The plan to put your health records in a computer cloud – the next expensive mistake by the NHS?

New World of NHSX doctor talking to patient once they have digitalised all patient records Pic credit: Gov.uk

NHSX, the new body behind the covid 19 tracing app,is planning a further IT revolution which will be a bonanza for multi national tech companies

Probably everybody remembers the fiasco under Labour to introduce a national computer system linking the whole of the NHS. The ten year programme which never worked properly was abandoned in 2011 after wasting some £10 billion of taxpayer’s money.

But now NHSX, the new body set up by the government in July 2019 without any Parliamentary approval and virtually no oversight outside the NHS, is planning a new national system to centralise NHS patient records.

I wrote about it last week in Byline Times following the publication of a report by the National Audit Office on NHS Digital.

Most of the press reports concentrated on the back story that the NHS was s in a digital mess and that a £8.4 billion programme under way to modernise the system had still not everything right- with 46 per cent of trusts relying on paper for patient records.

The real story was at the end of the report where the NAO raised a red flag about a plan to put everybody’s patient records in a cloud which has still not been fully worked out by NHSX.

It says NHSX is working on creating communication protocols known as Application Programming Interfaces (APIs) which would go through different layers so they could transfer patients’ data from an individual health trust or GP surgery to a cloud. This is similar to people transferring their own personal data and files on their computer or smart phone to a Google cloud.

A NAO spokesman said: “The use of APIs with a data layer, is at an early stage. It does not have a clear scope yet, so we are unable to comment on its implementation, much less how it affects the Covid-19 response. But we note that other parts of government found similar approaches to be difficult and expensive.”

The NAO also revealed that unlike the first failed computer system – which was paid out of general taxation – the new cloud service will come out of general day to day running costs – which means if it goes wrong the cash will be taken from patient services and given to tech multinationals to solve the problems.

More seriously how safe are your records when this happens. Already NHSX has had the embarrassment of computer magazine Wired discovering they had left future plans for the app – publicly accessible through Google Drive – by mistake.

Image how you will feel if your personal health records were hacked and sold on to commercial interests.Or some computer error released sensitive infoirmation. This plan needs to be thoroughly scrutinised before it goes ahead. Or it will be a waste of money and a possible security risk to your sensitive personal information.

Covid-19: NHS chaos and DWP indifference lead to tragedy for one 50s born woman

And why the BackTo60 Facebook crowdfunder is essential to bring these sad facts for many more to light

The family of Ray and Lesley Myers with daughters Nicola and Jenny in happier times.

This is a tragic tale that I suspect is being repeated across the UK now we have the largest number of deaths in Europe. It gives a little glimpse into the human cost behind the cold harsh statistics of the daily death toll. Her daughter contacted me and she agreed to be interviewed.

Ray and Lesley Myers thought they had their retirement well planned. He would get his pension at 65 and one year later she would get hers at 60.

He was a successful Welsh speaking self employed builder in North Wales. They had a comfortable four bedroomed house and two lovely daughters.

Then at 60 Ray developed cancer and was unable to work. They downsized from their four bed house to a one bed apartment in Chester.

Through the help of the NHS Countess of Chester Hospital & The Hospice of the Good Shepherd he was tackling his cancer and they were still looking forward to many more years together.

This winter Ray got pneumonia and went into the Countess of Chester Hospital. He got better , came out of hospital, but then fell ill again and was re-admitted.

Unfortunately for him he came back just as the Covid-19 was starting to spread across the UK. The doctors there also tried to press him to sign a ” do not resuscitate” form.

According to Lesley Myers the hospital did not have the right equipment to safeguard the staff or patients relying on paper masks and aprons. But they did regularly test him for Covid- 19. Three tests were negative, the last one was positive.

From there he deteriorated rapidly but his family heard nothing from the hospital and couldn’t visit him. Finally they allowed Lesley to visit him and provided her for the first time a gown and a medical mask. By then he was in a coma and close to death.

On April 7 aged 70 he died. The family have not been able to organise a proper funeral.

But the hospital have followed up her case and have got proper protection equipment and are changing the way they handle future cases.

Lesley then encountered all the problems from the Department for Work and Pensions. She was hours on the phone trying to claim bereavement benefit. The DWP just cut her off.

But they acted very quickly to stop his state pension,PIP, and ban her from being able to drive his mobility car. They still haven’t bothered to collect it one month later and it is parked at the apartment.

