Let me die, before I am killed – a black male schizophrenic plea in relation to the Mental Health Act White Paper.
By Colin King
Call for Action. Abolition of the Community Treatment Order, new Drapetomania: Whiteness, madness, and Mental Health Act reform
To be published by Lancet Psychiatry.
The Mental Health White Paper and modern white psychiatry reflects a form of ‘madness’, Beresford, 2015, in its repetition of Cartwright’s, (1851) use of the mental illness diagnosis, ‘Drepatomania’, a conjectural mental illness, hypothesized to explain why enslaved Africans ran away from slavery (Myers, 2014). Drapetomania is not a phenomenon confined to history – as a belief and practice it has re-emerged inside the white paper and mental health law as a political blindness to the legal control of black men. For black men like me with a diagnosis of ‘schizophrenia’, once entrenched in our defiance to the ‘care and control’ of the white slave master, we and our community are now entrenched in defiance to current care and treatment regimes, drapetomania is re-enacted within the Mental Health Act White paper, 2021.
The White Paper offers potential change and reform in its responses to the initial Mental Health Consultation paper, 2018. The White Paper assumes by its guiding principles, that the new emerging ‘undeserving victims’, Black and Minority Ethnic communities, people with learning disabilities and autism, and children, will be emancipated and saved by its narrative of ‘Quality improvement’. However, closer examination reveals this is not only a white paper, but a paper characterised by whiteness, as retained in its political power through the use of such neo-liberal terms as choice and autonomy, least restriction, therapeutic benefit and person as an individual (Fanning, 2020). Almost one year from the murder of George Floyd, will legal narratives such as Advance Choice documents, Statutory Care and Treatment plans, Independent Mental Health legally trained advocates, Nominated Person and Cultural Competency, makes visible the implicit white values that have contributed to black men like me being four times more likely to be detained and ten times more likely to be placed on a Community Treatment order (Section 17a, of the 1983/2007 MHA)? The White paper is too conservative, too narrow, and refuses to look at the role of whiteness in maintaining systems of oppression felt by black men with its implicit use of ‘drapetomania’, as reflected in the use of Community Treatment Orders. Wilson’s, 1995 Afro-centric model would interpret the MHA white paper, as failing to remove the conditional behaviourist diagnostic culture of a Euro-centric mental health system. More damaging still, with the death of black men (Sean Riggs, 2013, Olaseni Lewis, Seri Law 2018) in mind, are the legal concepts of mental disorder (Section 1 of the MHA) and compulsory detention (Section 135, 136, Section 2 and Section 3) that from my perspective needs radical change.
Whilst the MHA white paper does not offer an equality impact analysis of its proposed changes to the lives of black people, ironically it offers funded research to examine, as a perverse form of whiteness, why black men are more likely to be diagnosed with a mental disorder. This is in methodological opposition to how white values emerge in relation to the assessment, care and treatment (King, 2020) of black men. The potential of applying a civil rights coproduction model to community services that redresses structural inequality (Disparity Report, 2017), is negated by references to strengthening the detention criteria, rights to challenge detention, treatment, and discharge. Even more concerning is that the Human Rights legislation, 1998, the Care Act, 2014, and the Mental Capacity Act, 2005, are not used to examine the capacity to eradicate institutional racism in modern white psychiatry (Metz, 2009) through the need for fundamental changes to current diagnostic frameworks.
Despite the Parent and Care Race Equality Framework, the Advancing Equality in Mental Health policy, a diverse workforce, and representation in senior management, there appears a reluctance of a de-colonialization (Mbembe, 2015) of the hegemonic power of whiteness. This represents a continuing denial of the ‘first-person’ experiences of African men as normal inside the English psychiatric system. Consequently, the obsession with treating black men compulsorily in their community remains intrusive, despite new detention criteria, namely, ‘substantial likelihood of significant harm to the health and safety or welfare of the person or the safety of other people’. This criterion totally fails to deal with the historical fears of black men like me, Clunis,Richie Report,1994)
Consequently, the legacy of ‘drapetomania’ as an ideological framework is revisited by the use of ‘least restricted’ as a new legal control over the black body and mind. The slave master is replaced by the power of the Responsible Clinical Manager, the Approved Mental Health Practitioner under the CTO in returning the person for treatment, with new white agents, the community supervising clinician. This reveals a lack of accountability to the potential of a shared model of equality that considers the ontological and epistemological experiences of black men. A shared decision-making process that offers legitimacy of Afro-centric models and resources to redress the power of white psychiatry. Such a model is needed for effective coproduction, effective co-learning, and hence effective shared decision making based on values of liberation. The Community Treatment Order of the Mental Health Act White Paper should be abolished through a petition for radical change for black lives to matter.
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