The experience of African Caribbean patients in high secure care

Abstract

There is long-standing evidence of the anomalous treatment of black people, particularly African Caribbean men in psychiatric settings, including high security hospitals. This study was conceived and undertaken by a social work
practitioner working in Ashworth high secure hospital on Merseyside. The aims of the study were to gather rich accounts of the experiences of African Caribbean men in high secure care and to identify their specific needs. A representative from the black voluntary sector was recruited to assist in the data collection phase, a decision which ensured effectiveness and cultural sensitivity.
Twenty-five African Caribbean men located within different settings within the hospital were interviewed using a semi-structured interview schedule. The data were collected and analysed using grounded theory tools and techniques,
influenced by a transcultural perspective. The analysis identified seven themes: racism and discrimination, institutional life, social networks, care and treatment, cultural expression, fear and change. An important feature of the data was a form of cultural expression that drew on Rastafarian beliefs, customs and patios. These expressions of patient individuality speak of complexity of identity shaped by a historical legacy of colonialism, migration and racism that interact with personal experiences of contemporary society and institutional life.
Practical recommendations articulated by the patients are presented as a means of improving the situation short term. Conclusions are presented, however, arguing that these recommendations alone will not improve the experiences of black men detained in conditions of high security without a more transformational shift in the clinical, organisational and relational models that currently pertain. Effectively, large isolated institutions such as Ashworth are unable to comprehensively meet the needs of patients, irrespective of ethnicity, and these failings are exaggerated when faced with cultural diversity.