A three-tier system of accommodation is offered to users. The core hostel takes new referrals, the
cluster hostels take individuals at the second stage of their rehabilitation having found their feet,
and the third stage provides people with shared houses and flats when they are strong enough to
cope with minimum support.

Harambee has evolved around the needs of the users, not just providing housing but offering
therapeutic support from black mental health professionals coming from various backgrounds,
as well as advocacy services to question their diagnosis and care standardly offered by the mental
health services. On a therapeutic level, the project deals with issues such as the loss of self-
esteem, the loss of communication skills, rejection by family and peer group, the inability to seek
help. It encourages the local community to support its relatives and friends, who have been
distanced and de-skilled by institutional care.

Many more African-Caribbean mental health projects have been set up since 1985. 'ESCAPE', the
name of the African-Caribbean initiative day-care outreach service in Birmingham is an
acronym for: Encouragement and motivation; Support and rehabilitation; Care, counselling,
crisis support; Advice; Practical help, befriending; Experienced workers.

The Manchester African-Caribbean Mental Health Project set up in 1989 aims to offer
encouragement to the existing local authorities mental health services, in becoming more
accessible, appropriate and sensitive to the needs of the African-Caribbean community. There are
three drop-in workshops, one of which is called African-Caribbean Expressions, which uses the
services of a psychologist and an art and drama therapist to explore history and culture through
art forms.

NAFSIYAT Inter-Cultural Therapy Centre was set up in London by a group of mental health
professionals from different cultures in 1980 to offer psychotherapy to black people and people
from ethnic minorities. A professional from one background, they believed, could work
effectively with a patient from another in an inter-cultural way. European psychotherapists in
the 80's had felt unable to cope with difficulties around language and culture. NAFSIYAT
believed that there could be a middle ground. The three main functions were to provide
psychotherapy for adults, adolescents and children; to train mental health professionals; and to
work with health authorities at a consultancy level.

NAFSIYAT's workers regarded the major area of development as the provision of practical and
theoretical training courses to give other professionals skills, insights and understandings of
their work with their clients of different cultural backgrounds. The therapy offered to clients was
to be a dynamic psychotherapy, described by the late Clinical Director, J. Kareem as

...a psychotherapy that takes into account the whole being of the patient, not only the
individual concepts and constructs as present to the therapist but also the patient's
communal life, experience in the world, past and present.

The very fact of being from another culture employs both conscious and unconscious
assumptions both in patient and therapist. NAFSIYAT challenges many of the
preconceptions which have been traditionally associated with 'psychotherapy' and
'transcultural psychiatry': 1. that ethnic and cultural minorities are unsuitable for
psychotherapy. 2. that payment is necessary for successful therapy (NAFSIYAT is funded
by the Islington Health Authority) 3. that it always requires long-term commitment by the
patient with frequent attendance [1989].

Ipamo was set up in 1995 in London and is funded by Hackney Local Health Authority. The
name comes from the Yoruba word meaning 'a place of healing or safety'. They operate an
African extended family system using black mental professionals. The building itself is modelled

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