Count Me Out – Discrimination and Mental Health


When I read that the last ‘Count Me In’ survey was completed last year I was shocked. Count Me In was a survey of all inpatients in psychiatric wards on a particular day of the year and it was a time-limited exercise to attempt to break down some of the inequalities in the delivery of services and experiences of services by different groups.

There is a short piece on the Guardian website about it – venture into the comment section at your own risk.

Usually I try to keep fairly up to date with the news but this had completely passed me by.

Count Me In  was launched in 2005 as a five year project. It will be imminently releasing its sixth and final report. I had assumed that it would just continue.

The reason I felt that it was so important was that it was the clearest evidence provided of the different treatment of people in minority ethnic groups in the mental health system and produced with such stark evidence of differences in proportion and treatment pathways, it forced the services to look at issues of structural and institutional racism within mental health services.

Evidence and data matter. It has long been suggested that there were differences in the experiences of mental health services by those who come from  minority ethnic backgrounds but evidence proves it and allows services to be redesigned and redirected to work in a more inclusive manner. The reasons that the project was commissioned have not gone away though.

I used the figures in the Count Me In surveys to illustrate and think about some of the reasons for the differences in treatment pathways for different minority ethnic groups and it was very clear and precise way of contrasting the figures involved. I always asked students in our team to check out and look them up and think about the reasons for the differences in the proportions of black and minority ethnic people who were inpatients and those who were admitted under a compulsory section. Of course, I’ll still use the reports for a good few years but it surprises me that this data collection is not to continue. Through evidence provided – services can be improved.

While reading the comments and the article, it made me think how much people want to seem to downplay the effects that racism and the impact on racism has on others as if we all want to have a ‘minority tag’ to hold on to. Personally, I find that quite offensive when those of the majority or rather most influential groups claim that they are ‘suffering’ due to positive discrimination – whether that be MPs who run scared of feminism like Dominic Raab – or  discussions about the marginalisation of Christianity.  We of the predominant ethnic group, need to recognise the additional power and authority we can command by virtue of the colour of our skin. Yes, I could argue as a Jew, I can claim a ‘minority’ status but as my  Dad used to say, about the time of the Brixton Riots when he was involved in community work, we (jews) don’t walk around with a visible sign on our foreheads defining our ‘difference’. We can choose to stay silent while those who are born with different colour skins can never walk away so don’t pretend that it is an ‘equivalent’ minority.

Whether he is right or wrong, this isn’t a ‘race’ to compare discriminations and prejudices. I must accept that I have advantages that would not be open to me in the attitudes of others if I looked different, if I looked more ‘foreign’.

This is why we need evidence to inform our practice and to improve our practice. This is why we need to use the experiences and expertise of those who do live and grow up in a prejudiced society that wants to be colour blind, rather than revert to the imperialist ‘I know best’ mentality of service design.

Many many steps forward have been taken in user involvement across all levels but when we become complacent and think we’ve ‘done it’  – that’s when we are most likely to be displaying our innate discriminatory attitudes.

The best way to prove the continued existence of different experiences of mental health services for whatever reason that might be and I don’t doubt that lack of understanding is one of them, the loss of valuable statistics is going to be a hard blow.

Personally I think that discrimination is a part of the human condition. That doesn’t sound too hopeful, I know, but we all have an idea about status and where we place ourselves – or more crucially others – on our internal continuums of ‘worth’. We have an obligation to challenge our own assumptions and never ever assume we have nothing to learn.  If we can recognise our own innate prejudices we can consciously challenge and work on them, overcompensating if necessary.

We just have to work a bit harder with the people who don’t believe that discrimination exists when the figures are no longer there to prove it.

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