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TX: 12.02.04 - REPORT INTO ROCKY BENNETT’S DEATH CONDEMNS INSTITUTIONAL RACISM IN NHS – PART 2

PRESENTER: JOHN WAITE
THE ATTACHED TRANSCRIPT WAS TYPED FROM A RECORDING AND NOT COPIED FROM AN ORIGINAL SCRIPT. BECAUSE OF THE RISK OF MISHEARING AND THE DIFFICULTY IN SOME CASES OF IDENTIFYING INDIVIDUAL SPEAKERS, THE BBC CANNOT VOUCH FOR ITS COMPLETE ACCURACY.

WAITE
As we heard at the beginning of the programme a report published today has condemned the Department of Health for failing to tackle institutional racism in NHS mental health services. The report comes out of an independent inquiry into the death of 38-year-old David "Rocky" Bennett, who died on a psychiatric ward in October 1998, after being restrained - pinioned - face down by at least four nurses for over 25 minutes.

We first covered the story on Face the Facts a couple of years ago. A story which had shocked even the coroner at Rocky's inquest - William Armstrong.

ARMSTRONG
The horror of what happened to Rocky Bennett on that evening certainly I think will stay with me forever and I'm sure it will stay with all those who were in the court and who heard this sad and sorry story unfolding before us during this two week period. There were so many things that went wrong and so many things that shouldn't have gone wrong and they ended in a person dying who had, as I said at the time, been let down by the system.

WAITE
Rocky Bennett died on a ward at the Norvic Clinic in Norfolk. His parents had nicknamed him Rocky because of his resilience as a child. The resilient child became a talented teenager, so proficient at football he had trials at DerbyCounty and so successful at music that he joined a group which made recordings and appeared on TV. But in his late teens he developed severe mental illness and spent the last 15 years of his life drifting in and out of hospitals. And during that time his sister, Dr Joanna Bennett, became increasingly concerned at the way he was being treated.

BENNETT
There were times when I went to see Rocky where he couldn't speak, he was just so drugged up. I'd had to go and visit him in St. Andrews in Northampton to tell him my mother had died and then left him there totally confused and totally distressed.

WAITE
According to today's report Rocky's experiences before his death were typical. African and Caribbean men and women living in Britain are 10 times more likely to be diagnosed as schizophrenic than white people, they're more likely to be kept in locked wards and given high doses of medication. The night he died Rocky had been racially abused by a fellow patient. Aggrieved that it was he and not the white patient who'd then been moved off the ward Rocky had become violent and struck a female nurse. He was then restrained face down on the floor by as many as five members of staff. According to one account a nurse pinioning each side, two across his lower body and another holding his ankles.

ARMSTRONG
I think there was a feeling - and one can't be more precise about it than that - that Rocky Bennett was big, black and certainly he was dangerous and I would add, not only was he being regarded as big, black and dangerous but also possibly untreatable - it may be unfair to say he was being regarded as wholly untreatable but he wasn't responding to conventional anti-psychotic medication.

WAITE
Professionals say forcing someone to the ground and holding them is quite simply the wrong way to restrain a patient safely. During our Face the Facts investigation Alex Livingstone, a management of violence trainer in health and social care, and Steve, his colleague, demonstrated the method's dangers on me.

ACTUALITY
[Shouting] Bend the knees, that's it [indistinct words] just stop them.

Okay we're safe.

They've turned my head to the side and they are pinioning my arms and I think Alex has trapped one under his knee, he's holding my head down. Now he's placed his knee in the middle of my back. He's holding my head almost at right angles, it is very uncomfortable. There - I can breathe at the moment, it's not easy and that's just a few seconds.

WAITE
Today's report highlights the fact there's no national standard for training of staff and calls for no patient to be held down in such a way for more than three minutes, let alone 25.

BENNETT
I believe that on that night there was this perception of my brother as this big, black, dangerous man who we had to contain at all costs and even when he was saying - I can't breathe, you're killing me - they didn't think that he's a human being and that five people lying on top of one person for half an hour that they would kill him and that's exactly what happened.

WAITE
Rocky Bennett's sister Dr Joanna Bennett describing the underlying racism that she feels led to her brother's death.

Well the Bennett Inquiry published today makes 22 far reaching recommendations, some very uncomfortable reading for the Department of Health, which the report says has known about these problems for many years and is always pledging improvements which are always just round the corner. So, it concludes, it has lost the confidence of black and ethnic minority communities.

