Guest blog: Ethnic minority patients in secure mental health units
The journey to being a patient in a secure mental health unit is, by its nature, a traumatic one. By the time one gets admitted one has been assessed, prodded, and, with every step towards admission, been told, in many different ways, by many different professionals, that one is, in some way broken (has too much of the one, not enough of the other, and, or, the wrong type of what they should have). And, for one’s own protection, or that of others, one’s rights, rightly or wrongly, are stripped, curtailed, or modified.
For those from ethnic minority groups, that journey is often complicated by real and, or perceived, specific injustices borne out of their race, culture or both: ingrained mistrust of a system peopled by ‘other’; unconscious, or, sometimes conscious, biases expressed by well-meaning authority figures; language barriers that go deeper than merely speaking the same language, to name but a few.
It’s because of the nature of the journey that service users, especially those from ethnic minority backgrounds, in secure units, in very real ways, see their relationships with staff as, many times, more adversarial than therapeutic. Some, at one end, respond by lashing out to protect themselves while others, at the other end, simply retreat inwards and opt to take as inactive a role as they can get away with in their own care. Most react in ways on that gradient. All leads to lives half lived and potential lost, if not, as is so tragically common, suicide as the only option left.
The SACMHA Ward Presence Project was born because of the need for a bridge between: the time it takes for the service user to see their relationship with staff as more therapeutic than adversarial; the unconscious and conscious biases of staff who, because of cultural or social differences with service users, might not always be aware them; the service users’ stay in secure units and return to the community; and, because our team includes staff with lived experience, the all-important distance between one seeing their diagnosis and present situation as destiny and them coming to see they are capable of being more.
A lot of our work is soft work that requires, as more than one service user calls it, ‘just sitting and talking sh*t’. We are, in their eyes, far enough removed from their journey to secure units, and the ‘system’ to be trusted with concerns, hopes and plans that aren’t always shared with nursing and medical staff. Those in the team with lived experience are seen as mentors whose advice, even when having been ignored coming from staff (‘they don’t know what they’re on about’) can, at least, be given consideration. By inviting those well enough to have leave to go off the ward to our Wednesday wellbeing hub or Thursday social cafe where they can meet folks outside of their secure unit settings, play games, and then have an African Caribbean lunch they get to experience glimpses of ‘life outside’ and, more often than not, when it goes well, get a much needed self-esteem boost.
Staff in the secure units we work with have now started asking us to contribute to the care of the service users we support because the insight we have given others from different ethnic or cultural backgrounds, or without lived experience of being a service user in secure units aren’t always able to have.
All this works to give service users an ally who lets them know that they are not alone, because, above most of their other circumstances, it is them feeling abjectly alone that not only makes their stay in secure unit more uncomfortable than it needs to be, but their journey to, if not recovery, living as full lives as they can with their diagnoses more perilous.
With all this, our advocacy service, in which trained and qualified members of the team work with them and on their behalf, gives them the real sense that we don’t only stand for them, we stand with them.
Gambinga Gambinga is a Community Mental Health Officer at SACMHA Health and Social Care, lives with bipolar, and has lived experience with suicide and being a service user in a secure mental health unit.