Summary This chapter looks at some of the experiences of patients of Black (African and African–Caribbean) descent in forensic psychiatric hospitals and the likely effects of some aspects of the new mental health legislation in England and Wales. It describes the difficulties in meeting the objectives set out in the government's Delivering Race Equality programme and makes suggestions on the way forward through a focus on reducing length of stay in institutions, implementing preventive strategies to reduce the number of people who move into tertiary psychiatric services and improving the experience of those in hospital through a cultural consultation intervention.
The experience of Black service users within forensic psychiatric services in the UK has remained largely unchanged over the past decade. It is similar to that of Black patients in secondary mental healthcare services, as summarised in a Department of Health publication Inside Outside (Sashidharan, 2003). This document brought together evidence from clinical and epidemiological research, clinical observations, anecdotal accounts and testimonies of service users and carers. It summarised the problems of mental healthcare as experienced by Black and minority ethnic groups to be:
• the overemphasis on institutional and coercive models of care
• the prioritising of professional and organisation requirements over individual needs and rights
• institutional racism within mental healthcare services.
Despite the conclusion reached by Professor Sashidharan in Inside Outside, the Department of Health disagrees with the existence of institutional racism (also called structural or systemic racism) in mental healthcare services. Retired judge Sir John Blofield, in the independent report following the death of David Bennett in a medium secure unit, reported that institutional racism was present throughout the National Health Service (NHS) and that greater effort was needed to combat it. He noted that until that problem is addressed, people from Black and minority ethnic communities will not be treated fairly. He described the experiences of patients poignantly: ‘the black and minority ethnic community have a very real fear of the Mental Health Service.