health in specific groups of the population that it felt were being neglected. These were: Women,
children, ethnic minorities, and the elderly.

There was a general movement away from asylums in the 1980's (Campling [1996]). Research
from Jamaica showed that more localised community mental health services reduced the rate of
schizophrenia in Jamaica by 49% from 1971 to 1988. This research showed that black people were
less mentally ill in their country of origin (Hickling [1991]), and also highlighted research that
black people are over-diagnosed with schizophrenia (Fernando [1995]).

The question arose about reducing the rate of schizophrenia by making changes to the quality
and delivery of mental services in the UK. The document authorised the closing down of big
asylums and introduced the phasing in of local mental health units and local mental health
community teams. These teams consisted of various professionals working in mental health.

In the widely distributed leaflet outlining the new services arising from Health of the Nation,
the GP was to be the first port of call for mental ill health, and patients were advised to go early
to their GP, who was now trained to detect mental ill health, and who would refer patients for
treatment in the form of psychotherapy as well as medication. The Patients Charter January 1997
underlines the right of patients to information in their own language, choice of treatments other
than medications, single sex wards, and treatment and care in the least restrictive environments
appropriate to the patient's needs.

In Health of the Nation, specific policies were laid out for the welfare of the ethnic minority
communities.

(a) Working with the black community

Health and family care authorities were to develop supported housing for mentally ill patients
discharged from hospital to improve social functioning and lessen the impact of mental ill
health on individuals and families.

(b) Training for doctors

Funds were set aside to train doctors on ethnic awareness: Ethnic monitoring of admissions was
to be authorised in hospitals to ensure appropriate services for users. Doctors were to be trained
to recognize the suicide risks. (One third of people diagnosed with schizophrenia commit
suicide.) Doctors were to be trained to make services more culturally appropriate and sensitive to
the needs of ethnic minority users. Doctors were to develop education courses for carers, and
self-help courses for users. Training on race and culture meant that doctors could liaise with
voluntary black groups to develop services for the ethnic minority patients. So, with this
training, doctors could be more aware of alternative health services that were culturally more
acceptable.

(c) Statutory authorities

Statutory authorities were authorised to recognise the experience of black mental health
professionals and to purchase services from them as well as consulting them with casework 'to
provide more culturally appropriate services'.

(d) Black users

Black users and mental health professionals should work together to develop services that users
need, rather than have imposed on them

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