She found herself left with living on £420 a month – £320 from her own PIP as she is disabled and just £25 a week bereavement benefit. The widow’s pension has been abolished by the DWP. She has bills of £150 a month for council tax and another £100 for the apartment management charge.

She said :” How I am supposed to survive on this on this amount?
” I do have savings but do not know how long I will live for so do not wish to rely solely on this as I’m sure you can appreciate – I am only 64! “

“I am fortunate to have the support of my daughter and some savings but I ask you this for someone with nothing and all payments stopped immediately how would they now continue?
“I am very concerned for other people left in the same situation or worse off than myself.
” I do not like to complain, I have expressed my sincere gratitude to the hospital for their care and my daughters have raised nearly £3000 for them and the Hospice of the Good Shepherd in memory of my husband and in order to help them both at a difficult time.
I feel like a statistic, and this is not right. I am a person who also needs to survive”.

She said her situation would have far better if she had already got her pension as of right.

” I have supported BackTo60 for a long time and I feel it is disgusting that they changed the pension age without properly informing people. I have paid in since I was 15. We are entitled to that money and there should be full restitution.”

BackTo60 have just launched a £10,000 crowdfunder so they can keep the issue in the public eye right up until the judicial review appeal in July.

They intend to use the money for a film that will highlight how Covid-19 has made life worse for many 50s women already suffering in poverty and having difficulty making ends meet.

You can donate to the crowdfunder here. It is something that needs exposing.

On Byline Times: WHO guidelines ignored to shield over 60s because UK “not a developing nation.”

My first new article on Byline Times reveals the reason why the government is sticking to shield only those in their 70s rather than follow World Health Organisation guidelines to shield the over 60s. It is because the UK thinks this should only be applied to developing nations.

This disputed by WHO who point out that 95 per cent on the deaths in Europe are among the over 60s with France, Italy and Spain responsible for the vast majority of European deaths.

The article highlights the plight of people in their 60s – most of them still working because of the rise in the pension age – with some left with no money as jobs collapse and others working in the NHS where the risk of Covid- 19 is at its highest.

Read the full story on Byline Times here

Back to Work: Restarting investigations

Back to Work even if Westminster is closed – except for virtual contacts

This is just a note to my readers that after an absence of nearly three months I am now back in rather a different England that I left in January.

I have been extremely lucky as the trip I took with my disabled wife sailing round the whole of South America was about the safest place to be at the time – as the ship kept ahead of the spread of COFID 19 until the every end.

Then a very wise captain decided not admit any new passengers or crew when we docked at Fort Lauderdale and only allow passengers to disembark – not even go ashore and return – protecting the ship from the virus.

We then sailed straight for Southampton and were able to dock without facing the terrible fate some cruise liners had to endure where passengers had caught the disease. Cunard deserve a lot of praise for this. I will put up a blog with lots of pictures of what we saw in South America at a later date – as an antidote to today’s gloomy situation.

But now having had to painfully adapt to the new situation and look after and protect my wife from this invisible scourge I am back to investigating from home again.

I have a lot to catch up. I am planning fresh articles on developments on the BackTo60 campaign and the continuing plight of #50sWomen now hit by the fall out from the coronavirus. While I was away their victory at the Court of Appeal to challenge the findings of the judicial review on all grounds was an amazing achievement.

I am also back working for Byline Times which is doing a series of investigations in to the NHS and the coronavirus and I will keep an eye out for any other issues in Whitehall that are being buried by the current crisis.

I also have a number of more long term and complicated investigations – nearly all raised by people who contacted me directly and are taking many months to sort out. You will know who you are but I ask you for some patience as it will take time to get round to them.

In the meantime it will soon be back to business as usual.

Revealed:The chaotic free prescription and dental treatment scandal

An example of an attempt to check whether you are entitled to a free prescription by Trent Valley Surgery

If you are under 60 and over 16 do you know when you can get a free prescription and free dental treatment? No, if you don’t you are in good company and if you claim could even be one of 1.7 million people in England falsely sent a £100 penalty by the NHS.

A absolutely scathing report out today from MPs on the Commons Public Accounts Committee today describes the whole system for regulating free prescriptions and dental services as ” not fit for purpose “.

It reveals that despite a so called 24 page ” simplified ” guide telling you when you qualify most people are completely confused and rightly so.And if you get it wrong you are automatically guilty of fraud and get a £100 penalty fine rising to £150 if you don’t pay it promptly.

