Hello. Is the Mental Health Act racist?
Today I'm going to be looking at numbers per 100,000 people from different ethnic backgrounds who are detained (or sectioned) under the Mental Health Act.
I'm then going to go on to look at the recent Independent Review of the Mental Health Act.
My name is Dr Beth Colby.
I've got some data here that was published on the 26th of May this year from the Government.
It's from gov.uk and is the number of detentions under the Mental Health Act.
Important points are mentioned.
In the year to March 2019, black people were 4 times as likely as white people to be detained under the Mental Health Act.
Out of 16 specific ethnic groups, Black Caribbean people had the highest rate of detention out of all ethnic groups,
if groups defined as Other were excluded.
Right, here I have some information on rates of detention -
that's number of people from a particular ethnic group
detained (or sectioned) under the Mental Health Act per 100,000 of that population.
So here we've got Asian, Black, Mixed, White and Other,
and the top line is 2017-18, and the next line is 2018-2019.
You can see that the black line - that group are far more likely - black people are far more likely
to be detained under Mental Health Act than white people.
You've got Asian there Mixed there and this is Others.
Now when they broke it down into 16 different ethnic groups - I have some of them here -
and Black Others the biggest, but we're going to exclude that, because we don't know what it is;
but out of the Black groups, we've got Black Caribbean are the highest and then they go into other Black groups.
This one is Mixed Other, and then we go to White British - it is here.
Now the interesting thing here as well is, it's actually lower in people of Chinese origin.
One could ask lots of questions from that data.
What's the prevalence of mental illnesses in different ethnic populations?
What's the health-seeking behaviour like?
Does mental illness present itself in different ways in different cultural backgrounds?
But I'm not here to talk about that today.
Going on to the Independent Review of the Mental Health Act. This was published in December 2018.
The purpose of the review was to look at 3 things.
One was the rising rates of people being detained or sectioned under the Mental Health Act;
one was processes that are out of step with a modern mental health care system;
but the second one, which we're looking at today, is the disproportionate number of people from Black and Minority ethnic groups detained under the Act.
But just looking at the UK data shows it clearly that people from a Black background but also other Asian and Minority Ethnic
backgrounds are more likely to be detained under the Mental Health Act than somebody who's White.
The review sought the views of patients, carers, relevant professionals, and also affected organizations in producing recommendations.
So there was an African and Caribbean group set up
with prominent people from African and Caribbean heritage under the following
terms of reference. which I'll read. 'The group would make recommendations
designed to ensure that people of African and Caribbean descent with
mental health challenges received the treatment and support they need when and
where they need it; that they're treated with dignity, and that their liberty and
autonomy are respected as far as possible to achieve this. The group would
give due attention to the implementation and practice of the Mental Health Act as
experienced by people of African and Caribbean descent or heritage, identify
and critically evaluate a range of relevant evidence and data
to support thinking and recommendation developments. Identify and critically
appraise aspects of relevant legislation and consider issues that may
particularly impact people of African and Caribbean descent. Identify effective
practice and propose solutions to identified issues which will work in the
best interests of people of African and Caribbean descent.' As I said, the final
report of the Independent Review of the Mental Health Act 1983 was published in
December 2018. it was entitled 'Modernising the Mental Health Act:
Increasing Choice, Reducing Compulsion' - that's where people are compulsorily
detained under Mental Health Act. In the introduction in 'executive summary' under
the headings 'Supporting people from ethnic minority communities', it was
stated, 'One of the most troubling and difficult areas we have considered is
the fact that those from ethnic minority communities are far more likely to be
subject to compulsory powers under the Act, whether in hospital or in the
community. Even amongst that group, black African and Caribbean men are
significantly over-represented. The profound inequalities that exist for
people from ethnic minority communities in access to treatment, experiences of
care and quality of outcomes following mental health service care are
long-standing. There has been much anxious thought why this should be the
case, and why this group does not have adequate access to or else is reluctant
to use pre-crisis services. The answer, although not properly understood, is
multifactorial, involving long-standing experiences of discrimination and
deprivation, with a lack of understanding of the human dynamics of what is
happening, and some crucial gaps in trust between service users and providers. We
are in no doubt that structural factors which engender racism, stigma and
stereotyping, increase the risk of differential experiences in ethnic
minority communities. There is no single or simple remedy to resolve this
situation, which is not unique to the health
service in general or mental health services in particular. A similar and
equally depressing picture can be painted within our schools or criminal
justice system, or other aspects of modern society. No other issue has made
us more aware of our fallibility than this one. With that in mind, we still hope
that our recommendations will at least be a positive contribution, be it as
individual practitioners or system leaders, what is needed is honesty about
the scale of the challenge, a recognition that current approaches are not
delivering for people with ethnic minority backgrounds, and a firm
commitment to work together with service users, carers and communities. This starts
with having due regard for equality, as stated in the public sector equality
duty, which is why, amongst other measures, we strongly support the creation of an
organisational competency framework to tackle racial disparity, which has its
core, service user and carer accountability measures designed to
address this. The OCF (Organizational Competency Framework, as I said), should
focus on several core areas of competence: awareness, staff capability,
behavioural change, data and monitoring and service development. It is expected
that there will be a role from regulatory bodies to monitor compliance
and attainment at a national level with patient and para-representatives having
an active role in the assessment. One of the recommendations from the experiences
of people from ethnic minority communities is as follows: an
organisational competence framework and patient and carer service user
experience tool should be implemented across health and care services. This
should build upon ongoing work by NHS England to develop the patient and carer
race equality framework PCREF - that's a mouthful -
Regulatory bodies such as the CQC - which is the Care Quality Commission -should use their powers to support improvement in equality of access and
outcomes. The EHRC should make use of their existing legal powers to ensure
their organisations are fulfilling their public sector Equality Duty. Culturally
appropriate advocacy should be provided consistently for people of all ethnic
backgrounds and communities, in particular for individuals of black
African and Caribbean descent, and Heritage safeguards should be created so
that patients are able to continue religious or spiritual practices while
detained in hospital. This should prevent the use of restrictive practices that
limit a person's access to religious observance. In line with the NHS
workforce race equality standard programme, greater representation of people of
black African and Caribbean heritage should be sought in all professionals, in
particular psychology and occupational therapy. People of black
African and Caribbean heritage should be supported to rise to senior levels of
all mental health professions, especially psychiatry and psychiatric research,
psychiatric nursing and management. Behavioural interventions to combat
implicit bias in decision-making should be piloted and evaluated. Data and
research on ethnicity and use of the Mental Health Act should be improved,
with all decisions being recorded and reviewed consistently by organisations
involved in the process, in particular criminal justice system organisations
and tribunals. Funding should be made available to support research into: 1)
The issues that lead to mental disorder in people of a wide range of ethnic
minority communities, in particular African and Caribbean individuals, and 2)
Interventions which improve outcomes. Lastly, a call for research should be
made into tailored early interventions for
African and Caribbean children and young people, particularly those at risk of
exclusion from school. Thank you for listening. I hope that's been of interest
to you and will stimulate further thought and debate.