So will this report mark a watershed, as the original coroner who investigated Rocky Bennett's death hoped it would? And is appointing a second mental health tsar specifically for black and ethnic minorities the way to ensure radical change?

Well the Government's so far sole mental health tsar is Professor Louis Appleby, Professor Sashi Sashidharan is the director of the centre for research into ethnicity and mental health at Warwick University and one of the author's of today's report. But first I asked Richard Brooks from the mental health charity MIND for his views.

BROOKS
Well obviously at MIND we welcome the report and it's really helpful and I think the report makes it very clear that what we need is some centralised action. If the Government's accepting the report today and all 22 recommendations then we would be happy to see a mental health tsar put in place. But the issue really isn't about having a mental health tsar for mental health and ethnicity, what the real issue is actually getting a central and concentrated piece of action around these issues and as you've said they've gone on for years. And although it's very welcome to see some signs in the last couple of years, and I recognise that, the reality is that we've actually got to convince people who deliver services, such as the unit that we saw in Norwich, understand the issues that they're facing and help them to deliver better services. Now one of the real issues for us I think is the way that the responsibility for this is dissipated across government - we have the Department of Health, we have the National Institute of Mental Health, we have the Commission for Health Improvement - I could go on, I won't - and one of the realities is we've got to get the Department of Health centrally to take this much more seriously. I hope today's the start of that but I have some reservations because we have been here before.

WAITE
And the other very difficult thing with all of this is racist perceptions - changing those is not going to be easy. Richard Brooks, why is it that black people are more likely to be restrained, sectioned, medicated than any other group - this just presumes, doesn't it, they're more difficult, more dangerous, somehow madder than white people and they need these special measures? Now to reverse that perception is going to be extremely difficult.

BROOKS
Yes it is that and it's about people's understanding of culture and social context, it's about good training, it's all about those things. One of the really interesting statistics is after the Lawrence Inquiry into the institutional racism that happened in the police 40,000 police hours were committed to training and even then they've still got issues. Now one of the things we've got to say is it's more than just consultation activity, it's more than just recognition, it's actually action on the ground and are we going to see something like 40,000 hours put into the health service to deal with mental health issues? That's the sort of commitment we need to see about these sorts of issues.

WAITE
Are we going to see that Louis Appleby?

APPLEBY
Well I think the - Richard is right that there is a particular training issue here and we have to be prepared to grasp that. The way the NHS training system works - a lot of training is devolved to local level because it's thought that that's where people will recognise training needs but actually I think there's a need to grasp the training agenda nationally here and make sure that the right amount of training is given across the entire scope of frontline services. There are other things too, concrete measures on the ground of the kind that Richard's talking about - there is a plan to bring in community development workers across the country whose job is to engage with ethnic minority communities and help develop a broad approach to understanding mental health and mental ill health so that there's a kind of liaison between what happens in mental health services and in the wider community.

WAITE
How much faith do you place in retraining Professor Sashidharan?

SASHIDHARAN
That is going to be an important element in actually getting our workforce equipped to deal with cultural diversity and the particular problems that people from black and minority communities present. But the most important action that we want to see is leadership and commitment to change things from the centre and also plan of action that will implement the changes which have already been recommended, not just in this report but in previous reports. One of the most unfortunate things that's happened in this area is that every time there is a tragic incident government ministers and the Department of Health engage in kind of ritualistic hand wringing and saying that we will actually put the house in order. But our experience to date is that nothing much has changed - we still are in the process of developing policies and publishing consultation papers. But down on the ground, where the service interventions actually take place, things haven't changed substantially over the last 20 years at least and I think that calls for radical action and that requires not just a commitment from the top but also the capacity to deliver the plans which have already been agreed to some extent in the various reports before.

WAITE
Because these changes need to run right up to the top, Louis Appleby, Joanna Bennett felt her brother was not actually being treated, he was being controlled through heavy medication - that's a common theme in this, misdiagnosis, mistreatment - how are you going to get psychiatrists to change their approach, they're perhaps as racist as anyone to this section of the population?

APPLEBY
I don't think we have a major problem of conscious racism in mental health services, though of course it's bound to occur.