The report said :” Exemptions from prescription and dental charges include age, maternity, receipt of certain means-tested benefits, low income, and long-term medical conditions in some cases, although we are told that this list of long-term conditions has not been updated for 50 years [YES 50 YEARS -my point] save the addition of cancer in 2009. “

Worse qualification for a free prescription does not automatically qualify you for free dental treatment. And if you are on Universal Credit your right to claim will vary from month to month depending on your income.

The report says : “There is currently no way of indicating receipt of Universal Credit on prescription forms, resulting in more confusion, and the Department for Work and Pensions does not confirm eligibility when they write to claimants about their confirmed benefit entitlements.”

The result of all this chaos is that since 2014 no fewer than 5.6 million penalty notices have been issued and 1.7 million have had to dropped once the person challenged it because it was found out they were entitled to claim.

Naturally the threat of penalities has made vulnerable people more frightened of going to the dentist for essential treatment in case they were fined and to get prescription medicines.

Worse the policing of the system to prevent fraud has been an abysmal failure. The report found “nearly 115,000 people have received five or more PCNs [penalty notices] for prescriptions, over 1,600 have received 20 or more—yet only five cases have been referred to the Crown Prosecution Service. Only one has been heard in court ” Yes that it right one court case.

And anyway the NHS does not have a proper system for collecting the debt – relying in part on Capita.

The MPs said: “The PCN process generated a net yield of £25 million for the NHS, a pitiful sum compared to the annual cost of prescriptions which is around £9 billion. We do not dispute that it is right to try and deter fraud and recover costs mistakenly paid by the NHS, but the current system is not fit for purpose.

Now there is a simple high tech solution to check prescription entitlement in real time – and the government is committed to eventually introducing a computerised system. It is trialing one now in just four chemists. How pathetic is that.

Meg Hillier, chair of the committee, makes some very pertinent points .

Patients find it very confusing to understand whether or not they can claim free prescriptions or dental treatment because of a convoluted system that causes patients, in some cases, distress.

“A presumption of guilt means penalty charge notices are issued too readily, particularly where vulnerable people are concerned. Yet where there is clear evidence that people are persistently committing fraud by making false claims, there has been a failure to take effective action.

The Committee fully support efforts to deter fraud and pursue those who claim exemptions to which they are not entitled to but the current penalty notice system is cumbersome, inefficient and not fit for purpose.

The Department should substantially overhaul the system, so that those who are rightfully entitled to free prescriptions and dental treatment get the exemption they deserve.”

Over to the NHS to sort out this scandal – one among many. MPs want to call officials back next year to explain how they have solved it.

Suspicious deaths of the elderly in hospital: An appeal for people to contact me

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Appeal for people to come forward over suspicious elderly relatives deaths in hospital

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For the past four years I have been a member of the Gosport War Memorial Hospital Independent Panel that concluded that at least 456 elderly people had their lives shortened as ” a direct result of the pattern of prescribing and administering opioids that had become the norm at the hospital.”

Since publication of the report the events at Gosport are now the subject of an independent police inquiry so I cannot take up any cases involving Gosport.

However since the report’s publication a number of people have contacted me on  my website with allegations of a similar nature in other parts of the country,

As a result I have started investigations into these and would welcome other people –  relatives of  former patients, NHS staff  or lawyers representing them- to contact me in confidence as I am actively looking at this issue.

The aim will be to publicise and investigate  these fresh allegations to find out what happened to their relatives  and seek explanations from the various  hospitals who were responsible for their treatment.

You can get in touch with me by clicking on the contact me heading on my website or through byline.com. I  look forward to hearing from you.

 

 

 

Fifty Shades of Child Abuse: How a brave survivor is pioneering a fight back in Cumbria

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A snapshot from the Resilience film being shown across Cumbria

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Cumbria is amongst the first regions in England to try and tackle the poisonous chalice of adverse childhood experiences (ACEs), including child sexual and physical abuse using medical science developed in the United States and extensively trialled in Southern California and now here in the UK.

The Cumbria community initiative, known as The Cumbria Resilience Project, comes from a 61-year-old survivor himself – a victim of the notorious paedophile and abuser John Allen – sentenced to life imprisonment on 33 counts of sexual abuse against 19 boys and one girl- aged between 7 and 15 – while running a children’s home in North Wales. Allen like so many paedophiles denied all of this and claimed the people making the allegations all wanted to make money. But the jury at Mold Crown Court disagreed.

The  anonymous survivor has just written a very readable  book – available from Amazon here for £7.99p  – Aces in the shadows – Understanding Adverse Childhood Experiences.

