“I could have died in there”: Narratives of Mental illness and the

discourse of Structural ViolenceRubina Jasani and Sarah Pemberton

University of Warwick

Case Study One

• 21 year old male, African, asylum seeker with psychosis.

• Rejected from university because of his undeclared status.

• Differing understanding of cause of illness

• Gaps in care

Data Collection

• Research is based in the Heart of Birmingham (HoB)

• Research seeks to investigate the reasons behind ethnic variations in the experiences of, and admission to, acute psychiatric treatment.

• Area chosen because of its high BME population

Main Ethnic Groups in HoB

Total population of 250,755 of HoB

–        10% Black British/Black Caribbean

–        25% White British

–        3% White Irish

–        29% British Asian/Pakistani

–        13% British Asian/Indian

–         7% British Asian/Bangladeshi

Criteria for Interview

• Diagnosed as having had a psychotic episode by clinical team

• From all ethnic groups

• Aged between 18 and 65

• Not considered as a real/present risk to researcher or themselves.

• Ability to consent

Ethnicity of Sample

• 21% Black British/Black Caribbean

• 38% White British

• 1% Mixed Other

• 32% British Asian/Pakistani

• 3% British Asian/Indian

• 3% British Asian/Bangladeshi

Structural Violence

• Based on work of Paul Farmer (1997, 2003)

• Farmer examines ways in which women are structurally disadvantaged with reference to the treatment of Aids.

• This can be applied to mental health and the multiple ways in which people are marginalised and the impact that this has on access to care.

Case Study Two

• 30 year old male, British Pakistani with psychosis.

• Negative experiences of inpatient unit

• Differing understanding of cause of illness

• Neglect by the system

Case Study Three

• 29 year old female, White British with psychosis.

• Raped, children removed by social services, homeless, heroin user

• Differing diagnoses

• Gaps in care

Conclusion

• Case studies attempt to show how structural inequalities of culture, class and gender play a role in disadvantaging service users and excluding them from main stream health and political systems

• Our research is not necessarily making a claim for culture specific services, but instead shows how culture is a dynamic concept that needs to be explored in the context of time and space, while remaining sensitive to differences of class and gender.

Contact Us

• Rubina Jasani • R.Jasani@warwick.ac.uk

• Laura Griffith • L.B.Griffith@warwick.ac.uk

• Sarah Pemberton S.L.Pemberton@warwick.ac.uk