From School Exclusion to Mental Health Hospitalisation: Pathways to Mental Health Care for Black Men?

Mike’s story

Mike* who had just turned 21, was a young man from Africa**. He arrived in the country aged 7 with his family to seek asylum and had lived in London ever since. Mike was expelled from school at age 14 or 15 for truanting. He was convinced the teachers recurrently picked on him because they did not like him.  The day Mike got expelled he did not go back home.  He was scared. Instead, he started staying with friends and quickly became involved in petty crimes and in smoking cannabis.

Mike then got arrested several times for theft and possession of cannabis but was not sent to prison.  Quickly after Mike started smoking cannabis; at about 16, he developed what he called an ‘episode’ (Mike was initially diagnosed with ‘Drug Induced Psychosis’ and later with ‘Paranoid Schizophrenia’).  He was eventually taken to hospital by his mother and was discharged after one month. Once discharged, he stopped taking his medication, was readmitted within days and discharged again within a month.

Mike felt it was too early for him to be out and that he was not well enough. He also felt he lacked insight into his condition (his ‘own’ words) and was suspicious about taking medication. Once home Mike filled the days with smoking cannabis and worked out complex patterns as to when and how much cannabis he could smoke without it affecting his wellbeing. A month after his second hospitalisation, he got into trouble. He claimed to have been stopped and searched by the police 3 times in the same day. He became angry and defiant with the third Officer.  He reported to have been stopped the day before and demanded an explanation from the Police Officer who he said refused to provide one.

Mike ended up in a physical conflict with the Officer and was brought to his local police station where he was eventually charged with common assault.  Once convicted, Mike fell ill in prison and ended up on a Medium Secure Unit (MDU) on a Section 37, 41 of the Mental Health Act (a previous post here considers the potential experiences of Black mental health service users on MSUs).  Mike had been in the Unit for about 3 years when I spoke to him.  When I asked him what could have made a difference in his life he said the teachers ‘they gave up on me too easily’.

Some personal experience of the Education System

I was invited to the first parent-teacher evening to meet with my son’s tutor who taught science at the school. My eldest son had started secondary school a few weeks previously.  As we waited outside her room, I watched parent-child pairs entering the classroom looking slightly anxious but leaving it with a smile. This quietly reassured me.  When our turn arrived we were invited to come in and to sit at a pupil desk where we met a young looking White female teacher.  Upon brief introductions, the teacher buried her head in some kind of record book.  She re-established eye contact with me and then looking directly at my son declared with a beaming smile: ‘based on your current level of achievement, you can expect to achieve a grade C at your GCSEs’.

This statement was not an invitation to discuss potential remedial actions or support. Indeed there was no attempt at creating a dialogue on the mediocre prediction and I did not detect any concern or any indication of disappointment.  Instead, a definite sense of congratulatory determinism.  This was one of those awkward moments when the Psychologist in me has to wrestle with my ghetto side (in my head).  I am not going to lie; a vision of me slapping some sense into her did enter my mind.  Nonetheless, I reciprocated the smile for what seemed a very long time, long enough to compose myself and say to her ‘well that would not be good enough for us, we place a lot of importance on education at home and expect a lot more from him. He’s a very bright boy’. As I kept a smile on my face, I saw the smile on hers morph into an awkward grin betraying her embarrassment.

This was the beginning of year 7.  GCSEs were a few years away. There had been limited opportunities to test children.  I felt there was very little merit in the teacher’s prediction. What caused me the most concern was not the determinism but the sense of celebration which emanated from her voice. To me the subtext of the exchange read something like: grade C is perfectly commendable for a Black boy.  The relationship between school underachievement and social deprivation is well established as is the academic achievement/attainment gap between black boys and their peers (although it is important to remember that White boys coming from similarly socially disadvantaged backgrounds now fare worse academically than Black boys).  The influence of stereotypes and expectations on current educational attainments is receiving increasing attention.  There appears to be a link between low expectations and school exclusions and, although the relationship between school performance and the risk of being diagnosed with schizophrenia has been explored, one aspect that is less scrutinized is the relationship between school disengagement/exclusion and mental health care pathways. This is why Mike‘s story came to mind.