He thought he might call it 50 Shades of ACEs because of sadly the variety of adversity, including physical, sexual, and bullying abuse (some inflicted by other traumatised children as well as adults) which damages thousands of children in their homes, schools, places of safety and in war zones and among refugees.

ACEs science comes from a health questionnaire used in the CDC-Kaiser Permanente ACEs Study, which is one of the largest investigations of childhood abuse and neglect and later-life health and well-being in the USA, can now be used by GP’s and trained counsellors to act as a gauge on how deeply traumatised children and adults have become following adverse childhood experiences through abuse, neglect and household challenges, often caused by members of their family, teachers, children’s home staff , and priests leading to perpetual mental and physical health outcomes in later life including Cancer, Ischemic heart disease, Liver disease, Alcoholism, Chronic obstructive pulmonary disease and Depression.

The science, now accepted by the World Health Organization (WHO), shows beyond any doubt that a child’s growing brain can be arrested by such traumatic experiences, but the brain’s plasticity and the building of resilience can help people recover in later life. The book includes views from three professionals, Al Coates MBE, a social worker; Judy James, a coach-therapist; and Laura McConnell, a teacher and ADHD campaigner, on how to tackle this. The survivor adds his own views.

With a score of 10 ACEs, the anonymous survivor has endured it all – three marriages, fathered eight children, 40 sexual partners, 34 homes, two bankruptcies, copious drink and sleeping pills and a range of health conditions. Only the unconditional love of his third wife helped pull him through after years of therapy.

His psychiatrist diagnosed that he suffers from complex Post Traumatic Stress Disorder – something ( which I will return in a later blog) the authorities don’t wish to know about because of the expense of treating it. He concludes : ” I do not believe however he is likely to make a complete or rapid recovery because of the duration of his symptoms since childhood.”

The good news is that such episodes have become rarer while the work he is doing in Cumbria is growing beyond anything he could have expected.

” Cumbria might appear to be a beautiful place but behind the beauty are some of the highest numbers of sexual and domestic violence offences in the country,” he told me.

The Cumbrian Resilience Project has already attracted more than 300 members belonging to its closed social media forum. It also has free viewings of a film called RESILIENCE – The Biology of stress and the science of hope which explores the damage done to the body by the toxic trauma of  repeated adverse childhood experiences as a child and puts forward a scientific way of tackling it. Film showings this autumn will be in Carlisle, Penrith, Workington, Barrow, Eden Valley and Kendal to name but a few.

Interest has been shown by Cumbria Police, Cumbria NHS and across the care sector and the project founder is planning ACEs awareness training sessions for parents, social and care workers, and all frontline staff so they can understand what is needed to help children and adults affected by ACEs. Sessions this year are being held in Workington, Carlisle, Penrith and Barrow.

The project relies enormously on volunteers and survivor champions. But I hope when the Independent Inquiry into Child Sexual Abuse (IICSA) moves on to discuss how to help survivors that projects like these (they are more widespread in Scotland) are advocated on a national level. The author is a Core Participant in the inquiry and hopes to have the opportunity to raise issues of ACEs at the inquiry later in the year.

Among the supporters of the project are Graham Wilmer, who runs the Lantern Project on the Wirral :

He says: “There are people out there who are trying very hard to undermine the courageous efforts of survivors of child abuse to come forward and give their testimony. Some of these individuals claim to be survivors themselves, others include a diverse range of individuals, some professionals, others just perhaps misguided folks without much else to do, who, through the advent of social media, believe they have a right to call out and abuse anyone they want to, simply because they can.

“That will change, but, in any case, they matter not. It is the voices of those who had the courage to speak truth to power that will be remembered, not the voices of those who tried to stop them.”

Another is Dr Wendy Thorley who described the book as a ” An open and unrestricted account of the impact on ACEs for not only children but adults. The bravery of the author to put this in the public arena is not unrecognised.”

I would recommend it – the author does not go for intellectual sophism – but is direct, honest and tells the unvarnished truth – and it is all the better for that.

Race equality groups seek big changes to the mental health act to end stereotyping and over-medication

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Sir Simon Wesseley, planning to report on reviewing the mental health act later this year

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While Theresa May is battling to hold her line on Brexit her almost unreported initiative to reform the mental health act is leading to demands for the government to introduce radical reforms for treatment and new rights for patients.

A submission from Race on the  Agenda and the Race Equality Foundation to the review  by Sir Simon Wesseley, set up by Theresa May to look into why so many black Afro Caribbean people were being detained in mental hospitals and the need for changes to the Act. It also comes against a disturbing background of deaths in police custody.