WAITE
But African and Caribbean men and women, living in Britain, are 10 times more likely to be diagnosed with a serious mental illness like schizophrenia, more likely to be kept in locked wards, more likely to be given high doses of medication - they are seen somehow - and I'm sorry to say this, it sounds facetious, it isn't - as somehow madder than white people and that's a misperception and some of that comes from psychiatrists.

APPLEBY
Yes of course it does but the point I'm making is that there's a difference between the conscious racism of individuals, which is absolutely reprehensible and I don't think is a widespread problem in mental health care, and the way the system works for ethnic minority patients and communities which is the focus of these recommendations.

WAITE
But you say it's not widespread - the report, Professor Appleby, says institutional racism, it doesn't say pockets here, pockets there, it says institutional racism.

APPLEBY
Yes I'm agreeing that it's widespread, the point I'm making is the difference between individual conscious racism and the way the system works. The way the system works is clearly to the disadvantage of ethnic minority communities and that's what has to be addressed. And we have to - and that applies to psychiatrists and nurses, to right up to the top in the way that we design policies across the board - nobody is making a different point, it's absolutely right. But I don't agree with the implication of your question which is that there is racism by individual doctors as a major part of the problem, the problem is the way the system works, that's why we have far too many black people admitted under section, that's why they get drug treatments in preference to psychological treatments - it's not because people are overtly consciously racist, it's because the system is not providing them with proper care.

WAITE
Is it the system Richard Brooks or is it people?

BROOKS
I think we've got to go back to the report - I think Louis is talking about intention, well that's not get into that. The issue is that people's experience when they go through the door is of a racist service and black people do not engage with mental health services because in some cases - and this is well documented - they fear for their lives, as indeed Rocky Bennett's life was put at risk and ultimately was lost. So what we've got to understand and what we need is real leadership, we need to do away with this debate about whether it's individuals or not, the experience for people is their experience - what happens to them - and that is made up from contacts with individuals. Let's get away from the issue of intent - the experience is of a racist experience and that has to change. And that means that people have to confront their racism, just as they have done through issues like, for instance, the McPherson Report, we need to realise that racism exists.

WAITE
Another point the report makes is that the history of this has been a history of governments' new initiatives which are always just around the corner but which never materialised, we hope this report will change all that but how will we know - Richard Brooks how will you know if this report really has hit home and really is being implemented?

BROOKS
Well I think one of the main [indistinct word] in the report is the need to start to collect proper statistics about what happens to people from black and minority ethnic communities, that's long overdue, we need to put that in place. And we need both a carrot and a stick approach because all too often we actually recognise good practice but sometimes sadly we turn an eye to bad practice. We need that approach, we need good targets, we need very clear targets about how services should change and we should take action when they don't. And that will mean, in my view, that some people ultimately would have to face the consequences of not delivering the right sort of service.

WAITE
Professor Sashidharan you've been exasperated in the past, reports you've put a lot of work into have simply been forgotten, how will you know whether this one has hit home?

SASHIDHARAN
If these recommendations are implemented fully, comprehensively and seriously then there is bound to be substantial changes in the experience of mental health services by people from black and minority ethnic communities. There will be a reduction in the number of people who go into hospitals under coercive measures, there will be a reduction in the number of black patients held in psychiatric custody, in some of the most repressive conditions within psychiatry in this country. And we will know that evidence fairly quickly because people will be talking about it. This is a unique opportunity for the department and I daresay one of the last opportunities in trying to put this house in order and in trying to eradicate institutional racism from within our services.

WAITE
And a final word to you Professor Appleby, you're the mental health tsar, you'll presumably be in charge of making sure this happens - how will you know that something is finally being done?

APPLEBY
Well just to make one point - I can assure that you're underestimating the impact of Professor Sashidharan's report, which is at the centre of national policy and not at all forgotten. But we'll know because we will have inspection systems for hospitals and mental health trusts which focus on the experience of service users from ethnic minorities. We'll know because we will see the community development workers come into place. We'll know because we will have a national programme of training which will make sure that our frontline staff are adequately prepared to provide proper care for people from ethnic minorities. It's essential. And we'll have a proper timetable by which these innovations can be monitored and so we'll be able to say to Richard, to Professor Sashidharan, to everybody in the mental health field, here is the demonstrable progress.

WAITE
Professors Louis Appleby, Sashi Sashidharan and Richard Brooks, clearly this is an issue we're going to be following, thank you very much.

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