, I jumped out of the car and ran into the Whittington. I started screaming at the top of my voice,” says Harewood. “I don’t remember any of this, but my friends tell me that security was called. They came down, took one look at me – this big black man – and said, ‘No way.’ They called the police, and then several officers turned up with riot shields and rushed me.
“[They] sat on me for hours. Doctors pumped me full of sedatives and, at one point, they asked, ‘Has he taken any drugs? Because we’ve given him enough sedatives to knock out a horse and he’s not going down.’ I was fucking terrified. The thoughts in my head were telling me that the demons had caught me, so I thought I was fighting for my life. Physically, what was happening to me was that six policemen were sitting on me. But in my mind, the devils had caught me, so I was resisting. I mean, thank fuck it was here, because I’d be dead if I’d been in America, no doubt about it. I then spent five days in the Whittington, which I have very little memory of, because I was highly sedated. I’ve got all my records, but I haven’t read them because they’re quite upsetting. I will do some day.”
Like Gilbert, Harewood had been sectioned – an experience that is more familiar to black men than white men. In 2016, the Mental Health Taskforce, chaired by Paul Farmer, the CEO of Mind, found that men of African and Caribbean heritage were up to 6.6 times more likely to be admitted as inpatients or detained under the Mental Health Act. It concluded that this indicated “a systemic failure to provide effective crisis care for these groups”.
Two years earlier, the Lankelly Chase Foundation, a group that works to tackle hidden social disadvantages, claimed in its Ethnic Inequalities in Mental Health report: “The most egregious inequalities in mental health care continue to be the over-representation of black men at the hard end of services at point of arrest, in prison and within secure treatment.” For black men, it seems that the pathway to care – which should begin with a GP consultation and end with recovery – is fundamentally broken. But there are men and women in the UK striving to fix it.
“It would be foolhardy to believe that, one day, black men just wake up and are instantly ‘sectionable’,” says Chanelle Myrie, a clinical psychologist at South London and Maudsley (SLaM) NHS Trust. “What happens before that point? The standard route to care is that, when you start to experience difficulties in your mental health, you go to your GP. You talk about your experiences, and your GP recommends a course of action. You then engage with that. It helps, and that’s the end of the story.”
SLaM wanted to find out why black men were “presenting late” – a term that refers to those who don’t receive treatment for their mental ill-health until it’s at crisis point. So, it decided to ask them. During a series of focus groups, Myrie, together with Sadiki Harris of the Lambeth-based mental health charity Black Thrive, asked black men why the existing mental health services didn’t appear to be accessible to them. These conversations took place everywhere from barbershops to college classrooms. And in these comfortable and familiar settings, they gradually managed to gather insights.
Some men said that it was well known that doctors were quick to treat black men’s mental health with medicine, rather than support and therapy, and that didn’t suit them. “They thought, ‘You know what, if I’m unwell, I ain’t going to no GP, because they’ll just try to make me take something I don’t want to take,’” says Harris. (The Race Equality Foundation has previously reported that black and minority ethnic people are more likely to be medicated than their white counterparts.)
Other men simply stated that their GP surgery is somewhere they go when they have a physical health problem, not a place in which they want to open up about their feelings and vulnerabilities. Some told Myrie that if their mental ill-health was intrinsically linked to their experience of being a black man in Britain, and their doctor was white, they saw no reason to tell them in the first place. “That was the barrier,” explains Myrie. Given that almost 80% of NHS staff are white, the chances of being assessed by a black GP are low.
Almost invariably, the answer to the question of what could improve the support they received was that they needed spaces in which they could talk through their issues with like-minded people, without feeling like they were being judged. “Some of the guys said that they wanted an actual physical place you could go to, where you step through the door and everybody knows exactly why you’re there. But for others, that safe space could be an online chat room,” says Harris.
“What was very clear was that black men wanted black men – and in certain cases, black women – to be running the thing. Whatever it was, it was unanimously felt that they didn’t want white men in these spaces. Or, if there were white men involved, they didn’t want them holding senior positions. [They wanted to see that] it was being run by black people who understood black people.”
These spaces didn’t necessarily have to be provided by statutory services; they just needed to be accessible. “Lots of people were saying third-sector organisations such as Black Thrive were far more accessible, because they know that they’re geared up for supporting people who look like them – people who have had the same experiences,” says Myrie. “So, they were thinking, ‘Why can’t I go there instead of going to my GP?’”
Strength in Numbers
In January 2018, Marvyn Harrison’s wife gave birth to a baby girl. He couldn’t have been happier, but the new addition to his family also called into question his role within his home. When his baby daughter cried, she was crying for Mum, not Dad. His infant son wanted Mum, too, while his wife just wanted help with two kids who both craved her attention.
To deal with the feelings of rejection and resentment that were infiltrating his home, Harrison went to a few private therapy sessions, which appeared to help: he was starting to unpick why he was feeling the way he did. Then, Father’s Day happened. “My wife, who is one of those amazing, positive people, came upstairs with gifts and breakfast, but I just didn’t feel joyful,” says Harrison. “My family were adoring me, and I couldn’t feel it. I needed to speak to somebody, not professionally, but I needed some sort of connection with other people who would get what was going on.”