The submission has been backed by the Runnymede Trust;Patrick Vernon OBE, Chair of the Labour Party’s Race Equality Advisory Group, writer Amy Kenyon and Professor Rachel Tribe, of the School of Psychology at the University of East London among others.

NEED FOR BIG CHANGES

The Downing Street interim report  contained many warm words but not a lot of action. It stated: “Experience of people from black African and Caribbean heritage are particularly poor and they are detained more than any other group. Too often this can result in police becoming involved at time of crisis. The causes of this disparity are complex.” The  full report  and details of its members  and terms of reference is available here.

Now the submission to the inquiry proposes major changes to tackle the problem. The link to it is here. The main proposals are:

1. The Mental Health Act (the Act) should set out principles that define human rights, anti-discriminatory practice and a commitment to combat institutional racism.
2. The Act should be amended to include a clause that states explicitly that a diagnosis for a ‘mental disorder’ must take account of the patient’s social and cultural background. And the Act should allow for appeals against diagnoses via a Tribunal, with a panel that includes experts from BAME backgrounds.
3. Patients detained under the Act should be empowered to choose which carers or family members have a say in their care and can support them during an appeals process.
4. A new system of appeal whenever a new diagnosis is applied and/or continued, to a tribunal-like body, with the right of the patient concerned to have legal representation at the hearing.
5. All mental health service providers should be set targets to reduce the use of Community Treatment Orders and minimize racial inequalities in their use. This should be monitored by the Care Quality Commission  during inspections. Specific amendments in relation to supervised treatment in the community should be made to ensure this is statutory.
6. Statutory bodies should be regularly inspected by the CQC or other appropriate body to ensure that training of professionals working in mental health services addresses issues of racial bias and cultural competence.

The  submission  says: “:We were glad to see an emphasis on the urgent need to address the disproportionate number of people from black African and Caribbean backgrounds being detained under the Mental Health Act (MHA).

Equally, we were unsurprised that Black, Asian and Minority Ethnic (BAME) focus group participants highlighted a lack of cultural awareness in staff and a need for culturally appropriate care as paramount. We would express concerns about racism, stigma, stereotyping and overmedication. We hope that these findings will guide and underpin the recommendations made in the final report ”

It is to be hoped that Sir Simon and Theresa May do take action to remedy these many faults in the system. Otherwise it will be another case of political posturing  like help for the ” just about managing” which has so far amounted to warm words and little else.

There were concerns expressed at the recent conference organised by Rota at the University of East London that little would really be done to tackle this. If little happens it will only make matters worse and there is a need for strong campaign to make sure Downing Street does really listen.

Theresa May’s risky gamble with reforming an ” institutionally racist” mental health act

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Sir Simon Wessely, chair of the mental health review

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With very little publicity and dwarfed by Brexit  Theresa May has committed herself to a major reform of the Mental Health Act. Last year she convened a meeting at Downing Street and appointed a former president of the Royal College of Psychiatrists, Sir Simon Wessely. to conduct a review.

This month it published an interim report with a lot of warm words, some constructive proposals and a public admission that far too many people were locked up and a disproportionate number were from  the black and ethnic minority communities. A report in the Guardian on  May 1 highlighted some of the issues.

This Friday the charity Race on the Agenda  will host a conference at the University of East London on the  Stratford campus tackling the issues head on by addressing the issue of institutional racism in the mental health service.

They will have a lot to go from the interim review report which firmly  puts the case for change by highlighting the poor  and  often inhumane treatment of people of black African and Caribbean heritage in the worse case scenarios results in deaths in police custody.

It also appears to want to redress the balance between the role of the police and the NHS.

The interim report states: “Experience of people from black African and Caribbean heritage are particularly poor and they are detained more than any other group. Too often this can result in police becoming involved at time of crisis. The causes of this disparity are complex.” The  full report  and details of its members  and terms of reference is available here.

Among some of the salient points raised include phasing out the use of police cells to detain mentally ill people and using ambulances rather than police cars to transport mentally ill  people and increasing NHS involvement by looking at NHS England taking responsibility for  commissioning of health services in police custody.

This week’s conference will  go further than the report by looking at the culture and attitudes towards black people – the stereotyping, unconscious bias  and sometimes politically incorrect racism – as well as the role psychiatry has in defining who is mentally ill.

So why should this be a risky gamble for Theresa May ? The answer is the countervailing trends in society which could mitigate against reform.