Black Service Users’ lived experiences

One of my research projects a few years ago focused on the pathways to care of Black mental Health Service Users in South London. Mike’s story is derived from this qualitative data analysed using IPA (Interpretative Phenomenological Analysis). The results revealed that for all interviewees (n=16) remaining in education was valued and perceived as important in terms of avoiding contact with mental health services for Black men. The majority of participants cited their dropping out of school or their being expelled as the main factor leading to offending and getting into contact with mental health services.  There was a deep sense of regret and of missing out too which can be perceived in the following quotes from different interviewees:

‘Because I missed quite a bit (of school) I’m suffering the consequences now’

‘I could have done a lot more if I wasn’t truanting from school’

‘Looking back on it, if I could turn back the time I would go back to school’

Schools should not give up on kids too easily’

Of course the above accounts are retrospective and subject to the usual biases. But, perhaps they give us an indication as to where we might start to explore further investigation and/or investment in preventative support? This article is not written as a rant against schools. Many a teacher do a fantastic job in immensely trying circumstances. Some have had a life changing influences on me.  However, like the rest of us, teachers have prejudices and use the same human categorizing and labeling processes. The difficulty is that by virtue of the position of power and trust they hold in relation to children, such processes may well have more potent and further reaching consequences. Incidentally, 3 months after the meeting with the science teacher, mid-year, my son had already achieved all of the year targets in science and was working at grade A level (albeit, after he changed class and science teacher). Similarly, I remember my mother leading many battles against schools where my sisters and I were repeatedly dissuaded from going to university and from studying the subjects we were interested in because we were not deemed ‘academically gifted’ enough for them.  Particularly those of a (hard) scientific nature. These would have been too ‘challenging’ for us (I am sure our gender and social origin also had an influence)…

A decade or two later and after much defiance from my mother, two of my sisters are financial analysts; one is an accountant, one a physicist (the only female in her cohort when she completed her postgraduate studies).  Not bad for a bunch expected to struggle academically. I believe most young people have the capacity to resist low and stereotypical expectations but; this may well be more difficult for those with lower levels of social support and/or with other psychological or social vulnerabilities. Some Black children may only be able to frame what they are experiencing as ‘the teacher picks on me’, ‘the teacher does not like me’. Invariably, some children will be misguided in their interpretation and for some, such views may betray unhelpful thought patterns or other relational difficulties. However, teachers ‘expectations are powerful and many children will de-select themselves from academic pursuits by truanting or otherwise disengaging purely because the message they receive and internalise is, you do not belong here or you are not smart (sorry I meant ‘academically gifted’) enough…

Chicken and egg proposition?

Having spent much time speaking to Black men within the Mental Health System, I noted that difficulties with teachers, particularly exclusions, often seemed to precede their (coercive) pathways into the mental health system and/or contact with the criminal justice system.  School exclusion is strongly correlated with offending. Black boys are at least three times more likely to be excluded than their peers (for similar infringements). The incidence of behavioural difficulties and occupational/school disruption can be associated with various psychiatric diagnoses, including schizophrenia so there may be a potential circular (chicken and egg) dilemma. In any event, if low expectations contribute to underachievement and school exclusions which in turn increase the likelihood of offending (and of being exposed to other stressors or ‘precipitating’ factors for some) and; we know that offending in Black groups is more likely to result in contact with mental health services (and subsequent diagnoses of schizophrenia), isn’t there a potential case to explore how we might better equip schools to support truanting and disengaging Black boys? Might it not also be helpful to pay closer attention and to address the factors leading to school disengagement for this group? In the absence of relevant studies scrutinising life events and adverse pathways to care and assessing the weight of relevant variables; it is difficult to establish relationships and the potential unique influence school exclusions/disengagement may carry in terms of future, and more importantly, type of Mental Health Service use for Black men.

So…What do you think, do schools give up on (some groups of) children too easily?

Have low or high expectations influenced your academic achievements or those of your children?

Do you think that providing more timely support to children who encounter difficulties at school could help reduce inequalities within the Mental Health System, particularly in relation to Black and Minority Ethnic groups?

*Mike is a pseudonym. **I have chosen not to specify the country Mike originates from to minimize risks of him being identified. As part of the research project, consent for wide dissemination and internet publication was sought.

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Want to learn more?

To access The Poverty Site – A UK site for statistics on poverty and social exclusion – ‘s section on school exclusions (click here)

Black Mental Health UK has compiled a range of reports on race inequalities within both criminal justice and mental health systems, to access (Click here)

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