Harrison sent a WhatsApp message to 23 fathers and friends in his contacts list, telling them that he was having a tough time, but that he was thankful they were in his life and that their success at work and home inspired him. “Everybody was just like, ‘Thank you so much. I really needed that today. I wasn’t feeling great, either,’” says Harrison. “To hear that, out of 23 men, the majority of them weren’t feeling good was a massive eye-opener. You look on social media and you think that everyone’s having the time of their lives. It’s really hard to measure the inauthenticity. We had [the group chat] for maybe a week, and nobody left, which is a really good sign that someone cares about what it is you’re doing.”
Two years on, that WhatsApp group has become Dope Black Dads, a space for black fathers to connect, both online and in person. The group now has a presence in the UK, the US and South Africa – all territories in which, historically, black men and their experiences have been “othered”. In these spaces, men challenge each other to grow and are introduced to therapies and conversations that may be beneficial. With Dope Black Dads and its podcast, men who may not have engaged with the more traditional pathway to care – of which Harrison is one – find support and a space to share their feelings with others who know where they’re coming from and what they’re experiencing.
“When you go through these events together, it creates a ‘stickiness’,” says Harrison. “I care if one of our guys is going through a divorce, or having suicidal thoughts, or feels incomplete as a father, or is lonely, or just needs to travel to a new part of town by himself to save his relationship. All of those things matter.”
Through his work with Dope Black Dads, Harrison has conversations with a number of mental health professionals who speak to him about why black men are presenting late. He also has his own thoughts about why this might be the case. “For us, trying to [seek help from] an institution that employs a lot of people who have never had proximity to blackness, who then diagnose us by applying European-based psychotherapy understandings to black people who have been brought to a country, or invited to a country, or have arrived in a country, and have continually experienced ‘othering’ and dismissal… they just don’t get it,” he says. “And if you try to have those conversations, the escalation from treating a mental concern to being sectioned is too rapid.”
Rebuilding the System
Gilbert was sectioned a decade ago, but he says the experience has left him “fundamentally broken”. Maybe, he speculates, if he’d sought and received the support he needed at an earlier point, his condition wouldn’t have developed into bipolar disorder, and he wouldn’t need to take medication every day.
But in other ways, Gilbert can see that he’s one of the lucky ones. Since being discharged, he has been able to find effective treatments for his condition and is now in a position, as vice-chair of the Mental Health Act Review, to help ensure that other black men get the support they need.
In October 2017, the then prime minister, Theresa May, called for an independent review of the Mental Health Act 1983. Part of its remit was to investigate the disparity in experiences of people who fall under the awkward term BAME (black, Asian and minority ethnic), and in particular the disparity in outcomes for black African and Caribbean people. “We found that unconscious bias plays a role, but so does institutional racism,” says Gilbert. “Due to the way in which our core services are set up, even if you didn’t have anybody who was racist working in those services, you would still get different outcomes based on someone’s ethnicity and race, because of the way in which policies are written.”
Gilbert and the review’s other chairs made suggestions that they hoped could positively impact black men in the area of mental health. Their “landmark recommendation”, as Gilbert refers to it, is something called the Patient and Care Race Equality Framework. The framework would help organisations such as mental health trusts and the police force improve services delivered to black men by encouraging them to follow a three-stage process. They would, for example, be asked to identify areas in need of improvement – that, say, detention rates in their area are too high. They would then need to devise strategies to improve those numbers. Ultimately, the focus would be on monitoring how those new strategies are affecting things on the ground, while keeping relevant stakeholders informed of their progress.
“We’re going to [tell service providers] that, actually, there are comparable organisations that have invested in this process, and they’ve done it really well, and they have the results to prove it,” says Gilbert. “So, if you haven’t done that, we’re going to hold you to account.”
At the time of writing, Gilbert is waiting for the publication of the government’s white paper, its official response to the review. It was scheduled to take place before the end of 2019, but since the review was released at the end of 2018, the country has been through a change in prime minister, a general election, a formal EU exit and a global pandemic, all of which have delayed its arrival. Gilbert is adamant that two-thirds of the review’s 154 recommendations do not require legislative change, so relevant organisations should be free to make a start as soon as they wish. But regardless of whether change requires the goodwill of authorities, the goal of the review is simple: to produce a mental health-care system that is not just equal but equitable.
“This isn’t about treating everybody the same,” says Gilbert. “To ensure that everybody can achieve the same outcomes, we might need to do things slightly differently for different groups of people. It’s a bit like having a wheelchair access ramp, so people can get into a building. That costs additional money, but we do it because it’s the right thing to do. It’s also a legal obligation to make sure that the building is accessible, to make sure that any individual can come and go from that public space without help.”
Creating mental health services that are equitable might make them radically different to what we have now, but we have reached the point where something has to change. We know the statistics, we’ve heard the stories and we’ve seen the outcomes for black men suffering from mental ill-health. The next step is to implement solutions. Conducting research, making recommendations and having difficult conversations create a foundation for change, but that alone is not enough. Now’s the time to build on it.
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