First there is austerity. The state of some mental health hospitals , including one not far from the conference in Tottenham, have to be seen to be believed because there isn’t the money to provide adequate services. Thus all the reforms in the world could fall down because there are not the staff nor proper facilities to help people.

Then there is current hostile environment which led to the Windrush scandal , the rise of Islamaphobia and the Prevent strategy  which creates a climate of fear and fuels latent racism and fear among the white community of “the other”. The fight against terrorism can morph into discrimination against  particular ethnic groups in society.

So in the worst case scenario all Theresa May will be left with is warm words and no action – which, given the hope rising from the mental health act review, could make matters worse than they are now.

That is why it is important that conferences looking at issues the report may find difficult to confront – such as institutional racism – are being held and issues thoroughly aired.

 

 

A psychiatrist’s damning indictment of 500 years of racism – now revived by Trump and 9/11

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Suman Fernando. Pic credit: http://www.sumanfernando.com

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Suman Fernando is a gentle soft spoken  consultant psychiatrist, lecturer and honorary professor at the London Metropolitan University.    The 85 year old is not the sort of person at first sight to produce such a searing critique of racism in the UK and the US and the baleful role psychiatrists have had in treating ethnic minorities in both countries.

His book released at  the end of last year and launched by ROTA – Race on the Agenda – looks at both the history of racism which he dates from 1492 when the Spanish finally  removed the Moors from Europe and the role of psychiatry in treating ” mentally ill”  black and brown patients over a very long period.

The book is particularly relevant as Theresa May has  quietly decided to review the UK’s mental health laws  which cover some of these issues – signalling her intent by  holding a meeting of psychiatrists at Number Ten Downing Street.

It also comes at a time when the election of Donald Trump, the rise of Islamophobia in the wake of 9/11 and to an extent, the worst excesses of some people supporting Brexit, has seen a revival of popular nationalism and in the US, white supremacists.

He traces racism from the bloody Inquisition in Spain through the development of the slave trade, the rise of eugenics leading to Nazism,  the Imperialist destruction of other cultures by colonisation to the ” rivers of blood” speech of Enoch Powell as Britain faced an immigration wave in the 1960s and 1970s.

His  thesis is that – mainly because of the 1970s race relations legislation in Britain – overt racism has until recently been replaced with a form of institutional racism and psychiatry is no exception to the rule.

Indeed some of the worse psychiatric theories to treat people as seen by superior whites as ” the other” came from this profession. This was the profession that applied the concept of  ‘Drapetomania’  to slaves in the USA, the primary symptom being a persistent urge to run away.  The implication was Black Afro-Caribbeans were supposed to be happy and content as slaves  and had mental problems if they wanted their freedom.

In Britain the book provides numerous examples of how different ways of dealing what is an obvious imbalance in the number of Afro-Caribbeans being sectioned compared to white Britons. Attempts to change treatment or properly research the issue by black psychiatrists were undermined in a typical British way – their work was subsumed by more conventional psychiatrists or their findings were ignored.

He also reveals  how attempts to change matters politically were undermined. Tony Blair  appointed Paul Boateng – now Lord Boateng- as the first minister for mental health in 1997. At the time he was known to be  strident in wanting to change the treatment of black Afro Caribbeans like himself- but within months he was squashed.

Since 9/11 the danger is that racism is on the rise with Muslims rather than Afro Caribbeans as the main target. That is why the timing of this book is relevant in the context that the mental health legislation is being revised. Already psychological research is being used as a basis in the Prevent programme to decide whether teachers or NHS staff, their pupils and their patients, should be reported to the authorities if they show signs of radicalism.

The next slippery step would be to decide that these people are insane – and should be sectioned rather than prosecuted. This is not as fanciful as it sounds. Under  Labour there was a move to classify stalkers of VIPs as a mental illness and Jack Straw when he was home secretary is said to have considered whether paedophiles should be classified as insane rather than criminals.

That is why this book is so interesting because it tells how deep seated racism is among white Europeans  and how insidious the present system is in dealing with the ” other” – from stop and search to sectioning.

The one sad thing is that the book itself has been “Ghettoised” – it has been pigeon holed by the publisher  as part of ” contemporary black history ” when it is much more of an account of how contemporary British and US society has reached such a view on black and brown people.

The German publisher has created another ghetto by price – Palgrave Macmillan have priced it at a ridiculous £67.99 or £53.99 as an e-book. Amazon have a Kindle version at £45.19. So I suggest you try and get it in a public library or if you are a student make sure your university library has got one.

Institutional Racism in Psychiatry and Clinical Psychology. Suman Fernando