Providing patients with mental health problems with the proper care can be a difficult task. There are also many ethical issues that often arise in caring for patients who are mentally ill. The case of Rocky Bennett is a prime example of the ethical dilemmas that can arise when arriving for this particular population. These dilemmas can also be compounded when racial discrimination is involved. The purpose of this discussion is to examine issues related to the delivery of mental healthcare using the Rocky Bennett case as an example.
Delivery of community and health services
Mental illness is still a taboo subject in many communities throughout the world. As such the delivery of delivering community and mental health services can be difficult. Ethical issues abound in the field of mental health because of the sensitivities involved when treating patients who are mentally ill. The major issues are often associated with maintaining patient privacy and treating patients with dignity. As it pertains to patient privacy, those in the mental health field have a responsibility to ensure that the identity of patients and their families are held in the closest of confidence. In addition it is important and essential hat mental health professionals do all possible to ensure that patients are treated with dignity and respect. People with mental illnesses are often disregarded and their humanity is stripped. Additionally "Several psychiatric epidemiological studies have demonstrated that voluntary, professional mental health services are underutilized by the general public (e.g., Kessler et al. 1994; Wang et al. 2005). Even among people in the general population who perceive a need for mental health services, as many as 41% do not seek help from mental health professionals (Mojtabai et al. 2002). Recent research shows that service use among the general population has increased somewhat; however, there is still a discrepancy between need for treatment and actual utilization, and this difference is even more marked for ethnic and racial minorities (Wang et al. 2005). These findings exist across a wide range of disorders including depression (Sussman et al.1987), lifetime mood disorder (Kessler et al. 1994), anxiety disorders (Kessler et al. 1994; Neal and Turner 1991), and serious mental illness (Kessler et al. 1996; Anglin et al., 2008).
While the disparity between ethnic groups is not totally the fault of the mental health community, there are several ethical issues within the community that needs to be addressed. These issues include proper diagnosis, access to care and consistency of care. Institutional racism is also an ethical issue that must be addressed as it relate to both patients and practitioners. The research to follow will explore these issues as it pertains to the case of a black male patient who was killed by mental healthcare professionals in 1998.
David "Rocky" Bennett showed the first signs of mental illness in 1980 at the age of 20("Inquiry into the Death of David Bennett"). He was experiencing problems controlling his emotions and behaviors. At this time Rocky saw a general practitioner who prescribed him sleeping aids. This treatment did not eliminate his symptoms and the family went to other medical professionals and even a spiritualist to determine what was wrong with Rocky ("Inquiry into the Death of David Bennett"). The family explains that many of the medical professionals were dismissive of the problems that David was having. In fact one psychiatrist, Dr. Feggetter, was extremely dismissive of the situation and suggested that Rocky's problems were related to smoking marijuana and not mental illness ("Inquiry into the Death of David Bennett"). When Dr. Feggetter examined David for a second time he conceded that he had mental health issues but insisted that these issues were caused by David smoking marijuana. It is important to not the David and his family was originally from Jamaica and David was a Rastafarian ("Inquiry into the Death of David Bennett"). These factors seemed to have a profound influence in the manner in which David was treated and his treatment outcomes. Initially David was diagnosed with a drug induced psychosis. Ultimately Bennett was diagnosed with schizophrenia in 1985 but his family asserts that medical professionals did not explain to them what this diagnosis meant or how this disease would affect Rocky's life.
In 1984 Rocky had a run in with the law and was convicted of a crime. He was placed on probation under the condition that he sought psychiatric treatment. He was admitted to Peterborough District Hospital for psychiatric treatment. However he discharged himself from the facility and was forced to go to jail because this violated his probation. He then spent time in prison for six months where he endured abuse form other prisoners.
Rocky's story does not stop here but there are already some serious ethical issues that have arisen in the case. The first issue is the manner in which he was treated by the general practitioner. This doctor gave Bennett sleeping pills for behaviors that were clearly related to other issues. The family tried desperately to find remedies to the problems that this young man was experiencing and at every turn he was misdiagnosed or conclusions were made about his symptoms based on his nation of origin and his religious background. As such diagnosing his problem was complicated greatly. These doctors acted in ways that were unethical and had a profound effect on the manner in which Rocky's ability to receive the proper medications and to get well. Furthermore when Rocky got into criminal trouble, likely as a result of his mental health issues, he was not properly cared for and as a result he endured further abuse which likely resulted in worsening of his condition.
This situation is a major problem throughout the mental health because mental health professionals often have biases that lead them to stereotype individuals based on their ethnicity or race. The lack of proper care given to minorities by mental health professionals coupled with the stigma attached to mental illness that is prevalent in minority communities; often prevent minorities from receiving the care that they need (Anglin et al., 2008). In the case of Rocky, such stereotypes led to criminal behavior because he was not being properly treated for the illness.
The family also reported that Rocky's treatment was never really successful and instead he endured a cycle of being admitted to a psychiatric ward, getting heavily medicated while in the facility, being released, not taking his medicine and ending up back in the hospital. One of Bennett's sister explained that, "He told me he was racially abused and that he was taunted and was not prepared to tolerate it. The community care he received primarily consisted of his injections. Nobody seemed concerned about what he did or did not do, or where he was going with his life or whether he wanted a job, or whether he wanted any education or how the family was coping" ("Inquiry into the Death of David Bennett").
Throughout the years until his death in 1998 David was in and out of hospitals for psychiatric treatment. While at The Norvic Clinic from 1992-1993 David had considerable improvement and was placed on medications which seemed to be of benefit to him. However he was eventually sent to other facilities and his metal health began to deteriorate again. His siblings tried to get his the proper care but mental health facilities seemed to be indifferent to their pleas. In addition David seemed to be well aware that he was experiencing forms of racial discrimination. In addition he was concerned abouthis welfare and the welfare of other Black patients and while he was ay The Norvic clinic in 1993 he wrote a letter stating the following,
"As you know, there are over half a dozen black boys in this clinic. I don't know if you have realised that there are no Africans on your staff at the moment. We feel there should be at least two black persons in the medical or social work staff. For the obvious reasons of security and contentment for all concerned please do your best to remedy this appalling situation ("Inquiry into the Death of David Bennett")."
Obviously there were issues that concerned him as it pertained to the way he was being treated as it related to his race. Some experts who have studies this case have concluded that institutional racism is a major concern in the mental health field. people from black and ethnic minority communities are not getting the service they are entitled to. He described the institutional racism that was responsible for this as a "disgrace" and a "festering abscess which is at present a blot upon the good name of the NHS." In addition experts have concluded that one of the primary reasons why people of color are not getting the care that the serve is associated with the manner in which minority doctors are treated and the low percentage of minority mental health professionals.
"Research has shown that ethnic minority doctors, who…