What We’re Learning About Race & Mental Health

St Martin of Tours Housing Association

At St Martins, we pride ourselves on the work we do for people who have complex mental health issues.  We’ve been in existence for over 120 years and have a strong record of helping people recover and manage what is often a traumatic phase of their life.

But sometimes we have to admit that the work we do is not so easy, and the behaviour of our residents can be challenging. About 18 months ago we had to call a consultant in to help us deal with what was becoming an all too frequent problem; racist abuse from some of our residents toward staff.  Often it was wearily accepted by staff with a shrug, who excused it as part of their care for residents.

This led to us bringing in an expert to help us, but the success it led to has not just changed the way we deal with discrimination but has supported residents’ recovery itself.

The first step for the harassment was recruiting an expert to help us, and Pamela Leonce at Stowhill was our choice. Pamela spoke to more than 60% of the organisation and it was clear that there was some truth to the experience, with staff failing to report it and shrugging when it happened.  An action plan was created with over 30 recommendations and the key was a poster put up at every service unit which said:

This was also backed up by management meetings and an emphasis that said zero tolerance is the only answer to such behaviour.  All our residents have sufficient ‘capacity’, and we now deal with any such behaviours by quickly following procedures, leading to evictions if necessary.   People have now seen others get evicted and it has changed the culture of the home as residents are aware that this behaviour is not tolerated.

The result is that it’s now largely a thing of the past as staff can point to the poster before residents join us, and then in their regular recovery sessions, and know that we mean it.  But that isn’t the only thing we’ve noticed.

Amongst the other actions Pamela recommended was the formation of an Excellence group, for equality, diversity and inclusion, which would lead to delivering on the Action Plan.  This was us: Sara, Irene, Paul and Remi

One of the most difficult things she recommended we do was profile our residents against the ‘protected characteristics’ set out in the Equality Act.  We didn’t always have the data but what we did find out was what we probably guessed but didn’t know: that even though we had a fair amount of racial harassment the majority of our residents were in fact male and black, the majority African heritage but also Caribbean and British Black.  Why was this?  Was there some sort of bias in the mental health system that discriminated against black people?

When we did further research some of it was quite disturbing:

• A disproportionate number of people from Black, Asian and Minority Ethnic communities are detained under the Mental Health Act.
• Rates of detention for Black or Black British groups are over 4 times those of White groups. Community Treatment Orders (CTOs) for Black or Black British groups are over 10 times those of White groups.
• Black people are more than 4 times more likely to be the subject of ‘restrictive interventions’ such as being restrained or held in isolation while in hospital.
• Black adults have the lowest mental health treatment rate of any ethnic group, at 6% (compared to 13% in the White British group).
• Black men are more likely to experience symptoms of psychosis than other ethnic groups (3.2% compared to 0.3% of White men and 1.3% of Asian men – using combined 2007 and 2014 data.) There is no significant variation by Ethnic group among women.
• National data shows that African and Caribbean men in the UK are much more likely to be diagnosed with some types of mental health problem during adulthood. For example, symptoms relating to schizophrenia, and to a lesser extent post-traumatic stress disorder.

But what has this to do with our stance against racism against our staff?

Curiously, an unexpected development from our zero tolerance against racism has been better behaviour across all areas of the organisation.  Supporting people to manage their anger and find other solutions has led to incidents being lower than before.  Services are quieter, and much more stable environments to be in.  Even service charge collection is better (!), which Irene notices as our Finance Manager.

The actions we took to create zero tolerance against racial harassment appear to be having a positive effect in recovery for residents is our conclusion.  Residents are learning boundaries, which in turn helps them get ready for independence when they leave us.  Maybe, like some schools which get better exam results following greater discipline, being clear about expectations and having consequences seems to work for us too.  Equally important, staff have gained new skills in how to maintain boundaries as they feel confident that they will receive organizational support which they did not have previously.

Could it be that many of the issues that led to a breakdown in a person’s mental health: stigma and lack of support, are then addressed when a definitive approach is taken to behaviour management generally.  By giving a space that has clear expectations, boundaries and is safe we have enabled people to focus on their mental health. Which then leads to quicker recovery itself?

We’re not saying it’s a panacea as there are many mental health conditions which need medication and therapy to recover from trauma and serious illness.  For us to say they can be cured by better behaviour management would be misleading and trivialize some serious conditions.

But when we first started we thought we were dealing with racist abuse of staff.  Now, we’re beginning to think we’ve stumbled on something else just as important; help with recovery, and maybe prevention itself.  Is it just us, or has anyone else come to these conclusions?

Sara Michale

Irene Fredriksen

Paul Hardisty

Remi Adewuyi

EDI Excellence Group, St Martin of Tours Housing Association, London